Format

Send to

Choose Destination
J Am Coll Cardiol. 2019 Jul 9;74(1):70-79. doi: 10.1016/j.jacc.2019.04.047.

Trajectories of Non-HDL Cholesterol Across Midlife: Implications for Cardiovascular Prevention.

Author information

1
Section on Men's Health Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: kpencina@bwh.harvard.edu.
2
Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada.
3
Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
4
Framingham Heart Study, Section of Preventive Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; Section of Cardiology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.
5
Duke Clinical Research Institute, Durham, North Carolina.
6
Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
7
Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
8
Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada.

Abstract

BACKGROUND:

Extended elevations of non-high-density lipoprotein cholesterol (non-HDL-C) across a lifespan are associated with increased risk of cardiovascular disease (CVD). However, optimal testing intervals to identify individuals with high lipid-related CVD risk are unknown.

OBJECTIVES:

This study determined the extent to which lipid levels in young adulthood predict future lipid trajectories and associated long-term CVD risk.

METHODS:

A sample of 2,516 Framingham Offspring study participants 25 to 40 years of age free of CVD and diabetes had their non-HDL-C progression modeled over 8 study examinations (mean follow-up 32.6 years) using group-based methods. CVD risk based on 25 to 30 years of follow-up was evaluated using Kaplan-Meier analyses for those with mean non-HDL-C ≥160 mg/dl ("high") and <130 mg/dl ("low") at the first 2 examinations. Levels of non-HDL-C for participants on lipid treatment were adjusted by nonparametric algorithm.

RESULTS:

The trajectories of the lipid levels were generally stable over the 30-year life course; mean non-HDL-C measured in young adulthood were highly predictive of levels later in life. Individuals could be reliably assigned to high and low non-HDL-C groups based on 2 measurements collected between 25 to 40 years of age. Overall, 80% of those with non-HDL-C ≥160 mg/dl at the first 2 exams remained in the high group on subsequent 25-year testing, whereas 88% of those with non-HDL-C <130 mg/dl remained below 160 mg/dl. Those with high non-HDL-C in young adulthood had a 22.6% risk of CVD in the next 25 years as compared with a 6.4% risk in those with low non-HDL-C.

CONCLUSIONS:

Most adults with elevated non-HDL-C early in life continue to have high non-HDL-C over their life course, leading to significantly increased risk of CVD. The results demonstrate that early lipid monitoring before 40 years of age would identify a majority of those with a high likelihood for lifetime elevated lipid levels who also have a high long-term risk for CVD. This information could facilitate informed patient-provider discussion about the potential benefits of preventive lipid-lowering efforts during the early midlife period.

KEYWORDS:

cardiovascular disease prevention; lipids; non-HDL cholesterol

PMID:
31272554
DOI:
10.1016/j.jacc.2019.04.047

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center