Atherosclerosis is a major cause of cardiovascular diseases, including heart attack and stroke. Traditionally, risk factors for atherosclerosis, such as high blood pressure, obesity, and high cholesterol, have been associated with adulthood. However, a growing body of research indicates that high cholesterol levels during childhood and adolescence can also significantly influence the development of atherosclerosis in later life. A new study has revealed that high cholesterol during early life may predispose a person to develop harmful atherosclerotic plaques in adulthood, thereby increasing the risk of cardiovascular disease. In this article, we explore how high cholesterol in young age affects long-term cardiovascular health, the importance of early prevention, and strategies to reduce the risk of atherosclerosis.
When LDL cholesterol levels are high, it can build up in the walls of the arteries, promoting the formation of atherosclerotic plaques. These plaques, made up of cholesterol, fats, and other substances, narrow and stiffen arteries, impeding blood flow. Over time, atherosclerosis can lead to serious complications, such as complete blockage of the arteries or the formation of blood clots that can cause heart attacks and strokes. Until recently, most efforts to prevent atherosclerosis and cardiovascular disease focused on adults, as high cholesterol was primarily seen as an aging problem. However, new studies suggest that exposure to high cholesterol levels during childhood and adolescence may accelerate the atherosclerosis process, predisposing individuals to early cardiovascular disease.
A study by a team of researchers from the National Institutes of Health (NIH) followed a group of children and adolescents over several decades, monitoring their cholesterol levels and other cardiovascular risk factors. The results showed that participants with high levels of LDL cholesterol in childhood were significantly more likely to develop atherosclerotic plaques in adulthood, regardless of whether their cholesterol was managed or normalized later in life. This study provides compelling evidence that early onset of arterial damage can have long-term consequences, suggesting that cholesterol buildup in the arteries begins long before symptoms of cardiovascular disease become apparent. Therefore, high cholesterol during adolescence must be recognized as a major risk factor that must be addressed early in life.
One of the most concerning characteristics of atherosclerosis is that it often progresses silently for decades before it manifests with obvious symptoms. During childhood and adolescence, plaques can begin to form in the arteries without causing any noticeable problems. However, these early plaques can continue to slowly grow over the years until the artery becomes severely narrowed or blocked, leading to heart attacks, strokes, or other cardiovascular complications. A study published in The Lancet examined the coronary arteries of young adults who died from causes unrelated to cardiovascular disease. Surprisingly, researchers found early signs of atherosclerosis, with plaques present in more than 50% of the subjects between the ages of 20 and 30. In many cases, these individuals had high cholesterol levels as children.
These findings suggest that atherosclerosis may begin much earlier than previously thought and highlight the importance of monitoring and managing cholesterol levels from childhood. Early prevention and timely intervention could prevent or delay the development of atherosclerotic plaques and significantly reduce the risk of cardiovascular events in adulthood. Although high cholesterol in children can be influenced by a combination of genetic and environmental factors, some individuals are particularly at risk. Among genetic factors, familial hypercholesterolemia is one of the most common conditions associated with extremely high cholesterol levels from birth. This inherited disease, which affects about 1 in 250 people, causes very high levels of LDL cholesterol due to mutations that alter cholesterol metabolism.
Children with familial hypercholesterolemia are particularly at high risk of developing premature atherosclerosis if not treated promptly. Environmental factors, such as a diet high in saturated fat and sugar, a sedentary lifestyle, and obesity, can also contribute to high cholesterol in young people. According to the American Heart Association, childhood obesity is on the rise, and it is closely linked to high cholesterol levels and other cardiovascular risk factors. Identifying and managing high cholesterol levels during childhood and adolescence is crucial to preventing the development of atherosclerosis in adulthood. The most recent guidelines recommend cholesterol screening for all children between the ages of 9 and 11 and again between the ages of 17 and 21, with earlier screening for children with a family history of high cholesterol or cardiovascular disease.
Monitoring and managing cholesterol levels from childhood, along with promoting a healthy lifestyle, could be the key to preventing millions of cases of cardiovascular disease in the future. Some key prevention strategies include:
Promoting a balanced diet: a healthy diet rich in fruits, vegetables, whole grains, and unsaturated fats can help keep cholesterol levels low. It is important to reduce the consumption of foods high in saturated and trans fats, such as fried foods and packaged sweets.
Regular physical activity: regular exercise is essential for maintaining a healthy heart and lowering cholesterol. Experts recommend at least 60 minutes of moderate physical activity a day for children and adolescents.
Weight control: obesity is a significant risk factor for high cholesterol and cardiovascular disease. Maintaining a healthy weight through a balanced diet and exercise can reduce the risk of atherosclerosis.
Drug therapy: in cases of familial hypercholesterolemia or severely elevated cholesterol that cannot be managed through diet and exercise alone, doctors may recommend the use of lipid-lowering drugs, such as statins, even in children. These drugs can significantly reduce LDL cholesterol levels and slow the progression of atherosclerosis.
- Edited by Dr. Gianfrancesco Cormaci, PhD, specialist in Clinical Biochemistry.
Scientific references
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