Lowering LDL, the earlier the better

March 26, 2012

Coronary atherosclerosis – a hardening of the arteries due to a build-up of fat and cholesterol – can lead to heart attacks and other forms of coronary heart disease (CHD). Lowering low-density lipoprotein (LDL), or "bad" cholesterol, reduces the risk of CHD, and researchers found that lowering LDL beginning early in life resulted in a three-fold greater reduction in the risk of CHD than treatment with a statin started later in life, according to research presented today at the American College of Cardiology's 61st Annual Scientific Session. The Scientific Session, the premier cardiovascular medical meeting, brings cardiovascular professionals together to further advances in the field.

By the time most people begin treatment to lower LDL, CHD has often been quietly developing for decades. Because begins early in life, lowering LDL at a younger age may produce even greater reductions in the risk of CHD. Researchers sought to test this hypothesis by using genetic data to conduct a series of "natural" randomized controlled trials involving over one million study participants.

"Our study shows that the benefit of lowering LDL depends on both the timing and the magnitude of LDL reduction," said Brian A. Ference, MD, MPhil, MSc, FACC, director of the cardiovascular genomic research center at Wayne State University School of Medicine and the study's principal investigator. "The increased benefit of lowering LDL beginning early in life appeared to be independent of how LDL was lowered. This means that diet and exercise are probably as effective as statins or other medications at reducing the risk of CHD when started early in life."

Lowering LDL cholesterol at an early age, before the development of atherosclerosis, would understandably be more effective at reducing heart attacks, but testing this hypothesis has proven difficult. A conventional randomized trial would have to follow a very large number of young, asymptomatic people for several decades to test this hypothesis. As an alternative, researchers used a novel study design called a Mendelian randomized controlled trial (mRCT) to study the effect of nine single-nucleotide polymorphisms (SNPs), or single-letter changes in DNA sequence, each of which is associated with lower levels of LDL cholesterol. Because each of these SNPs is allocated randomly at the time of conception, inheriting one of these SNPs is like being randomly allocated to a treatment that lowers LDL cholesterol beginning at birth. The researchers found that all nine SNPs were associated with a consistent 50-60 percent reduction in the risk of CHD for each 1 mmol/L (38.67 mg/dl) lower lifetime exposure to LDL cholesterol. Lowering LDL by 2 mmol/L (77.34 mg/dl) could reduce the risk of CHD by almost 80 percent.

"The results of our study demonstrate that the clinical benefit of lowering LDL can be substantially improved by initiating therapies to lower LDL cholesterol beginning early in life," Dr. Ference said.

Coronary heart disease is the most common cause of death and disability throughout the world. Treatment of CHD and its risk factors is costly and consumes a large proportion of health care expenditures. Dr. Ference believes that the results of this study suggest that focusing on prolonged and sustained reductions in LDL cholesterol beginning early in life has the potential to substantially reduce the global burden of CHD.

Explore further: Low 'bad' cholesterol levels may be linked to cancer risk

Related Stories

Low 'bad' cholesterol levels may be linked to cancer risk

March 26, 2012
(HealthDay) -- There may be a link between low levels of "bad" low-density lipoprotein (LDL) cholesterol and increased cancer risk, according to new research.

Antibody injection lowers LDL, adding to effectiveness of statin therapy

March 26, 2012
A novel monoclonal antibody identified in a new study dramatically lowered circulating LDL cholesterol by 40 percent to 72 percent, a development with potential to provide a new option for patients who are resistant to cholesterol-lowering ...

Super-sticky 'ultra-bad' cholesterol revealed in people at high risk of heart disease

May 27, 2011
Scientists from the University of Warwick have discovered why a newly found form of cholesterol seems to be 'ultra-bad', leading to increased risk of heart disease. The discovery could lead to new treatments to prevent heart ...

Recommended for you

Five vascular diseases linked to one common genetic variant

July 27, 2017
Genome-wide association studies have implicated a common genetic variant in chromosome 6p24 in coronary artery disease, as well as four other vascular diseases: migraine headache, cervical artery dissection, fibromuscular ...

Could aggressive blood pressure treatments lead to kidney damage?

July 18, 2017
Aggressive combination treatments for high blood pressure that are intended to protect the kidneys may actually be damaging the organs, new research from the University of Virginia School of Medicine suggests.

Quantifying effectiveness of treatment for irregular heartbeat

July 17, 2017
In a small proof-of-concept study, researchers at Johns Hopkins report a complex mathematical method to measure electrical communications within the heart can successfully predict the effectiveness of catheter ablation, the ...

Concerns over side effects of statins stopping stroke survivors taking medication

July 17, 2017
Negative media coverage of the side effects associated with taking statins, and patients' own experiences of taking the drugs, are among the reasons cited by stroke survivors and their carers for stopping taking potentially ...

Study discovers anticoagulant drugs are being prescribed against safety advice

July 17, 2017
A study by researchers at the University of Birmingham has shown that GPs are prescribing anticoagulants to patients with an irregular heartbeat against official safety advice.

Protein may protect against heart attack

July 14, 2017
DDK3 could be used as a new therapy to stop the build-up of fatty material inside the arteries

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.