What are the guidelines for managing cholesterol levels in young adults?

From the Guidelines

Young adults should prioritize lifestyle modifications, including a heart-healthy diet and regular physical activity, to manage cholesterol levels, with the goal of maintaining total cholesterol below 200 mg/dL, LDL under 100 mg/dL, HDL above 40 mg/dL for men and 50 mg/dL for women, and triglycerides below 150 mg/dL, as recommended by the most recent guidelines 1.

Key Recommendations

• Lifestyle modifications are the first-line approach for managing cholesterol levels in young adults, including a heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins, while limiting saturated fats, trans fats, and added sugars 1.
• Regular physical activity of at least 150 minutes of moderate exercise weekly helps raise HDL and lower LDL levels 1.
• Weight management is important as excess weight contributes to higher cholesterol, and young adults should aim for a healthy weight through a combination of diet and exercise 1.
• Cholesterol screening should begin at age 20 and continue every 4-6 years for those without risk factors, with more frequent screening for those with a family history of premature cardiovascular disease or other risk factors 1.

Medication Therapy

• If lifestyle changes are insufficient, medications may be prescribed, with statins (like atorvastatin, rosuvastatin) being the most common, which work by blocking liver enzymes needed for cholesterol production 1.
• Young adults with familial hypercholesterolemia or other genetic disorders may require earlier and more aggressive treatment, including LDL-lowering therapy with a goal of decreasing LDL cholesterol levels to the 95th percentile (≥130 mg/dL) 1.

Additional Considerations

• Managing cholesterol early in life is crucial as atherosclerotic changes begin in youth, and maintaining healthy levels reduces the lifetime risk of cardiovascular disease 1.
• Young adults should avoid smoking and limit alcohol consumption, as these habits can increase the risk of cardiovascular disease 1.
• Bile acid sequestrants, such as cholestyramine, may be considered as an alternative to statins in certain cases, although they are not as commonly used in young adults 1.

From the FDA Drug Label

To reduce the risk of: Myocardial infarction (MI), stroke, revascularization procedures, and angina in adults with multiple risk factors for coronary heart disease (CHD) but without clinically evident CHD As an adjunct to diet to reduce low-density lipoprotein (LDL-C) in: Adults with primary hyperlipidemia Adults and pediatric patients aged 10 years and older with heterozygous familial hypercholesterolemia (HeFH). EZETIMIBE Tablets is indicated: • In combination with a statin, or alone when additional low density lipoprotein cholesterol (LDL-C) lowering therapy is not possible, as an adjunct to diet to reduce elevated LDL-C in adults with primary hyperlipidemia, including heterozygous familial hypercholesterolemia (HeFH) • In combination with a statin as an adjunct to diet to reduce elevated LDL-C in pediatric patients 10 years of age and older with HeFH.

The guidelines for managing cholesterol levels in young adults are to use statins or ezetimibe as an adjunct to diet to reduce elevated LDL-C in adults with primary hyperlipidemia, including heterozygous familial hypercholesterolemia (HeFH) 2, 3, 3.

• The recommended starting dosage of atorvastatin is 10 or 20 mg once daily; dosage range is 10 mg to 80 mg once daily for adults.
• The recommended starting dosage of ezetimibe is 10-mg orally once daily, with or without food.
• Pediatric patients aged 10 years and older with HeFH may start with a dosage of 10 mg once daily for atorvastatin and 10-mg orally once daily for ezetimibe. Key considerations for young adults with high cholesterol include:
• Dietary changes to reduce LDL-C
• Monitoring of LDL-C levels
• Adjustment of medication dosage as necessary
• Regular follow-up with a healthcare provider to assess the effectiveness of treatment and potential side effects.

From the Research

Guidelines for Managing Cholesterol Levels in Young Adults

• The management of dyslipidemia in young adults is crucial to prevent the development of atherosclerotic cardiovascular disease (ASCVD) later in life 4.
• Young adults with ASCVD (18-40 years) should receive lipid-lowering drugs to reduce LDL-C to less than 55 mg/dL 4.
• Early screening and detection of dyslipidemia in young adults can enable the implementation of management strategies to decrease future cardiovascular events 4.
• Lifestyle modification is the mainstay of treatment, including dietary recommendations, exercise, tobacco cessation, and weight reduction 4, 5.
• In certain cases, the use of statins in low dose or non-statin drugs may be suggested for young adults with associated risk factors, LDL-C greater than 160 mg, or a high coronary calcium score 4.
• Young adults who are carriers of the FH gene should receive aggressive lifestyle modification and appropriate antilipidemic therapy 4.

Lipid-Lowering Therapies

• Statins are a class of lipid-lowering drugs that inhibit the de-novo synthesis of cholesterol, lowering LDL cholesterol and increasing HDL cholesterol 6, 7, 8.
• Fibrates, ezetimibe, and PCSK9 monoclonal antibodies are also used as lipid-lowering therapies, each with different mechanisms of action and effects on lipid profiles 6, 7, 8.
• The choice of lipid-lowering therapy depends on the individual's risk factors, lipid profile, and other health conditions 6, 7, 8.

Importance of Physical Activity

• Physical activity is a critical component of first-line treatment for elevated blood pressure or cholesterol, with extensive benefits for improving both blood pressure and blood cholesterol 5.
• Increasing physical activity is recommended as a lifestyle behavior treatment option for all patients, including those with mild-moderate-risk blood pressure and cholesterol 5.