'Wake Up Call': Early Adult Health May Set Path for Later CVD

Marcia Frellick

July 18, 2019

People ages 18-39 years who have consistently high blood pressure and high cholesterol are at substantially greater risk of developing cardiovascular disease (CVD), which includes coronary heart disease (CHD) and heart failure (HF), later in life regardless of treatments and the way they live their lives in the middle years, new research indicates.

Yiyi Zhang, PhD, of the Division of General Medicine at Columbia University in New York City, and colleagues followed 36,030 participants over an average of 17 years. They found a strong link between three factors in patients’ younger years and CHD and HF later.

The results, published in the July issue of the Journal of the American College of Cardiology, indicate that compared with people under age 40 who had LDL cholesterol of less than 100, young adults who had LDL of 100 or higher had a 64% higher risk of CHD in late life, independent of later-life exposure.

When young adults' systolic BP was higher than 130 mm Hg, compared with those with under 120 mm Hg, they had a 37% higher risk of HF. When young adults had a diastolic BP of at least 80 (compared with < 80 mm Hg) they were found to have a 21% increased risk of HF.

"Stroke was the one outcome where the young adult period didn't seem to make an independent contribution," coauthor Andrew Moran, MD, MPH, with Columbia University, told Medscape Medical News.

Wake-Up Call

"This analysis brings the field 1 step closer to the 'holy grail' of a direct link between early life exposures and cardiovascular events, and provides a new novel methodology to study life course risk relationships," write Samuel S. Gidding, MD, of the Familial Hypercholesterolemia Foundation in Pasadena, California, and Jennifer Robinson, MD, MPH, with the departments of epidemiology and medicine at the University of Iowa in Iowa City, in an accompanying editorial.

The results should serve as an alert to the medical community, Gidding and Robinson write.

"The first response to the data of Zhang et al and similar analyses should be for the medical community to wake up and recognize the huge preventive care gaps currently experienced by younger adults," they write. "Less than one-third of adults < 50 years of age meeting treatment recommendations for hypertension are being treated, and less than one-half of NHANES (National Health and Nutrition Examination Survey) participants with diagnostic criteria for familial hypercholesterolemia were receiving statin therapy."

They say the second call to action should be addressing the lack of younger adults in clinical trials.

Moran says a primary message in the paper is that the years from 18 to 39 are important and may be critical in staying healthy. The challenge for medicine and society is how to reach these young people who may need to access the medical system in different ways and typically don't schedule regular doctor's office visits.

This age group also tends to feel they are invincible and are increasingly less able to count on reliable employer-provided insurance, Moran added.

Reaching young adults through social networks and making public spaces and work spaces more conducive to exercise are some ideas for improving health in this age group, he said.

"We could consider something radical like over-the-counter hypertensive medications or cholesterol-lowering medications and making doctors appointments available on weekends and after hours," he said.

What's unique about this study is that through piecing together observations from six large prospective cohort studies, the researchers were able to look at trajectories across different sections of the adult lifespan.

"These findings suggest that investment now in programs to control modifiable risk factors during young adulthood has the potential to reduce the future burden of CVD," the authors write.

Support for the study was provided by National Institutes of Health (NIH) grant R01 HL130500 (to Moran). Robinson reported research grants to her institution from Acasti, Amarin, Amgen, AstraZeneca, Esai, Esperion, Merck, Pfizer, Regeneron, Sanofi, and Takeda; and that she has served as a consultant for Amgen, Merck, Novartis, Novo Nordisk, Pfizer, Regeneron, and Sanofi. Zhang and Gidding have disclosed no relevant financial relationships.

J Am Coll Cardiol. 2019;74:330-41, 342-45. Full text, Editorial

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