'Bad' cholesterol can be deadly in otherwise healthy people

By American Heart Association News

Illustration of person with heart pain

Healthy people with a low risk of cardiovascular disease may still need to keep a close eye on their cholesterol, according to new research.

A study(link opens in new window), published recently in the journal Circulation, found that otherwise healthy people with high LDL cholesterol levels are at higher risk of dying from cardiovascular disease than those with lower LDL.

Often called “bad cholesterol,” LDL contributes to fatty buildups in arteries, which increases the risk for heart attacks, strokes and peripheral artery disease.

“Even if you have a low 10-year risk, that doesn’t eliminate the long-term risks of having high cholesterol levels and significantly poorer cardiovascular health,” said Dr. Shuaib Abdullah, the study’s lead author.

Researchers looked at data from 36,375 patients in the Cooper Center Longitudinal Study. Participants had no history of cardiovascular disease or diabetes and were deemed to have a low 10-year risk of developing cardiovascular disease.

After following participants for about 27 years starting in their 30s or 40s, researchers found that people with LDL levels of 160 or higher had a 70 percent to 90 percent higher risk of dying from cardiovascular disease compared to people with LDL below 100.

“There’s controversy within the medical community about what the LDL cutoff level should be, when patients should be treated, and if they should be treated at all,” said Abdullah, an assistant professor of internal medicine at UT Southwestern Medical Center in Dallas. “But this study shows a marked increase in death from cardiovascular disease and coronary heart disease at the 160 level.”

An estimated 28.5 million Americans have total cholesterol levels of 240 or higher, which roughly corresponds to an LDL level of 160 or higher, according to the study.

Abdullah said the study serves as a reminder that all adults should get regular cholesterols tests no matter how old they are. “A lot of patients with high cholesterol don’t know it until they have a heart attack,” he said.

Guidelines recommend people have their cholesterol checked every four to six years starting at age 20.

The study also showed an increased risk for people with non-HDL cholesterol readings above 160. Non-HDL levels are a person’s total cholesterol minus their HDL, the “good” type of cholesterol that helps the body get rid of some of the harmful LDL. Abdullah said past studies have shown non-HDL levels might be a better marker for cardiovascular risk than LDL in patients with additional risk factors.

Dr. Christie Ballantyne, who was not involved in the new research but coauthored an accompanying editorial(link opens in new window), said the study provides “more important information for the patient-doctor decision-making process.”

“A study like this helps doctors say, ‘Your risk has increased and there are things we can do to treat that risk, whether it’s lifestyle modifications or using medications like statins,’” said Ballantyne, chief of cardiology and cardiovascular research at Baylor College of Medicine in Houston.

Ballantyne said the new research shows that even healthy people should be following recommendations for ideal cardiovascular health, such as not smoking, managing blood pressure and staying physically active.

“Most cardiovascular disease is preventable, especially if we get patients and health care providers the right information so they can make the best decisions,” he said.

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