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Young adults with hypertension have higher risk of heart disease in later life

Those who had high blood pressure and cholesterol levels in their 20s and 30s have a higher risk of heart disease in later life – whether they got those levels under control or not, a new study warns.

The findings, from Columbia University, add to evidence that young adulthood is a critical period when high blood pressure or cholesterol are particularly harmful.

Researchers used figures from six large studies, involving more than 36,000 people, to model risk factor trajectories starting at the age of 18. 

They found that young adults who keep their blood pressure and cholesterol in check had the lowest risk of developing coronary heart disease, heart failure and stroke in old age.

Experts hailed the research as a ‘wake-up call’ to the medical community that young people need better access to preventative care. 

Young adults are the least likely to seek care but their heart health is pivotal for how they will fare in old age (file image)

‘Maintaining optimal levels of blood pressure and LDL cholesterol throughout young adulthood could yield substantial lifetime cardiovascular disease prevention benefits,’ said study senior author Professor Andrew Moran, of Columbia University.

‘However, young adults are difficult to reach by way of traditional, clinic-based preventive programs – they are transitioning between pediatric and adult-centered models of care, they often lack health insurance or experience frequent gaps in insurance coverage.

‘Young adult utilization of ambulatory medical care and adherence to preventive health guidelines are the lowest of any age group.’

To calculate risk, the team used those models to estimate how high blood pressure and cholesterol during young adulthood (aged 18 to 39) and in later adulthood (over the age of 40) affects the risk of coronary heart disease, heart failure and stroke. 

They calculated averages of systolic blood pressure (SBP), diastolic blood pressure (DBP), and high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol exposure levels for younger and older adults.

Over a follow-up period of 17 years, there were 4,570 coronary heart disease (CHD) events, 5,119 heart failure events and 2,862 stroke events.

Average measurements of SBP, DBP, LDL and HDL from young adulthood were all strongly correlated with later in life averages, according to the findings published in the Journal of the American College of Cardiology.

Elevated LDL during young adulthood was associated with a 64 per cent increased risk of coronary heart disease, independent of later life exposures.

High SBP and DBP in young adulthood were independently associated with a 37 per cent and 21 per cent increased risk of heart failure, respectively.

While no young adult exposures were independently associated with stroke, the findings showed that increased levels of high later life SBP or DBP were ‘strong predictors’ of stroke.  

The findings should be a ‘wake-up call’ for the medical community to recognize the preventive care gaps experienced by younger adults, according to two cardiologists who were not involved in the study, Drs Jennifer Robinson and Samuel Gidding.

The researchers recommend implementation of preventive programs targeting individual young adults that are web-based, patient-centered, mobile and account for the fact that the age group may discount the importance of their future heart disease risk. 

Drs Robinson and Gidding said: ‘The time has come to recognize that preventive interventions are occurring too late in life to have a substantial impact on the population burden of atherosclerotic cardiovascular disease (ASCVD) and heart failure.

‘Interventions in those with established ASCVD, advanced subclinical atherosclerosis, impaired myocardial function, diabetes or renal insufficiency are disease treatment studies and not true prevention.’

Drs Robinson and Gidding added: ‘By moving to trials in younger higher risk individuals who have less advanced disease more amenable to reversal and developing precision medicine strategies based on genetics, imaging and other risk factors, the next era of cardiovascular disease prevention can begin.’