Many young Americans are unaware that they already have high cholesterol levels, which is a cause for concern among doctors. It is estimated that millions of individuals have dangerous levels of “bad” cholesterol in their blood before the age of 40, but they are not screened or treated for this condition during their 20s or 30s. While current U.S. guidelines do not recommend screening for high cholesterol in young adults, some doctors believe that this should change due to the increasing rates of high cholesterol and its connection to heart attacks and strokes. This article explores the reasons behind the delayed screening and the arguments made by cardiologists who advocate for earlier intervention. To begin, it is essential to understand what is considered high cholesterol.
When your doctor informs you that your cholesterol is “high,” it means that the combined levels of your “good” HDL cholesterol and “bad” LDL cholesterol in your blood are over 200 mg/dL. However, it is primarily the high levels of LDL cholesterol, specifically 160 mg/dL or higher, that are cause for concern. It is important to maintain a relatively low combined cholesterol level and ensure that your HDL levels are higher than your LDL levels because HDL cholesterol aids in removing the harmful cholesterol that clogs arteries. According to Medline, cholesterol levels are considered healthy if your total cholesterol is below 200, LDL cholesterol is below 100, and HDL cholesterol is 60 or higher. If your total cholesterol falls between 200 and 239, LDL cholesterol falls between 100 and 159, or HDL cholesterol falls between 40 and 59 for men (or 50 and 59 for women), you are considered at-risk or borderline high. High cholesterol levels are categorized as follows:
The total cholesterol level is considered high if it is 240 or above.
If the LDL cholesterol level is 160 or higher, it is considered high.
For men, an HDL cholesterol level under 40, and for women, an HDL cholesterol level under 50, is considered low.
Research on cholesterol in young people has been limited.
Typically, doctors conduct tests to identify health problems and then determine the most appropriate treatment. However, when it comes to high cholesterol in young adults, doctors approach it differently. According to Dr. Andrew Moran, a Columbia University professor specializing in general medicine and cardiovascular disease prevention, they tend to work in reverse.
The U.S. Preventive Services Task Force (USPSTF) does not recommend using medication to treat high cholesterol in individuals under the age of 40. According to their guidelines, cholesterol-lowering drugs should only be prescribed to patients aged 40 to 75 if they have a 7.5% or higher risk of heart disease within the next decade. The commonly used heart disease risk calculator does not calculate risks for individuals under 40. Additionally, the USPSTF no longer has a separate guideline for screening without treatment. As a result, many healthcare providers question the necessity of screening for high cholesterol if there are no prescription options available.
Statins are the most commonly prescribed drugs for treating cholesterol. They have been extensively studied and proven to be safe and effective in large-scale clinical trials. However, there is a lack of trials involving young adults.
One reason for this is the cost and time required to test the effectiveness of statins in young people. Clinical trials for statins primarily focus on whether they reduce the risk of heart attacks and strokes compared to those not taking the medication. Conducting trials with young adults, who are at a lower risk for these events, would take a longer time to observe significant differences. As a result, limited research has been done on the efficacy of statins in this age group.
There is currently no scientific evidence to prove that statins are effective and safe for younger individuals. As a result, health agencies in the United States do not recommend the use of these drugs, and doctors do not prescribe them. Consequently, the guidelines suggest that there is little justification for screening cholesterol levels in young people if there are no available medications to lower it.
However, some cardiologists disagree with this viewpoint.
They believe that initiating cholesterol-lowering treatment at an early stage could potentially delay or even prevent the development of heart disease.
A significant number of young adults in their 20s and 30s have high or borderline-high cholesterol levels, partly due to American diets. The Centers for Disease Control and Prevention estimates that 7.5% of Americans aged 20 to 39 have high total cholesterol levels (greater than 240 mg/dL). Furthermore, research by Moran suggests that up to 27% of young adults have elevated levels of “bad” LDL cholesterol, which can lead to plaques and heart attacks, even without the presence of heart disease. Surprisingly, a recent study published in JAMA Cardiology reveals that 40% of Americans of all ages are unaware of their cholesterol levels.
Cholesterol begins to build up in the bloodstream from childhood, making it crucial to take action as early as possible. While high cholesterol can be managed later in life, starting in your 30s won’t have the same impact. According to Dr. Muhammad Siyab Panhwar, an interventional cardiologist at Sanford Health, it’s easier to lower cholesterol when you’re younger. Screening for cholesterol in your 20s or 30s allows for lifestyle changes like a healthier diet, more exercise, reduced alcohol intake, and quitting smoking, which can often bring cholesterol levels under control. Simply limiting saturated fats found in red meat and dairy can lower bad cholesterol levels by up to 10%, as stated by the Mayo Clinic.
According to Panhwar, making lifestyle changes is always the first choice for managing young adults’ cholesterol. However, if these changes are not effective, medication should be considered. Panhwar emphasizes that there are no supplements or internet health gurus that can lower cholesterol.
While there are concerns about the side effects of statins, such as an increased risk of developing type 2 diabetes, Moran explains that for millions of Americans with high cholesterol, the research shows that the benefits of preventing heart attacks and strokes outweigh the risk of diabetes.
The initial and crucial step is to undergo screening. Despite not being suggested by the guidelines, Moran and Panhwar recommend that young adults request their doctors to assess their cholesterol levels, particularly if there is a family history of high cholesterol or heart issues. Panhwar emphasizes the importance of immediate management for individuals in their 30s with high cholesterol, rather than waiting until they reach 40 to calculate a score using a calculator.