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.

Undertreatment of women with heart disease increases risk of serious preventable outcomes

11th December 2023

Women who are diagnosed with heart issues are consistently undertreated, leading to preventable heart attacks, strokes and death, according to a new study.

Researchers found that although men had a higher chance of developing heart disease over their lifetime, when heart disease was detected in either sex, women were up to 50% less likely to be treated with preventative medicine compared to men.

The study examined the heart health of approximately 24,000 people over a 25-year period to identify patterns in long-term health outcomes and how they differ between the sexes.

The findings are published in the European Journal of Preventive Cardiology and provide evidence of the need for sex-specific cardiovascular prevention strategies.

Cardiovascular disease is one of the leading causes of death and disability in the UK, Europe and worldwide, and accounts for significant healthcare spending.

Understanding how heart disease affects different populations, including different sexes, is essential in tailoring effective preventative care for individual patients.

Using data from The European Prospective Investigation into Cancer (EPIC)-Norfolk study, the researchers analysed a large population cohort over a very long follow-up period of over 25 years.

The EPIC-Norfolk study also records cardiovascular events, including myocardial infarction, stroke, peripheral artery disease, atrial fibrillation, heart failure and valve disease.

The analysis showed that men had a 49% greater risk of developing heart disease than women over their lifetime and a 43% higher risk of dying from a heart condition compared to women.

The age at which heart disease presented itself was found to be lower in men, with males typically presenting with a heart attack in their 50s. For women, cardiovascular disease would most likely present in their 60s in the form of a stroke or atrial fibrillation.

Despite women presenting later than men, the death rate from cardiovascular disease for women rose to the same level as men. Women were found to have diminishing sex advantage in survival once they developed heart disease.

The researchers believe that the rise in the mortality rate in women is explained by the different preventative treatments that men and women receive.

Dr Tiberiu Pana, honorary clinical research fellow at the University of Aberdeen, said: ‘This is the first study to delineate sex differences from the same population, over very long follow-up while controlling for factors such as lifestyle, socioeconomic status and history of cardiovascular disease.

‘Our analysis found that women were 30-50% less likely to be treated with preventative medicine compared to men.’

Dr Pana said the consistent undertreatment of women with heart or circulatory disorders is ‘worrying’.

She added: ‘Our findings highlight how it is important to consider how future prevention campaigns should focus differently on men and women.’

It is also possible that the menopause may influence outcomes for women, with hormonal changes eroding the early advantage that women have.

Dr Pana suggests that targeted preventative measures around the time of menopause in women may help prevent heart disease.

She said: ‘Everyone should consider minimising their risk factors for heart disease as early as possible in life, such as regularly monitoring their blood pressure, keeping a healthy weight and being physically active.

‘However, it is even more important that people be aware of the need to take preventative medicines after suffering a heart or circulatory disorder to minimise their risk of recurrence or death.’

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

Study suggests that mortality in heart disease patients lowest for BMI values between 25 and 35

8th February 2022

Mortality in heart disease patients is lowest with BMI values between 25 and 35, which is higher than in recommended prevention guidelines

The mortality in heart disease patients has been found to be lowest for those with a body mass index (BMI) between 25 and 35 and which is higher that the level recommended in prevention guidelines. This was the conclusion of the Stabilisation of Atherosclerotic Plaque by Initiation of Darapladib Therapy (STABILITY) study by researchers from the Department of Medical Sciences, Uppsala Clinical Research, Sweden.

According to the World Health Organization (WHO), overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. Obesity is measured using BMI values and WHO defines someone as overweight if their BMI is greater than or equal to 25 and obese if their BMI is greater than or equal to 30. Based on these criteria, WHO estimates that in 2016, 39% of adults (18 years and older) were overweight and 13% were obese.

Moreover, elevated BMI levels have been associated with numerous diseases and metabolic abnormalities including hyper-insulinaemia, insulin resistance, hypertension, dyslipidaemia, coronary heart disease and certain malignancies. However, despite the potential adverse cardiovascular sequelae associated with obesity, many studies and meta-analyses have demonstrated an obesity paradox in that the overweight and mildly obese having a better prognosis than do their leaner counterparts with the same level of cardiovascular disease.

The relationship between BMI and cardiovascular outcomes is therefore not straight forward and this relationship was further confused by the results of a 2019 study which concluded that while obesity was independently associated with increased risk for long-term mortality among patients with stable coronary artery disease, being overweight did not appear to confer an additional mortality risk.

For the present study, the Swedish team examined the association between BMI and mortality in heart disease patients based on data from the STABILITY study, a randomised, placebo-controlled trial evaluating the phospholipase A2 inhibitor in patients with stable coronary heart disease. Patient’s BMI was measured at baseline and the associations with cardiovascular outcomes were evaluated by Cox regression analysis with multivariable adjustments of several factors including gender, age, prior myocardial infarction, renal dysfunction, smoking status etc. The primary outcomes of interest were the composite of cardiovascular death, myocardial infarction and stroke whereas a secondary outcome was all-cause mortality.

Mortality in heart disease patients during follow-up

The study included 15,785 patients with a mean age of 64.9 years (18.7% female) and who were followed up for a mean of 3.7 years. In total, 1.5% of participants had a BMI < 20, 19.4% a BMI of 20 – 25, 42.8% a BMI of 25 – 30, 25.1% a BMI of 30 – 35 and 11.2% a BMI > 35.

In fully adjusted models, among those with the lowest BMI (< 20), there was a more than doubling of the risk of all-cause mortality (Hazard ratio, HR = 2.27, 95% CI 1.60 – 3.22), cardiovascular death (HR = 2.26) and heart failure (HR = 2.51) compared to those with a BMI of 25 – 30 which served as the reference point. Similarly, all-cause mortality was higher among those with a BMI of 20 – 25 (HR = 1.21) and cardiovascular mortality (HR = 1.26).

For the most obese patients (BMI > 35), the risk of all-cause mortality was higher than the reference group (HR = 1.18) and as was the risk for cardiovascular mortality (HR = 1.23).

In discussing their findings, the authors noted how mortality in heart disease was effectively U-shaped, i.e., the highest risks were in those with both the lowest and highest BMI values. They calculated that the lowest risk was for those with a BMI of 27 which was considered as ‘overweight’ in guidelines which advocate an ideal BMI of 20 to 25, suggesting how their data indicated that a slightly higher BMI was optimal.

Citation
Held C et al. Body Mass Index and Association With Cardiovascular Outcomes in Patients With Stable Coronary Heart Disease – A STABILITY Substudy J. Am Heart Assoc 2022