Current lipid guidelines in the U.S. base the initiation of prevention therapies on whether a person’s risk exceeds a certain threshold. Age is an important risk factor for cardiovascular disease, so healthcare professionals typically prescribe treatments more frequently in older adults.
However, a recent study published in JAMA Cardiology suggests that younger adults are also at risk of cardiovascular disease. For instance, the researchers found that approximately half of new-onset cardiovascular events in men occur before age 65 and approximately one-third of new-onset cardiovascular events in women occur before age 65.
Still, they cited previous studies that showed the indication for preventive therapy increases from approximately 30 percent of adults before the age of 60 to nearly 80 percent of adults who are 60 years old or older.
“Our results demonstrate that, by this age, many cardiovascular events have already occurred,” the researchers wrote. “Furthermore, by age 60 years, asymptomatic intramural atherosclerotic disease is well advanced in many other individuals. Our findings highlight the need to refine strategies to identify individuals younger than 60 years who are candidates for preventive therapies.”
Lead researcher Allan D. Sniderman, MD, of McGill University in Montreal, and colleagues made a few recommendations on when to initiate therapy. They suggested lowering the risk threshold to 5 percent or adopting age- and sex-specific thresholds. They also said that healthcare professionals could consider additional risk factors such as low-density lipoprotein cholesterol of 160 mg/dL or higher, family history of premature cardiovascular disease, elevated C-reactive protein level, high calcium score, low ankle brachial index or high lifetime risk of cardiovascular disease.
Although medication therapy may be beneficial, the researchers recommend that healthcare professionals consider alternative options and assess patients on a case-by-case basis.
“Any preventive strategy must include health promotion across the life span, enhancing societal efforts to eradicate CVD, and new strategies to prevent premature cardiovascular events,” they wrote.