High cholesterol common in younger adults, but screening rates remain low
■ A new study recommends that physicians screen young adults' cholesterol levels and discuss risk factors for coronary heart disease.
By Christine S. Moyer — Posted Aug. 13, 2010
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Two in three young adults have at least one risk factor for coronary heart disease. But fewer than half of the people in this age group get their cholesterol levels tested, according to a study in the July/August Annals of Family Medicine.
Lead author Elena Kuklina, MD, PhD, recommends that physicians bolster cholesterol screening efforts in adults 20 to 45 to help prevent coronary heart disease and discuss with patients the importance of maintaining a healthy weight, exercising and not smoking -- regardless of whether they are at risk for heart disease. Risk factors include having a parent with heart disease, smoking, high blood cholesterol, physical inactivity and being obese or overweight, according to the American Heart Assn.
"I find that to be incredibly troublesome. ... Obviously our sensitivity to risk for coronary heart disease needs to move up earlier in the timeline," said Clyde Yancy, MD, immediate past president of the AHA and medical director of the Baylor Heart and Vascular Institute at Baylor University Medical Center at Dallas.
Heart disease is the leading cause of death for men and women in the U.S., according to the Centers for Disease Control and Prevention. Coronary heart disease is the most common type, causing 445,687 deaths in 2005, according to the CDC's most recent data.
For the Annals study, researchers examined data on 2,587 young adults who participated in the National Health and Nutrition Examination Survey between 1999 and 2006. The men in the study were age 20 to 35; the women, 20 to 45 (link).
Researchers found that the rate of elevated low-density lipoprotein cholesterol levels ranged from 6.7% in participants with no increased risk of heart disease to 25.9% for those with two or more risk factors. The levels were higher (65.1%) in people with a history of coronary heart disease (angina or myocardial infarction), and for participants with heart disease equivalents. These conditions were defined in the study as self-reported stroke, diabetes and fasting blood glucose levels of 126 mg/dL or higher.
Cholesterol-screening rates increased with the number of risk factors present but remained low overall, said Dr. Kuklina, a nutritional epidemiologist with the CDC Division for Heart Disease and Stroke Prevention.
The screening rate was 45.1% for people with one risk factor and 47.4% for those with two or more risk factors. Among participants with a history of heart disease or heart disease equivalents, the rate was 67.7%.
The AHA recommends that universal screening start at age 20, with follow-up tests every five years for those considered at normal risk for heart disease. Screening should occur more frequently in people with risk factors for heart disease.
The U.S. Preventive Services Task Force suggests that physicians screen men 20 to 35 and women 20 to 45 if they are at increased risk for coronary heart disease. The task force strongly recommends screening all men 35 and older and women 45 and older.