Keeping an eye on your cholesterol is usually seen as something to start doing as we get older.
But people as young as 30 could also consider taking cholesterol-lowering drugs, as the medicines can do most good if they are started earlier, according to new research.
The NHS usually recommends people have a cholesterol test only once they are over 40, as part of a “mid-life MOT”. However, an analysis has found that more heart attacks can be prevented by people starting the lifelong medication in their thirties, even if their risk of a heart attack is quite low.
“I’m not saying we should neglect the high-risk people – but we need to focus on low-risk people equally,” said Dr Irene Karungi, a research physician at Imperial College London, who was involved in the research, published in the American Journal of Preventive Cardiology.
Statins lower cholesterol in the blood, and aim to slow the growth of plaques on artery walls. Plaques can cause heart attacks and strokes if a small piece breaks off and forms a clot that blocks important blood vessels.
One in 10 chance of a heart attack
Statins were initially given to people who survived a first heart attack, with the goal of preventing another one.
Later they began to be offered to somewhat younger people in the hope of preventing their first heart attack. But the medicines are usually given only if someone has at least a one in 10 chance of a heart attack or stroke within the next decade.
This is calculated by measuring levels of “bad cholesterol” – the type that promotes plaques – and plugging it into an equation that calculates heart attack risk, based on a range of other factors, including age, weight and blood pressure.
But could more people benefit from statins than are currently offered them? To find out, Dr Karungi analysed results from 15 trials of statins and five trials of other cholesterol-lowering drugs.
They included more than 100,000 people, who had a wide range of cholesterol levels and risk factors, when they started taking the medicines. About 6,000 of them had a heart attack or stroke or some other kind of major cardiovascular event during the study period.
The analysis found that the lower the patient’s calculated risk at the start of the trial, the smaller the cholesterol reduction needed to achieve a 25 per cent lower chance of a heart attack or stroke.
“Our analysis shows the benefit of reducing [bad cholesterol] in people who are low risk is much greater than waiting until they might become high risk,” said Dr Karungi.
“Once disease is established, treatment has to be more intensive – with higher doses of drugs and greater risk of side-effects or the need for more than one drug.”
“It’s not possible to give an age cut-off, but if say a 30-year-old is categorised as having a [certain] amount of risk, then treatment should not wait based on their age.”
Long-term benefits of drugs
Fellow researcher Professor Kausik Ray said: “It’s like a pension scheme – the earlier you start, the bigger the long-term benefits. Nobody has shown this before using clinical trial data.”
Professor Ian Graham, cardiologist at Trinity College Dublin, who was not involved in the study, said the current NHS policy of wating until people are 40 before they are offered a cholesterol test “makes no sense”.
“Focusing on the highest-risk persons may help them, but, at a population level, most events occur in the vastly greater numbers at mild to moderate risk,” he said.
An editorial accompanying the study said it shows cholesterol lowering is probably beneficial even in low-risk patients. “These findings emphasise the importance of engaging in discussions very early on with patients,” it said.
The i Paper previously reported how statins could be recommended to people in their twenties and thirties who don’t even have high cholesterol levels yet, based on calculating their heart attack risk from DNA sequencing.
