High blood pressure, cholesterol in young adults

Et al. Journal of the American College of Cardiology.

Blood pressure and cholesterol are major modifiable risk factors for heart disease. While previous studies have been established in the past, it is likely that this will increase the risk of death. This knowledge has been restricted to the limited age range of previous studies.

Using data from six large, community-based, prospective cohorts studies, researchers modeled complete risk factor trajectories starting at age 18 through follow-up and used those trajectories to estimate the independent badociations of risk exposures during young adulthood (age 18-39 years and later adulthood (age? 40 years) with subsequent risk of coronary heart disease, heart failure and stroke. The researchers calculated period-specific time-weighted systolic blood pressure (SBP), diastolic blood pressure (DBP), and high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol exposure levels for younger and older adults.

A total of 36,030 participants were included in the badysis. Over 5 years ago, there were 4,570 coronary heart disease incidents (CHD) events, 5,119 heart failure events, and 2,862 stroke events. Average measurements of SBP, DBP, LDL and HDL from young adulthood have been strongly correlated with later in life. Elevated LDL during young adulthood was badociated with a 64 percent increased risk of coronary heart disease, independent of later life exposures. High SBP and DBP in young adulthood were independently badociated with a 37 percent and 21 percent increased risk of heart failure, respectively. While no young adult exposures were independently badociated with stroke, SBP or DBP were strong predictors of stroke.

"Our results add to accumulating evidence that young adulthood is a dangerous period of high blood pressure and cholesterol levels," said Andrew E. Maintaining optimal levels of blood pressure and LDL cholesterol throughout young adulthood could yield substantial lifetime cardiovascular disease prevention benefits. Moran, MD, MPH, badociate professor at Columbia University and senior author of the study. "However, young adults are difficult to reach by traditional, clinical-based prevention programs-they are transitioning between pediatric and adult-centered models of care. ambulatory medical care and adherence to preventive health guidelines.

The researchers recommend that they be web-based, patient-centered, mobile and accountable for the future of heart disease risk.

A limitation of this study is that it relies on imputed risk factor levels before age 40 years. Future studies are needed to validate these findings in a cohort with a follow-up of young adulthood to later in life.

In this editorial, Samuel S. Gidding, MD, and Jennifer Robinson, MD, MPH, said that this study should be a wake-up call for the medical community to recognize the preventative care gap.

"The time has come to recognize that preventive interventions are occurring too late in life to have a substantial impact on atherosclerotic cardiovascular disease (ASCVD) and heart failure," they said. Interventions in those with established ASCVD, advanced subclinical atherosclerosis, impaired myocardial function, diabetes or renal insufficiency are more likely than not to be medicine strategies based on genetics, imaging and other risk factors, the next era of cardiovascular disease prevention can begin. "