Single measures of non HDL-C and LDL-C between ages 18 and 30 years may predic CAD, finds study

The effectiveness of a single measurement of non–high-density lipoprotein cholesterol (non–HDL-C) or low-density lipoprotein cholesterol (LDL-C) in predicting cumulative lipid exposure from ages 18 to 40, and its subsequent impact on ASCVD risk after age 40, remains uncertain. To fill this knowledge gap, John T. Wilkins, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA, and colleagues aimed to assess whether a single measurement of non-HDL-C or LDL-C in young adults can predict their cumulative exposure to these lipids during early adulthood, and to quantify the relationship between this cumulative lipid exposure and the risk of ASCVD after age 40.

For this purpose, the researchers analyzed data from CARDIA (Coronary Artery Risk Development in Young Adults Study) participants who were cardiovascular disease-free before age 40, were not on lipid-lowering medications, and had at least three measurements of LDL-C and non–HDL-C before age 40.

First, they evaluated how a single measurement of LDL-C or non–HDL-C taken between ages 18 and 30 could predict the quartile of cumulative lipid exposure from ages 18 to 40. Second, they investigated the relationship between these quartiles of cumulative lipid exposure and the incidence of atherosclerotic cardiovascular disease (ASCVD) events, including both fatal and nonfatal myocardial infarction and stroke, occurring after age 40.

The following were the key findings of the study:

• Of 4,104 CARDIA participants who had multiple lipid measurements before and after the age of 30 years, 3,995 participants met our inclusion criteria and were in the final analysis set.
• A 1-time measure of non–HDL-C and LDL-C had excellent discrimination for predicting membership in the top or bottom quartiles of cumulative exposure (AUC: 0.93 for the 4 models).
• The absolute values of non–HDL-C and LDL-C that predicted membership in the top quartiles with the highest simultaneous sensitivity and specificity (highest Youden’s Index) were >135 mg/dL for non–HDL-C and >118 mg/dL for LDL-C; the values that predicted membership in the bottom quartiles were <107 mg/dL for non–HDL-C and <96 mg/dL for LDL-C.
• Individuals in the top quartile of non–HDL-C and LDL-C exposure had demographic-adjusted HRs of 4.6 and 4.0 for ASCVD events after age 40 years, respectively, compared with each bottom quartile.

The optimal levels of non–HDL-C and LDL-C for predicting high exposure to atherogenic lipids during early adulthood are notably lower than those identified in studies of middle-aged adults.

"These findings could improve clinical strategies for assessing lipid-related risk in individuals under 40 years," the researchers concluded.

Reference:

Wilkins, J. T., Ning, H., Allen, N. B., Zheutlin, A., Shah, N. S., Feinstein, M. J., Perak, A. M., Khan, S. S., Bhatt, A. S., Shah, R., Murthy, V., Sniderman, A., & Lloyd-Jones, D. M. (2024). Prediction of Cumulative Exposure to Atherogenic Lipids During Early Adulthood. Journal of the American College of Cardiology, 84(11), 961-973. https://doi.org/10.1016/j.jacc.2024.05.070