It has long been known that a person’s LDL (low-density lipoprotein, or “bad”) cholesterol level is tied to the risk for cardiovascular disease, including coronary artery disease — buildup of fatty deposits in the arteries leading to the heart. What has been less clear is at what point in time LDL cholesterol begins to contribute to cardiovascular disease risk. Since most studies have looked at middle aged and older adults — the stage in life when cardiovascular disease usually begins — they have also typically looked at LDL cholesterol as measured around that time. But it’s possible that the same people with high LDL cholesterol in middle or older age also had high LDL cholesterol when they were younger — and that having it at a younger age contributed to cardiovascular disease later on.
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For the latest study, researchers looked at 18,288 participants in four different study groups in the United States. Participants had their LDL cholesterol levels tracked throughout adulthood, and cardiovascular disease and events — namely coronary artery disease, heart failure (inability of the heart to adequately pump blood throughout the body), and ischemic (clot-based) stroke — were also recorded during a follow-up period that lasted a median of 16 years. The data used in the study spanned the period from 1971 to 2017.
Cumulative LDL linked to higher risk for coronary disease
During the overall follow-up period, there were 1,165 cases of new coronary artery disease, 1,145 cases of new heart failure, and 599 cases of ischemic stroke. After adjusting for the most recent LDL cholesterol measurement (in middle age) as well as other known risk factors for cardiovascular disease (such as body weight), the researchers found that cumulative LDL cholesterol throughout adulthood was linked to a 57% higher risk for developing coronary artery disease in middle age. Another measure of cumulative LDL cholesterol — called the time-weighted average — was linked to a 69% higher risk for coronary artery disease. There was no significant link between cumulative LDL cholesterol and either heart failure or ischemic stroke.
The researchers concluded that LDL cholesterol throughout young adulthood and middle age was independently linked to the risk for coronary disease in middle age, regardless of a person’s recent LDL cholesterol level. “These findings have substantial clinical implications,” they wrote. “Clinical decisions are currently guided by contemporary LDL [cholesterol] values, whereas our findings suggest that incorporating serial LDL [cholesterol] measures and cumulative LDL [cholesterol] burden into clinical practice may further refine [cardiovascular] risk assessment and help inform strategies for primary prevention” of coronary artery disease.