Cardiovascular disease remains our number one killer. Guidelines state that all men older than 40 and women older than 50 or postmenopausal should be screened. With risk factors such as diabetes, high blood pressure, current smoking, obesity and a family history of premature heart disease, screening for high cholesterol – or what we like to call “an abnormal lipid profile” – should begin earlier. We know that an abnormal profile is common but can also be changed. The U.S. Preventive Services Task Force also calls for a targeted cholesterol screening approach for young adults: men aged 20 to 35 and women 20 to 45. Targeted screening would identify those young adults who are at higher risk. Risks include high blood pressure, smoking, family history, diabetes and obesity.
In this week’s Annals of Family Medicine is a study that looked at whether young adults identified as being at risk are screened in the U.S. Their study relied on information from on ongoing study called NHANES which continually monitors the health and nutritional status of US civilians. NHANES stands for the National Health and Nutrition Examination Survey. The information looked at was in men 20 to 35 and women 20-45. We know that about 2/3 if all young adults had one or more risk factor for coronary heart disease. Despite that, less than 50% of women and 40% of men were screened for high cholesterol. In their study, about 59% of participants were identified as having one or more risk factors. As expected, the prevalence of high cholesterol levels increased with the number of risk factors. Despite that, there was no real difference in the screening for cholesterol by a number of risk factors.
In another study this week in the CMAJ, risk factors for coronary heart disease are also looked at. This study looked at whether something called a “hypertriglyceridemic-waist phenotype” could be used as a marker of abnormalities of metabolism that could predict the risk of heart disease. The definition of this so-called phenotype is an increased waistline and a high triglyceride level.
Their study found that in both men and women, and increased waist circumference — even without a high triglyceride level — and the converse — a high triglyceride level even without the higher waist circumference — increased the risk of developing coronary heart disease. But if you had BOTH, that was associated with the highest risk of coronary heart disease. We know that in young adults, we typically treat with lifestyle modification, rather than medication. But clearly, we have to do a better job of getting those at risk to be screened and be identified before we can go about making changes!