The new ACC-AHA guidelines for the management of cholesterol would increase the number of adults who would be eligible for statin therapy by 12.8 million, with the increase seen mostly among older adults without cardiovascular disease. (Funded by the Duke Clinical Research Institute and others.).

Background Many young adults with moderate hyperlipidemia do not meet statin treatment criteria under the new AHA/ACC cholesterol guidelines as they focus on 10-year cardiovascular risk. We evaluated the association between years of exposure to hypercholesterolemia in early adulthood and future coronary heart disease (CHD) risk. Methods and Results We examined Framingham Offspring Cohort data to identify adults without incident cardiovascular disease to age 55 (n=1478), and explored the association between moderate hyperlipidemia (non-high-density lipoprotein cholesterol [HDL-C] ≥160 mg/dL) duration in early adulthood and subsequent CHD. At median 15-year follow-up, CHD rates were significantly elevated among adults with prolonged hyperlipidemia exposure by age 55: 4.4% for those with no exposure, 8.1% for 1–10 years, and 16.5% for those with 11–20 years exposure (p<0.001); this association persisted after adjustment for other cardiac risk factors including non-HDL-C at age 55 (HR 1.39, 95% CI 1.05–1.85 per decade of hyperlipidemia). Overall, 85% of young adults with prolonged hyperlipidemia would not have been recommended for statin therapy at age 40, under current national guidelines. However, among those not considered statin therapy candidates at age 55, there remained a significant association between cumulative exposure to hyperlipidemia in young adulthood and subsequent CHD risk (adjusted HR 1.67, 95% CI 1.06–2.64). Conclusions Cumulative exposure to hyperlipidemia in young adulthood increases subsequent risk of CHD in a dose-dependent fashion. Adults with prolonged exposure to even moderate elevations in non-HDL-C have elevated risk for future CHD and may benefit from more aggressive primary prevention.

clinicaltrials.gov Identifier: NCT00699998.