High Cholesterol, High Blood Pressure Earlier In Life May Raise Your Risk of Heart Disease

A younger woman takes her blood pressure while sitting in her dining room at home
Experts say young adults should monitor their blood pressure on a regular basis. Getty Images
  • A genetic study reports that high blood pressure and high LDL cholesterol, even at younger ages, can increase the risk of coronary heart disease later in life.
  • Researchers said the risk was higher regardless of a person’s blood pressure and cholesterol levels later in life.
  • They say the findings highlight the need for managing these heart disease risk factors throughout a lifetime, including at younger ages.

High blood pressure and high LDL (or “bad”) cholesterol that is linked to genetics increases the risk of developing coronary heart disease throughout life, a new study reports.

In addition, researchers say high blood pressure and high LDL cholesterol before age 55 are linked to a greater risk of coronary heart disease later in life, regardless of a person’s blood pressure and cholesterol levels in their later years.

This suggests that high blood pressure and high LDL cholesterol have lasting effects on a person’s future risk of coronary heart disease, the researchers write.

It also supports the need for earlier treatment of these two risk factors for coronary heart disease, researchers say, as well as ongoing treatment for older adults.

“This study provides compelling evidence that elevated blood pressure and LDL-cholesterol beginning early in life substantially raise the lifetime risk of coronary heart disease, irrespective of later interventions to lower these risk factors,” said Dr. Michael Shapiro, a professor of cardiology at Wake Forest University School of Medicine in North Carolina who was not involved in the new research.

The study was published in the journal PLOS ONE.

What is coronary heart disease?

Coronary heart disease is a condition where the heart’s arteries can’t deliver enough oxygen-rich blood to the heart, which can lead to a heart attack.

This condition is the result of coronary artery disease, which is the buildup of plaque in the arteries of the heart.

Risk factors for coronary artery disease include:

  • high LDL cholesterol
  • low HDL (“good”) cholesterol
  • high blood pressure
  • family history of coronary artery disease
  • diabetes
  • smoking
  • being post-menopausal (women)
  • being older than 45 years (men)

While the formation of plaques can begin early in life, living a healthy lifestyle — such as eating healthy, managing your weight, and getting regular physical activity — can reduce the risk of developing coronary artery disease.

Genetic study provides peek at heart disease risks

The new study is called a Mendelian randomization study, which is like a genetic version of a randomized controlled trial.

Mendelian randomization relies on the fact that people are born with different variants of genes, in this case related to blood pressure or LDL cholesterol. Some variants increase a person’s risk while others lower their risk.

With this approach, researchers “were able to consider individuals that have a genetic predisposition to higher blood pressure or cholesterol, and compare them to those that have predisposition to lower blood pressure or cholesterol,” said Dr. Dipender Gill, a clinical research fellow in the School of Public Health at Imperial College London who was not involved in the study.

This allows them to examine how blood pressure and LDL cholesterol levels influence the risk of developing coronary heart disease across the lifespan.

The study included more than 450,000 participants in the UK Biobank, a large-scale research resource containing genetic, lifestyle, and health information.

The results of the study show that having a “genetic predisposition to higher LDL-C and blood pressure in those under age 55 years leads to a… higher likelihood of ultimately developing coronary disease,” Shapiro told Healthline.

This applies not just to people with a genetic risk but to all people because lifestyle factors can also lead to high blood pressure and high LDL cholesterol, even at younger ages.

Benefits of treating risk factors in older adults

The results of the new study contrast with those of an earlier Mendelian randomization study, which found that high blood pressure and LDL cholesterol may not be related to a greater risk of coronary heart disease at older ages.

That earlier study suggests older adults may not benefit from medications that lower their blood pressure and LDL cholesterol, at least in terms of lowering their risk of coronary heart disease.

However, the authors of the new study point out that the earlier study used a different method of analysis, compared to the one they used.

As a result, “our findings suggest that old age alone should not be a reason to withhold otherwise appropriate [LDL cholesterol]- and [blood pressure]-lowering treatments,” they wrote.

The new study’s results do fit with an earlier Mendelian randomization study by Gill and his colleagues that found that elevated blood pressure in midlife can increase the risk of coronary artery disease later on.

Large randomized controlled trials have also found that older adults may benefit from blood pressure medications and cholesterol-lowering statins.

Managing blood pressure and cholesterol early

The authors of the new paper write that their findings highlight the importance of controlling blood pressure and LDL cholesterol levels early in life.

“Even in individuals that are younger, having a genetic predisposition to lower blood pressure or cholesterol still has a beneficial effect,” Gill told Healthline.

Sometimes high blood pressure and LDL cholesterol is thought to be a problem of older age, but what the study shows is that “modifying these risk factors throughout life is important,” he said. 

“So even below the age of 55, lowering your blood pressure and cholesterol is still likely to have a beneficial effect on your overall risk across the life course,” Gill added.

Shapiro agreed.

“Delaying aggressive management of LDL cholesterol and blood pressure in younger patients, even those not yet at high near-term cardiovascular risk, allows a cumulative disease process to take hold that may be difficult to reverse,” he said.

Committees that write clinical treatment guidelines should reconsider whether blood pressure or cholesterol-lowering medications may be appropriate for younger adults, he added.

Currently, these drugs are mainly reserved for people with “immediate high risk” of coronary artery disease, said Shapiro, a trend that overlooks the “lasting harm” of being exposed to high blood pressure or LDL cholesterol earlier in life.

While medications may be appropriate for some younger people — if you’re wondering about whether you can benefit, check with your doctor — lifestyle changes made earlier in life can also help people maintain healthy blood pressure and cholesterol levels.

“Even if you’re young — younger than 55 — it’s still important to have a good healthy lifestyle and a good blood pressure and a good cholesterol level,” said Gill.

“It’s not just relevant once you’re older,” he said. “It’s an important thing to be on top of all through your adult life.”

Takeaway

In a genetic study called a Mendelian randomization study, researchers found that people with a genetic predisposition to high blood pressure and high LDL cholesterol had a higher risk of coronary heart disease later in life.

This was true regardless of their blood pressure and cholesterol levels later in life, suggesting the need for earlier treatment of these risk factors for heart disease. It also highlights the importance of treating these conditions in older adults.

Medications are available to help manage blood pressure and cholesterol, but lifestyle changes such as eating healthy and getting regular physical activity can also help.

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