A group of Wisconsin researchers are questioning the National Cholesterol Education Program guidelines’ assumptions that coronary artery disease is rare in younger adults and that moderate cholesterol elevations in the under-50 age group don’t need treatment.

 The NCEP issues periodic cholesterol guidelines that are disseminated to physicians and the public in hope of raising awareness of the dangers of high cholesterol.

The researchers’ findings suggest that even mild cholesterol abnormalities can have a significant effect in patients living in areas with high rates of other coronary artery disease, or CAD, risk factors, such as smoking and obesity.

Coronary artery disease, caused by narrowed arteries supplying the heart, is the leading cause of death for both men and women in the United States. The manifestations of this disease include heart attack and angina pectoris, a severe but brief chest pain. More prolonged angina pain, called acute coronary syndrome or ACS, is often a warning sign of imminent heart attack.

The research group, led by Kwame Akosah, M.D., at the Gundersen Lutheran Medical Center in LaCrosse, Wis., evaluated 449 patients, 50 years old or younger, who had been admitted to the hospital with ACS as the admitting diagnosis over a two-year period (1996 and 1997). This group represented 22 percent of all admissions for ACS during that interval. There were 317 men (71 percent) and 132 women (29 percent), and their average age was 44.

The study group was further analyzed to determine the following:

• presence of CAD documented by angiography or evidence of heart attack
• smoking, past or present
• hypertension (high blood pressure)
• diabetes
• cholesterol level, and history of elevated blood cholesterol or other similar abnormalities involving triglycerides (a fatty substance in the blood) and LDL/HDL cholesterol (“bad” and “good” cholesterol)
• obesity
• family history of premature CAD

The analysis revealed that smoking, diabetes, being male and a history of high cholesterol were all associated with an increased risk of premature CAD. They found that more than half (55 percent) of the patients with CAD had severe coronary artery disease. The CAD was proven by angiogram, or dye injected into the coronary arteries, and the researchers defined severe disease as narrowing in more than one coronary artery.

When the lipid (blood cholesterol and triglyceride) studies were compared to the guidelines issued by the NCEP, it was found that among these relatively young patients, almost one-half had “normal” levels of LDL, or bad, cholesterol, and either no other or one other CAD risk factor.

The study found that a high proportion of younger patients were admitted to a regional, rural hospital for ACS; those patients often already had severe, advanced CAD; and that the NCEP cholesterol guidelines do not predict the real risk well enough to prevent the onset of CAD.

According to the researchers, prevention guidelines should be revised to start prevention efforts earlier, at lower levels of total and LDL cholesterol. They also state that more attention should be paid to smoking, obesity and hypertension as risk factors for heart disease in younger people.

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