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Monday, April 13, 2015

The Health Test You Need to Get in Your 30s

Your dad’s not the only one who should be watching his cholesterol. Moderately elevated cholesterol in your 30s could foreshadow heart disease later in life, according to a new, decades-long study from Duke University.
The researchers found that only 4 percent of participants who had normal cholesterol levels before the age of 55 ended up with heart disease by the time they hit 70. 
But 17 percent of them who spent 11 or more years with high cholesterol—which the researchers defined as non-HDL cholesterol, meaning your total cholesterol minus the “good” cholesterol, over 160 mg/dl—before the age of 55 had coronary heart disease by 70.
So how exactly can that tank your ticker? Cholesterol buildup in your arteries can form plaques, which can cause blockages that may lead to heart attack.
“The earlier those plaques start developing, the longer they have to grow,” says study coauthor Ann Marie Navar-Boggan, M.D., Ph.D. 

Do Moderately High Levels Need Treatment?
However, most of the men who were labeled as having high cholesterol in the study wouldn’t meet the current guidelines for treatment. In fact, only 15 percent of those with high cholesterol at age 40—and just 35 percent at age 50—would have been targeted for statin therapy, says Dr. Navar-Boggan.
That’s because the new guidelines set by the American Heart Association (AHA) and the American College of Cardiology emphasize using a person’s 10-year risk of developing heart disease to determine whether they should take statins. Because of their age, most young people don’t have a high enough risk score to be prescribed statins. 
And the researchers believe that can be a problem, since some of the people in the study likely had cholesterol levels dangerous enough to contribute to heart disease, though their risk wasn’t considered severe enough to require drugs. 
(Keep in mind that there are also other factors related to cholesterol—like sizes of LDL particles—that can be more telling than just an overall number, as we reported in Your Unstoppable Heart.)
What’s more, because this study was just looking at cholesterol levels and future heart disease—not cholesterol lowered by statins and subsequent disease—it’s uncertain whether treating these levels would be beneficial. In fact, a 2010 meta-analysis of over 65,000 patients published in JAMA Internal Medicinefound that statins didn’t decrease the mortality rate in high-risk patients without heart disease over a followup of just under 4 years. 

What Does This Mean for You?
The present study does show how early heart-health is crucial in determining how it ticks later on in life, says Bob Eckel, M.D., current spokesperson and former president of the AHA. But it’s unlikely it’ll cause the AHA’s official recommendations on statin therapy to change.
He notes that the study looked at only a relatively small group of people—just over 1,000. That means it’s not quite as telling as full, large-scale trials that were conducted in creating the current guidelines in place for statin treatment, he says. 
The best thing you can do now is to learn your 10-year risk of heart attack and stroke, says Dr. Eckel. Gather your most recent lab results and plug in the info in the AHA’s Heart Attack Risk Test. Then share your results with your doctor.
If you have moderately high cholesterol and a 10-year risk that's under 5 percent, stepping up your workouts and maintaining a heart-healthy diet should be enough to lower those levels—no statins necessary. (Find out one writer’sEscape from Statins, where he tried to conquer cholesterol without any meds.) 
But if your risk is over 7.5 percent, you’ll generally meet the recommendations for statin therapy.
And if you fall in that middle ground between 5 and 7.5 percent, your doc may order further medical tests that assess your heart health, like the coronary calcium score or the hs-CRP test. The results of these can help determine whether you may benefit from the statins, says Dr. Eckel. 

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