According to a study published in JACC, the flagship journal of the American College of Cardiology, and presented at the 2025 American Heart Association Scientific Sessions. The 2018 ACC/AHA cholesterol guidelines recommend statin use in patients with LDL-C levels greater than 190 mg/dL and these findings highlight important care gaps in lipid management in adults aged 18 to 39 years, particularly those at high risk for premature atherosclerotic cardiovascular disease (ASCVD).
People with high LDL-C levels are more likely to have a heart attack or stroke. More than half of young American adults have high LDL-C levels (above 100 mg/dL), but they are significantly less likely than older adults to be aware of their cholesterol levels or to receive recommended treatment. This study is one of the largest to date examining real-world patterns of LDL-C testing and statin initiation in this age group.
“Within our integrated system in Southern California, we observed that some high-risk young adults were not consistently following guideline-recommended LDL-C testing or statin treatment. said Teresa N. Harrison, SM, researcher in the Department of Research and Evaluation at Kaiser Permanente Southern California and lead author of the study. “Our findings highlight that early adulthood is a critical window for prevention, and that identifying these areas of opportunity for earlier intervention is critical to reducing the lifetime cardiac risk of young adults.” »
Researchers analyzed data from 771,681 Kaiser Permanente Southern California members ages 18 to 39 who had their first elevated LDL-C measurement between 2008 and 2020. Participants were stratified by LDL-C levels and high-risk ASCVD groups, and researchers tracked follow-up LDL-C testing and statin initiation over one, two, and five years.
Key findings include:
- Among those with LDL-C ≥190 mg/dL, only 28.4% started taking a statin within one year, and only 45.7% after five years.
- Among people with an LDL-C level between 160 and 189 mg/dL and a high risk of ASCVD at age 30, 25.3% started taking a statin within one year, increasing to 46.4% within five years.
- Follow-up LDL-C testing within 1 year decreased from 52.5% in 2008 to 35.4% in 2018 among high-risk individuals.
- Statin initiation within 1 year also decreased, from 31.7% to 20.1% for those with LDL-C 160 to 189 mg/dL and high risk, and from 36.5% to 12.6% for those with LDL-C ≥ 190 mg/dL.
“The good news is that health systems have a potential roadmap to develop next-generation models of care,” Harrison said. “The promising results from our safety net program, SureNet, suggest that integrating patient education and clinician decision support may be an effective strategy to further advance proactive and early cardiovascular prevention.
Harlan M. Krumholz, MD, SM, Editor-in-Chief of JACCsaid the findings highlight how often prevention opportunities are missed and that, for many young adults, high LDL cholesterol marks the start of a decades-long exposure to cardiovascular risk.
“By identifying and addressing these gaps early, we can change the trajectory of heart disease across the lifespan,” Krumholz said.
This study was conducted among a large population insured by the Southern California health system, which may limit the broad application of the results to uninsured populations or those in different care settings. The researchers did not assess whether patients consistently took their prescribed statins, which could influence long-term cardiovascular outcomes. Additionally, the study did not take into account patient or clinician perspectives on why statins were not started or follow-up tests were not completed – factors that can play a key role in real-world treatment decisions.
Results will be presented at AHA.25 on Monday, November 10 at 1 p.m. CT/2 p.m. ET. For an embargoed copy of the study “Lipid Test Monitoring and Statin Initiation Among Young Adults in a U.S. Health System,” contact JACC Media Relations Manager Olivia Walther at (email protected).
