Cardiovascular guidelines advise statin therapy for adults aged 20-75 with low-density lipoprotein cholesterol (LDL-C) of 190 mg/dL or greater with a goal of lowering LDL-C by 50% or more. Furthermore, early-life accumulation of cholesterol exposure increases future cardiovascular risk independent of total cumulative cholesterol exposure, highlighting the importance of LDL-C management in young adults. However, real-world management of hypercholesterolemia in young adults is not well described. To address this knowledge gap, researchers used the Mass General Brigham clinical data registry, isolating two cohorts of patients with hypercholesterolemia who had cholesterol testing on at least two occasions and were aged 20-39 at the time of a qualifying LDL-C value between 2005-2018: those with LDL-C greater than 190 mg/dL (Cohort 1) and LDL-C ranging from 160 to less than 190 mg/dL (Cohort 2). Follow-up LDL-C values were extracted through 2019. Primary endpoints were 50% reduction in LDL-C for Cohort 1 and 30% reduction for Cohort 2. Cohort 1 (severe hypercholesterolemia) included more than 5,400 patients, and Cohort 2 (moderate hypercholesterolemia) included more than 12,600 patients. In Cohort 1, 1,638 individuals achieved at least 50% LDL-C reduction overall throughout median 7.8 years of follow-up. The youngest individuals were less likely to achieve 50% LDL-C reduction. In Cohort 2, 4,515 individuals achieved at least 30% LDL-C reduction throughout median 7.5 years of follow-up. In a large, integrated healthcare system, less than 30% of young adults with severe hypercholesterolemia achieved guideline-directed LDL-C-lowering throughout 8 years of follow-up. “These findings highlight the need for strategies to promote guideline-recommended cholesterol management in young adults,” researchers noted.
