Dyslipidaemia persisting into adulthood spells increased heart disease risk

Elevated nonhigh-density lipoprotein cholesterol (non–HDL-C) levels in childhood that persist into adulthood poses an increased risk of cardiovascular disease (CVD), according to a study. But the good news is that the resolution of dyslipidaemic non–HDL-C levels adulthood may help prevent CVD events.

For the study, researchers collected individual participant data from six prospective cohorts of children (mean age at baseline 10.7 years) in the US and Finland. Age- and sex-specific non–HDL-C z-scores were obtained for children (age 3–19 years) and adults (age 20–40 years) based on clinical guideline-recommended cutoffs for dyslipidaemia. The main outcomes were incident fatal and nonfatal CVD events.

Over a mean follow-up of 8.9 years after age 40 years, 147 CVD events were documented among 5,121 participants (60 percent women, 15 percent Black). The risk of CVD events was positively associated with non–HDL-C levels during childhood (1-unit increase in z score: hazard ratio [HR], 1.42, 95 percent confidence interval [CI], 1.18–1.70) and adulthood (1-unit increase in z score: HR, 1.50, 95 percent CI, 1.26–1.78). However, the association for childhood non–HDL-C was attenuated after adjusting for adult levels (HR, 1.12, 95 percent CI, 0.89–1.41).

In a complementary analysis, both childhood non–HDL-C levels and the change between childhood and adulthood showed an independent association with CVD events. Participants with incident non–HDL-C dyslipidaemia from childhood to adulthood had increased risks of CVD events compared with those whose non-HDL-C levels remained within the guideline-recommended range in childhood and adulthood (HR, 2.17, 95 percent CI, 1.00–4.69) and those with persistent dyslipidaemia (HR, 5.17, 95 percent CI, 2.80–9.56).

The risk increase was not observed in individuals who had dyslipidaemic non–HDL-C in childhood but whose non-HDL-C levels were within the guideline-recommended range in adulthood (HR, 1.13, 95 percent CI, 0.50–2.56).

These data underscore the potential of interventions to prevent and reduce elevated childhood non–HDL-C levels to prevent premature CVD.