Heart disease: Hypertension, high cholesterol raise young adult risks

• In a new study, researchers say younger people may be more vulnerable to developing cardiovascular problems than previously believed.
• They say young adults need to pay more attention to cardiovascular risk indicators such as cholesterol and high blood pressure at an early age.
• Experts say early lifestyle modifications can reduce the risk of heart problems later in life.

Cardiovascular issues aren’t just a concern for the young at heart.

A new study says younger adults may be at a greater risk for developing artery-narrowing atherosclerosis and may be especially vulnerable to the effects of elevated blood cholesterol and hypertension, two typical modifiable cardiovascular risk factors.

Undertaken at the Centro Nacional de Investigaciones Cardiovasculares (CNIC) in Spain, the research concludes that people need to start paying attention to their cardiovascular health at a younger age.

Published this week in the Journal of the American College of Cardiology, the findings stress that younger adults need to aggressively control cardiovascular risk factors.

Researchers said that primary prevention strategies need to include “surveillance of subclinical atherosclerosis and early cardiovascular risk factor control.”

“Screening for subclinical atherosclerosis from an early age together with aggressive risk-factor control could help to reduce the global burden of cardiovascular disease,” said Dr. Valentin Fuster, the study’s co-leader and CNIC general director as well as physician-in-chief at Mount Sinai Medical Center in New York, in a statement.

Younger adults and blood pressure, cholesterol

The research team said subclinical atherosclerosis often progresses in middle-aged individuals, especially when blood pressure and LDL-cholesterol levels are even mildly elevated.

They also said both medical professionals and the general public should be aware that atherosclerosis progression can be halted if risk factors are managed aggressively from an early age.

“In this study, we show that moderate increases in blood pressure and cholesterol have a much more pronounced impact on atherosclerosis progression in younger people,” said Dr. Borja Ibáñez, CNIC scientific director and a cardiologist at Hospital Universitario Fundación Jiménez Díaz in Madrid, in a statement.

The team said few studies have investigated the progression of silent atherosclerosis in people who are symptom free – whether they’re young or apparently healthy in middle-age – and how this disease progresses throughout life.

Details from the study on younger adults heart disease risks

The PESA-CNIC-Santander study (Progression of Early Subclinical Atherosclerosis) started in 2009 in close collaboration between the CNIC and Santander Bank.

More than 4,000 apparently healthy bank employees in Madrid ages 20 to 39 volunteered for an exhaustive, noninvasive analysis of the carotid, femoral, and coronary arteries and the aorta.

Participants also provided blood samples for advanced genomic, proteomic, and metabolomic analysis.

The researchers said the study’s findings have important implications for cardiovascular prevention and personalized medicine. It shows controlling risk factors (principally elevated cholesterol and hypertension) should begin early in life, when arteries are more vulnerable to the effects of the risk factors.

Dr. Guiomar Mendieta, a cardiologist and the study’s first author said in a statement the study’s other key finding was atherosclerosis, which was previously believed to be irreversible, can disappear if risk factors are controlled from an early stage.

The importance of the hypertension and cholesterol study

Dr. Samantha Lee, a director of cardiac telemetry at Northwell Health in New York who was not involved in the research, told Medical News Today that the “incredibly thorough study” sends an important message.

She noted that the longer someone has high cholesterol and high blood pressure, the more likely they are to have atherosclerosis, which she called “a fancy term for plaque build-up in the arteries.”

“This isn’t a new idea,” Lee said. “But what is novel about this study is the amount of plaque in your arteries can actually go away (as seen in 8 percent of participants) by treating your cholesterol and blood pressure at a young age. By waiting to treat these risk factors, you might miss out on the opportunity for your atherosclerosis to improve.”

Dr. Rigved Tadwalkar, a cardiologist at Providence Saint John’s Health Center in California who also was not involved in the study, told Medical News Today the study shows screening for subclinical atherosclerosis at an early age could play an important role in identifying those at risk.

“Given these findings, it would be worthwhile for healthcare professionals to start assessing cardiovascular risk earlier on, including during check-ups in early adulthood,” Tadwalkar said. “This approach is consistent with the idea of early intervention and aggressive control of cardiovascular risk factors as a means for reducing cardiovascular disease burden.”

Younger adults and cardiovascular health

Tadwalkar said most people at higher risk are still older, but the research highlights an important fact: younger individuals are also vulnerable to cardiovascular disease.

“Proactive strategies are of importance, even in apparently healthy young adults,” Tadwalkar said. “We know that those with a family history of cardiovascular diseases may face an increased risk, additionally warranting early testing and vigilant monitoring, especially considering that the progression of atherosclerosis is often silent.”

Tadwalkar said people should watch out for elevated blood cholesterol levels and hypertension.

“Moderate increases in these risk factors were shown to have a more pronounced impact on atherosclerosis progression in younger individuals,” Tadwalkar noted.

He said other indicators may include poor dietary habits, lack of physical activity, and smoking, all known contributors to elevated cholesterol and hypertension.

Dr. Nieca Goldberg is the medical director of Atria New York City and a clinical associate professor of medicine at NYU Grossman School of Medicine.

Goldberg, who wasn’t involved the study, told Medical News Today that young people are at risk for atherosclerosis, as “autopsy studies in young people who have died in car accidents have shown atherosclerosis.”

“What is new about this study is that it advocates for early risk factor intervention,” Goldberg said. “Genetics show that you are at risk and an unhealthy lifestyle accelerates the process.”

How to reduce cardiovascular risk factors

Goldberg said everyone needs to work on lowering their cardiovascular risk factors, the earlier the better.

“It is about advocating healthy lifestyles and living the talk,” she said. “It is important to address this in school children with healthy lunch programs and stop smoking campaigns for young people. We need to get better at our messaging to people of all ages.”

“One way is to encourage them to get a primary care doctor where risk factors like blood pressure, weight and laboratory testing can be ordered for cholesterol and glucose,” Goldberg said.

Dr. J. Wes Ulm, a bioinformatic scientific resource analyst and biomedical data specialist at the National Institutes of Health who wasn’t involved in the study, told Medical News Today that “as a rule, CAD (coronary artery disease) risk factors are remarkably modifiable by sustained lifestyle improvements across a vast genetic spectrum.”

“Increased exercise of various forms, moderation of refined sugar and saturated fat intake (and replacement of saturated and trans fats with unsaturated fats), better stress management, meditation, smoking cessation, minimization of alcohol intake, healthy weight maintenance — all are quite effective in nudging the above CAD risk factors in a healthier direction, including in younger people,” Ulm said.

Ulm added that the study could have much broader societal significance.

“One of the most significant public health conundrums of our era is the markedly diminished life expectancy of Americans compared to citizens of other developed countries, even when controlling for common factors, genetic and otherwise,” Ulm said.

“It is here that the referenced research may have some of its most interesting and surprising implications, in helping to underscore the immense and often underappreciated importance of specific geographic, structural, and cultural factors that encourage certain lifestyle choices,” he said.

Tadwalkar added that sleep apnea and poor sleep quality are emerging as noteworthy factors for cardiovascular disease. He said lifestyle modifications play a pivotal role, including adopting a heart-healthy diet low in saturated fats and cholesterol, engaging in regular physical activity, and avoiding tobacco.

“These lifestyle changes can contribute significantly to managing contributory risk factors such as high cholesterol levels and blood pressure,” Tadwalkar said. “Regular health check-ups and screenings are critical for early detection of risk factors. This can also help identify individuals who need to move beyond lifestyle modifications alone and into pharmacological interventions, such as cholesterol-lowering medications or antihypertensive drugs.”

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