Fewer than half of young adults with severely elevated low-density lipoprotein cholesterol (LDL-C), or bad cholesterol, begin statin therapy within five years of their first high measurement, according to a new study published in the Journal of the American College of Cardiology, and to be presented at the American Heart Association’s 2025 Scientific Sessions.
The 2018 ACC/AHA Cholesterol Guideline recommends statin therapy for individuals with LDL-C levels above 190 mg/dL. However, the study reveals substantial gaps in lipid management among adults aged 18 to 39, particularly those at high risk for premature atherosclerotic cardiovascular disease (ASCVD).
Elevated LDL-C significantly increases the risk of heart attack and stroke. More than half of young adults have LDL-C levels exceeding 100 mg/dL, yet they are far less likely than older adults to know their cholesterol numbers or receive appropriate treatment. This study is among the largest to examine real-world patterns of LDL-C testing and statin initiation in this age group.
Study researchers observed that some high-risk young adults were not consistently following up with LDL-C testing or starting statin therapy as recommended. These findings underscore that early adulthood is a critical window for prevention, and identifying opportunities for earlier intervention is essential to reducing lifelong heart risk.
The analysis included data from 771,681 Kaiser Permanente Southern California members aged 18–39 years who recorded their first elevated LDL-C between 2008 and 2020. Participants were stratified by LDL-C level and ASCVD risk, and researchers tracked follow-up testing and statin initiation at one, two, and five years.
Key findings:
- Among individuals with LDL-C ≥190 mg/dL, only 28.4% started a statin within one year and 45.7% within five years.
- Among those with LDL-C 160–189 mg/dL and high 30-year ASCVD risk, 25.3% initiated a statin within one year, increasing to 46.4% by five years.
- Follow-up LDL-C testing within one year declined from 52.5% in 2008 to 35.4% in 2018 among high-risk individuals.
- Statin initiation within one year also decreased, from 31.7% to 20.1% for those with LDL-C 160–189 mg/dL and high risk, and from 36.5% to 12.6% for those with LDL-C ≥190 mg/dL.
Healthcare systems have a potential roadmap to develop next-generation care models. The SureNet programme shows that combining patient outreach with clinician decision support may be an effective strategy to advance proactive, early cardiovascular prevention.
The findings illustrate how often opportunities for prevention are being missed and that elevated LDL-C in young adulthood can mark the beginning of decades-long cardiovascular risk exposure. By identifying and addressing these gaps early, the trajectory of heart disease across the lifespan can be changed.
The findings will be presented at AHA.25 on Monday, November 10, at 1:00 p.m. CT/2:00 p.m. ET.
Source: American College of Cardiology
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