Being screened for cholesterol early would allow effective long-term treatment to be instituted to reduce the risk of cardiovascular disease and stroke later.
Cholesterol is a sterol lipid that plays a central role in many biochemical processes. It is essential for the proper functioning of the body, participating for example in the synthesis of vitamin D in the skin. It is transported by lipoproteins. And, while high-density lipoproteins (HDL) transport it to the liver where it is broken down, allowing excess to be eliminated, low-density lipoprotein (LDL) transports it to the cells of the body, which prevents its elimination. Hence the nickname bad cholesterol, dangerous to health when it is too high. Too high a rate would notably promote cardiovascular and stroke risks, recalls a new study. According to the work published Wednesday, December 4 in the review The Lancetgiving treatment to lower the level of bad cholesterol in people under 45 would reduce these risks later in life.
To reach this conclusion, the authors analyzed data from nearly 400,000 residents of 19 Western countries. The median age of participants was 51 years and the median follow-up period to observe cardiovascular events was 13.5 years (maximum 43 years).
They were thus able to notice the rates of cardiovascular events over 30 years were three to four times more frequent in people with too much bad cholesterol than in the others (33.7% against 7.7% for women, and 43.6% against 12.8% for men). This increase in long-term risk would also be increased in relatively young patients (under 45 years of age).
Duration of exposure to high cholesterol puts health at risk
Thus, women under 45 with a slightly high level of bad cholesterol (between 1.45 and 1.85 grams per litre) and presenting at least two risk factors for cardiovascular disease (obesity, diabetes, hypertension or smoking ) were 16% more likely to have a cardiovascular event before the age of 75. Among those with the same profile but aged 60 or over, the risk was only 12%. Among men with these factors, the odds were 29% and 21%, respectively.
“Which suggests that it is not just the level of cholesterol but the duration of exposure to high cholesterol that puts health at risk”, comments Paul Leeson, professor of cardiovascular medicine at the University of Oxford (United Kingdom). UK), in an independent commentary on the study.
Especially since by simulating a 50% reduction in cholesterol levels over a lifetime thanks to drugs from the statin family, the researchers observed a reduction in cardiovascular risk at all ages. The benefits are even more significant in young people, probably because they would have lowered their exposure to cholesterol for a longer period of their life. In detail, the cardiovascular risk of women and men under 45 would drop to 4 and 6% respectively.
Control your cholesterol level earlier
“These results support the idea that controlling cholesterol levels earlier in life could be more fruitful than if you wait until you are older,” says Professor Leeson.
“Most people these days don’t think about getting a cholesterol test until they’re in their 50s or 60s. By then they could have been living with high cholesterol for more than 40 years and a lot of damage has already been done,” Stefan Blankenberg, who took part in the study, told the site. Medscape Medical News.
“Our data suggests we shouldn’t wait until middle age to think about it. The younger you are when you find out you have high cholesterol, the more you can do to minimize the damage (…) We don’t recommend everyone take a statin for life, but our results suggest that a cholesterol test as an adult is a good idea. In this way, it will be possible for each individual to determine their risk and decide whether or not to take a statin,” he continues.
The side effects of statins remain poorly evaluated
Before being able to establish precise medical recommendations, however, more research is needed to measure the effects of a treatment to reduce cholesterol over the long term. Indeed, the current data on statins “have not evaluated treatments for several decades, which means that the risk of adverse effects – which would modify the benefit-risk ratio – is not clearly established”, recalls Jennifer G. Robinson, professor in the department of epidemiology at the University of Iowa (USA), in another independent commentary on the study.
A few months ago, a study published in the New England Journal of Medicine reported an alternative to controversial statins for lowering cholesterol. According to the researchers, bempedoic acid, not yet approved in Europe, would effectively prevent the body from creating too much cholesterol. And, this without side effects such as muscle damage, hepatitis or diabetes. On the strength of these encouraging results, the American pharmaceutical company behind the tested drug is now seeking a license to market it this year in Europe and the United States.
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