Lipid screening and intervention for dyslipidemia in adolescence can halt the progression of atherosclerosis

Lipid screening and intervention for dyslipidemia in adolescence can halt the progression of atherosclerosis

Consistently elevated lipids and dyslipidemia in early life were associated with worsening subclinical atherosclerosis, but simulated lipid treatment in late adolescence halted atherosclerosis progression, according to an article published in Atherosclerosis. The study was conducted in collaboration between Northwestern University in the US, the Baker Heart and Diabetes Research Institute in Australia, the University of Bristol in the UK, the University of Turku in Finland and the University of Eastern Finland.

Über einen 9-jährigen Nachbeobachtungszeitraum von der Adoleszenz bis zum jungen Erwachsenenalter waren erhöhte Lipid- und Dyslipidämiespiegel mit einer Verschlechterung der subklinischen Atherosklerose verbunden. Unter Verwendung eines kürzlich entwickelten zeitlichen inversen Zuordnungsmodells zur Simulation von Behandlungsinterventionen zeigte die Studie jedoch, dass ein Versuch, den Cholesterinspiegel im jungen Erwachsenenalter zu senken, möglicherweise zu spät und unwirksam ist, um das Fortschreiten der Atherosklerose zu stoppen. Das Alter von 17 Jahren scheint die goldene Gelegenheit zu sein, das Fortschreiten der Atherosklerose in einer allgemeinen Population asymptomatischer Jugendlicher zu behandeln und zu stoppen. Bildnachweis: Andrew Agbaje.

Abnormal levels of cholesterol and triglycerides in the blood, known as elevated lipids and dyslipidemia, are major causes of atherosclerosis, in which cholesterol plaques build up in the blood vessels. There is still no consensus on screening children and adolescents for elevated lipids and dyslipidemia in the general population. There is evidence that children and adolescents with congenital disorders of lipid metabolism do well with treatments if they are started early. However, it is unknown whether elevated lipid and dyslipidemia lead to early cardiovascular damage before middle adulthood in a large asymptomatic adolescent population.

The current study, conducted in 1779 adolescents aged 15 years and followed for 9 years until age 24, found that almost 1 in 5 adolescents had elevated lipids or dyslipidemia by the age of 15 years. The prevalence of elevated lipids and dyslipidemia increased to 1 in 4 young adults nine years later. Importantly, only 1 in 1000 adolescents had received treatment for dyslipidemia at follow-up at age 17. This leaves more than 440 adolescents with untreated elevated lipids and dyslipidemia.

The researchers found that these 440 asymptomatic adolescents showed signs of subclinical atherosclerosis and, unfortunately, the disease was already worsening. According to the researchers, this is worrying because almost all adolescents at potential risk of cardiovascular disease largely escape early childhood screening and treatment.

Because clinical trials on the effect of lipid treatment on cardiovascular disease in asymptomatic children and adolescents are rare, researchers developed a novel model to simulate a clinical trial intervention. The novel Temporal Inverse Allocation Model involved a treatment intervention at a specific age or follow-up period, after which researchers analyzed whether this treatment stopped the worsening of atherosclerosis progression.

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To their surprise, the researchers found that lipid treatment at age 24 failed to stop the worsening of atherosclerosis. This suggests that treatment in early adulthood may be too late to provide optimal cardiovascular health benefits. Importantly, lipid treatment at age 17 effectively stopped and reversed the progression of atherosclerosis.

This study provides crucial evidence for cardiovascular health in the general population and emphasizes the need for early childhood screening and prevention of elevated lipids and dyslipidemia from an early age.

We don't have to wait until we're in our 40s to get our cholesterol levels checked. High total cholesterol and low HDL levels have already damaged the vascular wall during puberty, and if we don’t get treatment early, we may miss a golden opportunity for better cardiovascular health.”

Andrew Agbaje, physician and clinical epidemiologist, University of Eastern Finland

Treatment of atherosclerosis at a later stage is expensive, lengthy and complicated with often unsatisfactory results. “Atherosclerosis progresses silently over time and the earliest possible intervention may provide the opportunity to halt the progression of the disease.”

"It is important to note that in this study, high total cholesterol, high non-HDL cholesterol, and very low HDL levels were associated with signs of atherosclerosis, even in normal-weight adolescents. Interestingly, elevated LDL cholesterol levels and triglycerides." “This should not be a problem in this age group, especially if there is no genetic inheritance of lipid diseases.”

"These novel findings should change our approach to atherosclerosis prevention. Public health experts, pediatricians and government health policy makers should consider lipid screening in adolescence and initiate treatment for high cholesterol and low HDL at age 17. In terms of primary prevention of atherosclerosis, the diet what we eat from a young age could either be poison for our blood vessels or an antidote for atherosclerosis, the choice is ours," says Andrew Agbaje.

The research group of Dr. Agbaje (urFIT-CHILD) is supported by research grants from the Jenny and Antti Wihuri Foundation, the Finnish Cultural Foundation Central Fund, the Finnish Cultural Foundation North Savo Regional Fund, the Orion Research Foundation sr, the Aarne Koskelo Foundation, the Antti and Tyyne Soininen Foundation, the Paulo Foundation, the Yrjö Jahnsson Foundation, the Paavo Nurmi Foundation, the Finnish Foundation for Cardiovascular Research and the Foundation for Pediatric Research.

Source:

University of Eastern Finland (UEF Viestintä)

Reference:

Agbaje, AO, et al. (2022) Cumulative Dyslipidemia With Arterial Stiffness and Carotid IMT Progression in Asymptomatic Adolescents: A Simulated Intervention Longitudinal Study Using a Time-Inverse Allocation Model. Atherosclerosis. doi.org/10.1016/j.atherosclerosis.2022.11.011.

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