Millions of Americans already have high cholesterol in their 20s and 30s – and don’t know it. Here’s why this worries doctors.

It’s estimated that millions of Americans are walking around with dangerous levels of “bad” cholesterol in their blood well before their 40th birthday. But many have no idea, because doctors generally don’t screen, much less treat, people with high cholesterol in their 20s and 30s. U.S. guidelines do not require Americans to get screened in early adulthood, but some doctors think that should change, given that high cholesterol levels are increasing and the disease is a leading cause heart attacks and strokes.

Here’s why screening starts later in life and why some cardiologists shy away from the rules.

First, what is considered high cholesterol?

When your doctor says your cholesterol level is “high,” this usually refers to your combined blood levels of “good” high-density lipoprotein (HDL) cholesterol and “bad” low-density lipoprotein (LDL) cholesterol. greater than 200 milligrams per deciliter (mg/dL). But it’s the high levels of LDL cholesterol – 160 mg/dL or more – that make this number worrying. It’s important that your combined cholesterol levels stay relatively low and that your HDL levels are higher than your LDL levels, because “good” cholesterol helps eliminate the “bad” cholesterol that hardens the arteries, according to Medline.

Levels are considered healthy if:

• Total cholesterol is less than 200

• LDL cholesterol is less than 100

• HDL cholesterol is 60 or more

You are considered at high risk or borderline if:

• Total cholesterol is between 200 and 239

• LDL cholesterol is between 100 and 159

• HDL cholesterol is between 40 and 59 for men, or between 50 and 59 for women

And the levels are high if:

• Total cholesterol is 240 or more

• LDL cholesterol is 160 or more

• HDL cholesterol is less than 40 for men and less than 50 for women

Scientists haven’t studied cholesterol in young people much

Typically, doctors test for signs of health problems and then decide on the best treatment.

But doctors are sort of working backwards when it comes to high cholesterol in young adults, Dr. Andrew Moran, a professor of general medicine at Columbia University whose research focuses on preventing high cholesterol, tells Yahoo Life. cardiovascular illnesses.

Treating high cholesterol with medications is not recommended by the US Preventive Services Task Force (USPSTF) for people under 40 years of age. In fact, USPSTF recommendations state that cholesterol-lowering medications should only be given to patients ages 40 to 75 if they have at least a 7.5% chance of developing heart disease in the next 10 years. . The widely used heart disease risk calculator doesn’t even calculate heart disease risks for someone under 40. And the USPSTF no longer has separate guidelines for screening without treatment. “So many (health care providers) ask, ‘Why should I screen for high cholesterol if there’s nothing to do about it?’ “” in prescription terms, Moran said.

The most commonly prescribed medications to treat cholesterol are statins. Doctors prescribe them because statins have been studied extensively and found to be safe and effective in large clinical trials — but there haven’t been many of these trials involving young adults.

This is partly because it would be expensive and slow to test the effectiveness of statins in young people. The important measure for a clinical trial of statins is whether people who use them have fewer heart attacks and strokes than those who don’t take them. “To run a clinical trial, if you have a limited budget, the smart thing to do is to find the people who are relatively high risk, because in a relatively short period of time you can measure the difference,” Moran explains. “In young people, this” – a major cardiovascular event – ​​“probably won’t happen for another 20 or 30 years. »

So if scientists haven’t done it proven Although statins work and are safe for young people, U.S. health agencies will not recommend these drugs and doctors will not prescribe them. And if there’s nothing to prescribe to lower a young person’s cholesterol, then the guidelines suggest there’s no reason to screen for it.

But some cardiologists think that’s incorrect.

Lowering cholesterol early could delay or prevent heart disease

Partly because of American diets, many young adults already have high or close to high cholesterol levels in their 20s and 30s. The Centers for Disease Control and Prevention estimates that 7.5% of Americans ages 20 to 39 have high total cholesterol levels (above 240 mg/dL). Moran’s research suggests that up to 27 percent of young adults have high levels of “bad” LDL cholesterol (the type responsible for plaques and heart attacks), but do not yet have heart disease. And about 40 percent of Americans, regardless of age, don’t know their cholesterol levels, according to a recent study published in JAMA Cardiology.

Cholesterol accumulates in the blood throughout life, starting in childhood. So the sooner you can act, the better. High cholesterol can certainly be managed and treated later in life, but it “wouldn’t have the (same) impact if they started in their 30s.” It’s easier to lower cholesterol the younger you are,” Dr. Muhammad Siyab Panhwar, an interventional cardiologist at Sanford Health, told Yahoo Life.

If a person’s cholesterol level is screened between the ages of 20 and 30, there is a good chance that changes in their lifestyle – such as eating healthier, more exercise, drinking less alcohol and stopping drinking. smoking – are enough to control its rate. According to the Mayo Clinic, limiting saturated fats found in red meat and dairy products can reduce bad cholesterol levels by up to 10%.

These changes are still the first choice in managing cholesterol in young adults, says Panhwar. But “if you have done everything (non-medicated) products and you still have high cholesterol, you need to consider taking medication,” he says. “There is no other option. There is no supplement that some health and wellness gurus on the internet will sell you that will reduce it.

There are legitimate concerns about the side effects of statins, Moran says. Taking them long term can increase the risk of developing type 2 diabetes. But for millions of Americans with high cholesterol, “research on this topic shows the benefits of preventing heart attacks and stroke outweigh the risk of diabetes,” says Moran.

But the first and most important step is screening. Although it’s not recommended by guidelines, Moran and Panhwar advise young adults to ask their doctor to check their cholesterol levels, especially if they have a family history of high cholesterol or heart problems. “If I have a 30-year-old in my clinic with high cholesterol, I don’t wait 10 years until they reach 40 and then use a calculator to calculate a nice little score for them “, says Panhwar. “It’s stupid. They need treatment now, not after 10 years of uncontrolled high cholesterol.