Minority of young adults with severe hypercholesterolemia achieve LDL-c goal
Management of Severe and Moderate Hypercholesterolemia in Young Women and Men
Literature - Newton SL, Hoffmann AP, Yu Z et al. - JAMA Cardiol. 2022 Feb 1;7(2):227-230. doi: 10.1001/jamacardio.2021.4983.Introduction and methods
//Background//
Hypercholesterolemia at a young age increases future CV risk independent of cholesterol levels at midlife and total cumulative cholesterol exposure during life [1-3]. It is therefore important to start treatment of hypercholesterolemia at a young age. ACC/AHA guidelines recommend statin therapy for individuals aged between 20 and 75 years old with LDL-c ≥190 mg/dL, with the goal of lowering LDL-c by ≥50% [4].
Aim of the study
This study investigated the management of hypercholesterolemia in two contemporary cohorts of young adults with moderate or severe hypercholesterolemia.
Methods
A total of 17591 adults aged 20 to 39 years were included in the study. Cohort 1 (n=5438) included individuals with severe hypercholesterolemia, defined as LDL-c ≥190 mg/dL, and cohort 2 (n=12513) included individuals with moderate hypercholesterolemia, defined as LDL-c 160-<190 mg/dL. Follow-up LDL-c values and prescriptions for lipid-lowering therapy (LLT) were analyzed. Median follow-up for cohort 1 and 2 was 7.8 and 7.7 years, respectively.
Outcomes
The primary endpoint in cohort 1 was a 50% reduction in LDL-c. In cohort 2, the primary endpoint was a 30% reduction.
Main results
1 in 3 young adults with severe hypercholesterolemia achieve a LDL-c reduction of ≥50%
- 30.1% of individuals in cohort 1 achieved a LDL-c reduction of ≥50%.
- Women were less likely to achieve the LDL-c reduction goal than men (27.2% of women vs. 31.9% of men; P<0.001).
- Younger individuals with severe hypercholesterolemia were less likely to receive LLT (P for trend<0.001) and less likely to achieve the LDL-c reduction goals than older individuals (age 20-24: 24.9%; age 25-29: 25.4%; age 30-34: 31.0%; age 35-39: 33.0%; P for trend <0.001).
- 48.5% of individuals received a prescription for LLT. Women were less likely to receive LLT compared to men (43.7% vs 51.5%; P<0.001).
- 23.4% of individuals in cohort 1 had a LDL-c value of ≥190 mg/dL at last follow-up.
Management of moderate hypercholesterolemia in young adults
- 36.1% of individuals in cohort 2 achieved a LDL-c reduction of ≥30%.
- 20% of individuals received a prescription for LLT. Also in this cohort younger individuals (P for trend <0.001) and women were less likely to receive LLT (14.9% of women vs. 23.4% of men; P<0.001).
- 30.4% of individuals had LDL-c ≥160 mg/dL at last follow-up.
Conclusion
This study showed that 30.1% young adults with severe hypercholesterolemia achieved a LDL-c reduction of ≥50%. In those with moderate hypercholesterolemia, 36.1% achieved a LDL-c reduction of ≥30%. Women and younger individuals were less likely to receive a prescription for LLT.
References
1. Zhang Y, Pletcher MJ, Vittinghoff E, et al. Association between cumulative low-density lipoprotein cholesterol exposure during young adulthood and middle age and risk of cardiovascular events. JAMA Cardiol. Published online September 22, 2021. doi:10.1001/jamacardio.2021.3508
2. Domanski MJ, Tian X,Wu CO, et al. Time course of LDL cholesterol exposure and cardiovascular disease event risk. J AmColl Cardiol. 2020;76(13):1507-1516. doi:10.1016/j.jacc.2020.07.059
3. Pletcher MJ, Bibbins-Domingo K, Liu K, et al. Nonoptimal lipids commonly present in young adults and coronary calcium later in life: the CARDIA (Coronary Artery Risk Development in Young Adults) study. Ann Intern Med. 2010;153(3):137-146. doi:10.7326/0003-4819-153-3-201008030-00004
4. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J AmColl Cardiol. 2019;73(24):e285-e350. doi:10.1016/j.jacc.2018.11.003
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