Elevated blood pressure and cholesterol levels in young adulthood may lead to an increased risk of heart disease later in life, regardless of later in life exposure to these risk factors, according to research* published in the Journal of the American College of Cardiology.
Previous studies have found young adult with high blood pressure and high cholesterol levels to be at greater risk of heart disease later in life, but it was unclear whether this risk was independently of exposures later in life due to the limited age ranges studies.
For this study researchers used data from six large, community-based, prospective cohort studies and modelled complete risk factor trajectories starting at age 18 through follow-up and used those trajectories to estimate the independent associations of risk factor 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 averages of 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 analysis. Over a follow-up period of 17 years, there were 4,570 incident coronary heart disease events, 5,119 heart failure events and 2,862 stroke events. Average measurements of SBP, DBP, LDL and HDL from young adulthood were all strongly correlated with later in life averages. Elevated LDL during young adulthood was associated with a 64% increased risk of coronary heart disease, independent of later life exposures. High SBP and DBP in young adulthood were independently associated with a 37% and 21% increased risk of heart failure, respectively. While no young adult exposures were independently associated with stroke, increased levels of high later life SBP or DBP were strong predictors of stroke.
"Our results add to accumulating evidence that young adulthood is a critical period when high blood pressure or cholesterol are particularly harmful. Maintaining optimal levels of blood pressure and LDL cholesterol throughout young adulthood could yield substantial lifetime cardiovascular disease prevention benefits," said Andrew Moran, associate professor at Columbia University and senior author of the study.
"However, young adults are difficult to reach by way of traditional, clinic-based preventive programs, they are transitioning between paediatric and adult-centered models of care."
The researchers recommend implementation of preventive programs targeting individual young adults that are web-based, patient-centered, mobile and account for the fact that this age group may discount the importance of their future heart disease risk.
*Zhang Y, Vittinghoff E, Pletcher MJ, et al. Associations of Blood Pressure and Cholesterol Levels During Young Adulthood With Later Cardiovascular Events. Journal of the American College of Cardiology, Volume 74, Issue 3, 23 July 2019, Pages 342-34. DOI: 10.1016/j.jacc.2019.03.529