People whose "bad" cholesterol (LDL cholesterol) was high when they were in their 20s were more likely to have calcium lining their coronary arteries after age 35, the researchers found. In a subset of participants without abnormal blood fat levels who were not taking lipid-lowering medicine, low levels of good HDL cholesterol were also associated with a higher risk of calcifications.
For example, 44 percent of those with an average LDL of more than 160 milligrams per deciliter (mg/dL) when they were young had plaque buildup in their coronary arteries 20 years later, compared with 8 percent of those whose LDL levels were less than 70 mg/dL, Pletcher noted.
Even a modest rise in LDL, as low as 100-129 mg/dL, was associated with a higher risk of atherosclerosis, the researchers said. Sixty-five percent of the young adults had LDL levels greater than 100 mg/dL, they added.
The study had some limitations, the researchers noted in the Annals of Internal Medicine. "Coronary calcium, although a strong predictor of future coronary heart disease, is not a clinical outcome," they wrote.
The researchers also wrote that "safety concerns [about cholesterol-lowering treatments] are rightly magnified when starting treatment early in life is considered." The findings, they said, "cannot provide evidence for the effectiveness or safety" of using cholesterol-lowering drugs, such as statins, during young adulthood, although they added that could be an area for further investigation.
"It is an active area of debate," Pletcher said, adding that new guidelines are expected next year that will consider the use of statins in young ad
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