Adolescent cholesterol checks may reduce premature heart damage and death

12th January 2024

Paediatric cholesterol tests and the adoption of an ‘adolescent cholesterol passport’ could help prevent up to one-fifth of premature heart disease, a new study has revealed.

Published in the journal Atherosclerosis, the research shows that elevated levels of cholesterol and dyslipidaemia in children and adolescents increases the risk of heart issues such as subclinical atherosclerosis in their mid-20s and premature death by their mid-40s.

Scientists from the Universities of Exeter, Bristol and Eastern Finland found that earlier cholesterol checks, such as universal paediatric lipid screening, could reduce the number of adults suffering from preventable heart disease.

Using data from the University of Bristol’s ’Children of the 90’s’ cohort, also known as the Avon Longitudinal Study of Parents and Children, the researchers analysed data from 1,595 adolescents at the age of 17 and followed up with each participant for seven years. Cholesterol levels and evidence of heart damage were assessed at the start and throughout the follow-up period.

The scientists found an 18-20% increased risk of premature heart damage in adolescents with increased low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol and higher overall cholesterol levels.

An increase in triglycerides was also found to be associated with up to a three-fold increase in the risk of premature heart damage within seven years.

The study‘s lead author Dr Andrew Agbaje, paediatric clinical epidemiologist at the University of Eastern Finland and honorary research fellow at the University of Exeter, said: ‘Health guidelines generally recommend a cholesterol check by the age of 40 years. However, we are seeing the first evidence of the catastrophic effects of elevated cholesterol levels on the heart more than two decades earlier.

‘Waiting until age 40 years might result in one in five of the adult population developing preventable heart problems which are very expensive to treat.’

Elevated cholesterol levels were seen in both adolescents of a healthy weight and those considered overweight or obese.

The findings also revealed that while these increased levels were responsible for around a third of the direct damage to the heart, increased fat mass and blood pressure indirectly contributed to around 40% of heart damage.

The researchers showed that genetics and sedentary time could explain the remaining 30% of damage.

Dr Agbaje added: ‘Recently we discovered that increased sedentary time from childhood contributed 70% of the increase in cholesterol level before mid-20s and that engaging in light physical activity can completely reverse elevated cholesterol and dyslipidaemia.

‘Taken together, these findings suggest that being sedentary is at the root of health problems and childhood and adolescent sedentariness is a one-way ticket for cardiovascular diseases and death.’

The researchers state that public health experts, paediatricians, parents and health policymakers should encourage early cholesterol checks, especially in the teenage years, to reduce the risk of dyslipidaemia and to enable early preventive treatment.

And the adoption of an ‘adolescent cholesterol passport’ to help track any increases in cholesterol levels could help to initiate a timely preventive treatment in the young population.

A version of this article was originally published by our sister publication Nursing in Practice.

Review finds plant-based diets reduce plasma lipid levels

30th May 2023

A meta-analysis of 30 trials suggests that plant-based diets are associated with significant reductions in total cholesterol, LDL cholesterol and apolipoprotein B.

Published in the European Heart Journal, the Danish researchers undertook a systematic review and meta-analysis, to estimate the effect of vegetarian and vegan diets on plasma levels of the main lipid fractions, TC, LDLC, triglycerides (TGs) and ApoB.

Randomised trials looking at the effect of both plant-based diets on the different lipid fractions were considered in comparison to an omnivorous diet in adults over 18 years of age. A total of 30 eligible trials were identified, which included an equal number of both types of plant-based diets and had an overall sample size of 2,372 participants.

Compared to the omnivorous group, the plant-based diets significantly reduced TC (mean difference, MD = -0.34 mmol/L 95% CI -0.44 to -0.23, p < 0.001). Significant reductions were also seen with LDLC (MD = -0.30, 95% CI -0.40 to – 0.19, p < 0.001) and ApoB (MD = -0.34, 95% CI -0.44 to -0.23, p < 0.001). However, no significant reductions were seen in the level of triglycerides compared to an omnivorous diet.

Despite these significant reductions, the researchers also reported substantial heterogeneity in the findings for TC, LDLC and ApoB (ranging from 69-74%).

Benefits from lipid reductions

To get a better understanding of the impact of these reductions, it is worth putting the changes into context.

A previous analysis of the benefits from lipid reductions indicated that for every 1 mmol/L decrease in TC, there was a 17.5% reduction the risk of all-cause mortality, a 24.5%, reduction in coronary heart disease (CHD)-related mortality and 29.5% for any CHD-related event.

Using TC as an example, a 0.34 mmol/L reduction, as found in the current analysis, equates to a 6% decrease in the risk of all-cause mortality and a 10% reduction in the risk of a CHD-related event.

Consequently, whilst relatively modest for an individual, these reductions would become substantial at the population level, thereby potentially reducing the society burden and mortality associated with cardiovascular disease.

Diet and cardiovascular disease

Data from the World Health Organization suggests that cardiovascular diseases result in nearly 18 million annual deaths, emphasising the importance of any strategies that could reduce this risk. One strategy at the individual level is to move away from an omnivorous diet. In fact, this approach was advocated in guidance from the European Society of Cardiology in 2021. The guidance suggested that individuals could reduce their risk of cardiovascular disease through adoption of a more plant-based and and less animal-based food pattern. In recent years there has been an increase in vegetarian eating patterns in several continents around the world, including Europe and North America. In addition, there are also reported increases in the number of people eating a vegan diet.

In a previous analysis from 2015, it was shown that a vegetarian diet reduced lipid markers such as total cholesterol (TC) and LDL cholesterol (LDLC). However, the analysis did not examine the impact of this plant-based dietary pattern on levels of apolipoprotein B (ApoB), despite strong evidence that this lipid is a more accurate indicator of cardiovascular risk than either TC or LDLC.

Low-density lipoprotein reduction from daily intake of walnuts

21st September 2021

A study has found that elderly patients who ate a handful of walnuts every day for 2 years saw reductions in low-density lipoprotein levels.

Regular intake of nuts has been associated with a 15% lower risk of cardiovascular disease and a 23% lower risk of cardiovascular mortality. This reduction in risk is probably due to a reduction in low-density cholesterol (LDL-C) levels with one pooled analysis of 25 intervention trials finding that a mean daily intake of 67g of nuts produced a 7.4% mean reduction in LDL-C levels. However, none of the 25 trials lasted longer than 8 weeks and have not examined the effect of nuts on different LDL sub-fractions. In trying to establish the effect of both daily nut consumption and any differences in the effect on low-density lipoprotein levels, a team from the Lipid Clinic, Endocrinology and Nutrition Services, Villarroel, Barcelona, Spain, decided to explore these effects in a randomised trial. The team established the Walnuts and Healthy Aging (WAHA) trial which ran from 2012 to 2014 and was designed to examine the impact of bioactive compounds, such as n-3 fatty acids (found in walnuts) on both cognitive function and retinal health. Free-living participants were randomised to receive 30 – 60g/day of walnuts, which were delivered to the intervention group individuals, or to abstain from the nuts for the two years of the trial. One of the secondary outcomes of the original trial was changes in lipoprotein levels. Together with fasting glucose, lipoprotein levels were were measured at baseline at after 2 years. In addition, given that those eating walnuts were consuming more fat and thus likely to experience weight gain, this was also measured and compared with the baseline reading.

Findings
There were 636 participants with a mean age of 69 years (67% female) who completed the two-year trial. The mean baseline LDL-C and triglyceride levels were 117 and 105 mg/dL respectively. Among those taking walnuts, mean total cholesterol levels decreased by 4.4%
(-8.5 mg/dL, 95% CI -11.2 to -5.4), LDL-C by 3.6% (-4.3, 95% CI -6.6 to -1.6) and intermediate-density lipoprotein cholesterol by 16.8% (-1.3, 95% CI -1.50 to -1.0). Interestingly, levels of both triglycerides and high-density lipoprotein levels were unchanged. Weight changes in the walnut group were negligible at 0.06kg (95% CI -0.32 to 0.44). Furthermore, LDL-C reductions were higher for men than women (7.9% vs 2.6%, men vs women). In addition, there were also reductions in total LDL particles and small LDL particle number by 4.3% and 6.1% respectively.
The authors suggest that the reduction is LDL-C cholesterol at 4.3 mg/dL was modest and concluded that daily walnut intake may be useful way to improve cardiovascular risk.

Citation
Rajaram S et al. Effects of Walnut Consumption for 2 Years on Lipoprotein Subclasses Among Healthy Elders. Findings From the WAHA Randomized Controlled Trial. Circulation 2021.