People in their 30s, an age when good health is easily taken for granted, can face up to a 23% higher risk of heart attack and stroke if pre-stage hypertension, diabetes and dyslipidemia appear at the same time, according to a new study.
Hallym University Dongtan Sacred Heart Hospital said Wednesday that the findings came from a joint research team led by cardiology professors Chun Dae-young and Lee Jin-ah, along with Professor Lee Min-woo of the neurology department at Hallym University Sacred Heart Hospital. The team analyzed people aged 30 to 39 who participated in the 2009 national health screening — drawn from 1.74 million examinees — and who had no prior history of hypertension, diabetes, dyslipidemia, heart attack or stroke.
Dyslipidemia is a condition in which cholesterol or triglyceride levels in the blood fall outside the normal range. It can be confusing because various terms such as hyperlipidemia and hypercholesterolemia are used, but dyslipidemia is a broader concept. While hyperlipidemia refers to a state in which low-density lipoprotein cholesterol (LDL-C), the so-called "bad cholesterol," is higher than normal, dyslipidemia includes not only high LDL-C or triglycerides but also a state in which high-density lipoprotein cholesterol (HDL-C), the so-called "good cholesterol," falls below normal levels.
The team extracted 44,553 people who fell into all three categories — pre-stage hypertension, pre-stage diabetes and borderline dyslipidemia — based on LDL-C, the so-called "bad cholesterol," along with blood pressure and blood glucose levels. It then compared them with 452,763 people whose levels were all within the normal range, taking into account factors such as age and sex. Pre-stage hypertension was defined as systolic blood pressure of 120–139 mmHg or diastolic blood pressure of 70–89 mmHg. Pre-stage diabetes was defined as fasting blood glucose of 100–125 mg/dL, and borderline dyslipidemia as LDL-C of 130–159 mg/dL.
The team tracked the participants for an average of 14.2 years, analyzing the occurrence of heart attack, stroke and cardiovascular death. As a result, the "combined pre-stage group," which had all three pre-stage conditions, showed roughly twice the incidence of cardiovascular and cerebrovascular disease — including heart attack, stroke and cardiovascular death — compared with the normal group. Even after adjusting for various factors such as age, sex, body mass index (BMI), smoking and drinking, the combined pre-stage group's risk of cardiovascular and cerebrovascular disease remained 23% higher.
In detail, the risk of heart attack and stroke rose by 18% and 35%, respectively, driving up the overall risk. By contrast, there was no statistically significant difference in overall mortality and cardiovascular mortality. In subgroup analyses, the increased risk of cardiovascular and cerebrovascular disease in the combined pre-stage group appeared largely consistent regardless of BMI, smoking and drinking status, exercise habits and cholesterol levels.
"Through this study, we confirmed that even at a young age in one's 30s, if blood pressure, blood glucose and cholesterol all rise to pre-stage levels, the long-term risk of heart attack and stroke increases," Professor Lee Jin-ah said. "Because there are no symptoms and the condition has not yet been diagnosed as hypertension, diabetes or dyslipidemia, it is easily left unattended, but this shows that from a long-term perspective it is by no means a safe zone."
"It is important for young people, too, to keep their blood pressure, blood glucose and cholesterol as close to the normal range as possible through weight management, smoking cessation, moderate drinking, dietary control and regular exercise," Professor Lee Min-woo said. "We need to recognize young people who simultaneously have multiple metabolic abnormalities as a high-risk candidate group and apply close follow-up monitoring and tailored lifestyle interventions."
The study was presented as an oral presentation at the 18th Asian-Pacific Society of Atherosclerosis and Vascular Diseases (APSAVD) conference held in Manila, the Philippines, in April this year, and was published in the online edition of the European Journal of Preventive Cardiology, an SCIE-level international journal issued by the European Society of Cardiology (ESC).
