Trajectories of Non-HDL Cholesterol Across Midlife: Implications for Cardiovascular Prevention.
cardiovascular disease prevention
lipids
non-HDL cholesterol
Journal
Journal of the American College of Cardiology
ISSN: 1558-3597
Titre abrégé: J Am Coll Cardiol
Pays: United States
ID NLM: 8301365
Informations de publication
Date de publication:
09 07 2019
09 07 2019
Historique:
received:
28
11
2018
revised:
19
03
2019
accepted:
23
04
2019
entrez:
6
7
2019
pubmed:
6
7
2019
medline:
21
5
2020
Statut:
ppublish
Résumé
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. This study determined the extent to which lipid levels in young adulthood predict future lipid trajectories and associated long-term CVD risk. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 31272554
pii: S0735-1097(19)35146-0
doi: 10.1016/j.jacc.2019.04.047
pmc: PMC7346311
mid: NIHMS1597595
pii:
doi:
Substances chimiques
Cholesterol, HDL
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
70-79Subventions
Organisme : NHLBI NIH HHS
ID : K01 HL133416
Pays : United States
Organisme : NHLBI NIH HHS
ID : K23 HL133601
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Références
Circulation. 2016 Apr 19;133(16):1574-81
pubmed: 26945047
Psychol Methods. 2001 Mar;6(1):18-34
pubmed: 11285809
Curr Opin Endocrinol Diabetes Obes. 2018 Apr;25(2):130-136
pubmed: 29324459
JAMA Cardiol. 2016 Jul 1;1(4):492-4
pubmed: 27438330
Circulation. 2018 Nov 20;138(21):2315-2325
pubmed: 30571575
JAMA Cardiol. 2018 Nov 1;3(11):1090-1095
pubmed: 30422172
J Clin Lipidol. 2016 Sep-Oct;10(5):1248-58
pubmed: 27678443
J Lipid Res. 2018 Jul;59(7):1266-1275
pubmed: 29769239
N Engl J Med. 2014 Apr 10;370(15):1422-31
pubmed: 24645848
J Am Coll Cardiol. 2018 Oct 2;72(14):1677-1749
pubmed: 29097294
Circulation. 2015 Feb 3;131(5):451-8
pubmed: 25623155
J Am Heart Assoc. 2018 Oct 16;7(20):e009778
pubmed: 30371276
J Am Coll Cardiol. 2016 Jan 19;67(2):193-201
pubmed: 26791067
Hypertension. 2000 Oct;36(4):477-83
pubmed: 11040222
Lancet. 2012 Aug 11;380(9841):565-71
pubmed: 22883507
Eur J Prev Cardiol. 2015 Oct;22(10):1321-7
pubmed: 25633587
Stat Med. 2005 Oct 15;24(19):2911-35
pubmed: 16152135
BMJ. 2014 May 21;348:g3047
pubmed: 24850828