High Blood Pressure; Elevated blood pressure and cholesterol levels in young adulthood may lead to an increased risk of heart disease later in life, regardless of later in life exposure to these risk factors, according to research published today in the Journal of the American College of Cardiology. Blood pressure and cholesterol are major modifiable risk factors for heart disease. While previous studies have found young adult exposures to be associated with heart disease later in life, it is unclear if this contributes to later risk independently of exposures experience later in life. This knowledge has been restrict due to the limit age range of previous studies.
High blood pressure
Using data from six large, community-based, prospective cohort studies; so researchers model complete risk factor trajectories starting at age 18 through follow-up and use those trajectories; so to estimate the independent associations of risk factor exposures during young adulthood (age 18-39 years) and later adulthood (age ?40 years) with subsequent risk of coronary heart disease, heart failure and stroke. The researchers calculated period-specific time weight averages of systolic blood pressure (SBP), diastolic blood pressure (DBP); also high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol exposure levels for younger and older adults.
A total of 36,030 participants were include in the analysis. Over a follow-up period of 17 years; so there were 4,570 incident coronary heart disease (CHD) events, 5,119 heart failure events and 2,862 stroke events. Average measurements of SBP, DBP, LDL and HDL from young adulthood were all strongly correlate with later in life averages. Elevate LDL during young adulthood was with a 64% increase; so risk of coronary heart disease, independent of later life exposures.
“Our results add to accumulating evidence that young adulthood is a critical period; so when high blood pressure or cholesterol are particularly harmful. Maintaining optimal levels of blood pressure and LDL cholesterol throughout young adulthood; could yield substantial lifetime cardiovascular disease prevention benefits,” said Andrew E. Moran, MD, MPH, associate professor at Columbia University and senior author of the study.
The researchers recommend implementation of preventive programs; hence targeting individual young adults that are web-based, patient-centered, mobile and account for the fact that this age group may discount; so the importance of their future heart disease risk. A limitation of this study is that it relied on impute risk factor levels before age 40 years. Future studies are need to validate these findings in cohorts with a follow-up spanning from young adulthood to later in life.
In an editorial comment accompanying this study, Samuel S. Gidding, MD, and Jennifer Robinson, MD, MPH, said that this study should be a wake-up call for the medical community to recognize the preventive care gaps experience by younger adults. “The time has come to recognize that preventive interventions are occurring too late in life to have a substantial impact on the population burden of atherosclerotic cardiovascular disease (ASCVD) and heart failure,” they said.
“Interventions in those with establish ASCVD, advance subclinical atherosclerosis, impair myocardial function, diabetes or renal insufficiency are disease treatment studies and not true prevention. By moving to trials in younger higher risk individuals who have less advance disease more amenable to reversal and developing precision medicine strategies base on genetics, imaging and other risk factors, the next era of cardiovascular disease prevention can begin.”