AHA sheds light on CVD risks among American Indian and Alaska Native adolescents

14 Mar 2024 --- Dyslipidemia, characterized by abnormal levels of cholesterol or fats in the blood, has long been recognized as a significant risk factor for cardiovascular disease (CVD) in older adults. However, a new study from the American Heart Association (AHA) examines the link between dyslipidemia and CVD risk in a cohort of American Indian and Alaska Native adolescents and young adults participating in the AHA’s Strong Heart Family Study (SHFS).

The AHA points out that data on the prevalence and impact of dyslipidemia among this high-risk cohort of adolescents and young adults has been limited.

The SHFS is a multicenter, family-based, prospective cohort study aimed at investigating CVD in American Indian and Alaska Native populations across 12 communities in central Arizona, southwestern Oklahoma and the Dakotas. Led by researchers from the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital, the study evaluated data from SHFS participants aged 15 to 39 years at the baseline examination conducted between 2001 and 2003.

“This is the first study of total cholesterol levels in American Indian adolescents and young adults, and we were surprised by the levels of high cholesterol, especially in adolescents,” says the study’s principal investigator Dr. Ying Zhang. “The high cholesterol in this population will likely lead to subtle damage in blood vessels and to premature heart disease.”

“There is a need for care including early screening and treatment for high cholesterol levels.”

A too-high prevalence
Published in the Journal of the American Heart Association, the study reports dyslipidemia prevalence rates of 55.2%, 73.6% and 78.0% among participants aged 15-19, 20-29 and 30-39 years, respectively. These rates far exceed those observed in the general US population, highlighting the disproportionate burden of dyslipidemia in this population.

Of particular concern was the identification of elevated low-density lipoprotein cholesterol (LDL-C) levels — a known risk factor for CVD — in a substantial proportion of young participants. Approximately 2.8% of participants had LDL-C levels greater than or equal to 160 mg/dL. Most experts and health organizations set LDL-C levels at 100 mg/dL, with 160 mg/dL or above considered high.

The levels found greatly exceed the recommended threshold for lifestyle or medical interventions in young adults aged 20 to 39 years. Alarmingly, few participants with dyslipidemia, including those with primary hypercholesterolemia, received medical treatments during the study period, underscoring the need for improved screening and management strategies.

Over the course of follow-up, the researchers observed significant associations between dyslipidemia and both subclinical and clinical CVD outcomes. Participants with elevated total cholesterol, LDL-C, or non-high-density lipoprotein cholesterol (non-HDL-C) levels were more likely to develop incident plaque and experience plaque progression, indicating early pathogenic changes associated with atherosclerosis.

Dire associations
The researchers spotlight that, importantly, elevated LDL-C levels were independently associated with incident clinical CVD events, highlighting the heightened risk of cardiovascular morbidity and mortality in this young population.

The study findings also underscore the importance of early screening and intervention strategies to address dyslipidemia and mitigate CVD risk among American Indian and Alaska Native adolescents and young adults.The AHA outlines the alarming rate of dyslipidemia and CVD in young American Indians and Alaskan Natives.

Given the substantial burden of cardiometabolic disorders in this population, including diabetes and obesity, targeted approaches aimed at promoting awareness of dyslipidemia, lifestyle modification and guideline-directed medical therapy are urgently needed.

The AHA has published guidelines in the form of its Life’s Essential 8 checklist for lifelong health. The list of eight best lifelong healthy practices includes eating better, being more active, quitting tobacco, getting good sleep, managing weight, controlling cholesterol, managing blood sugar and managing blood pressure.

Next steps
The AHA states that, moving forward, further research is warranted to explore the effectiveness of intervention strategies tailored to the unique needs of this population. By fostering collaboration between researchers, healthcare providers and tribal communities, the AHA aims to improve dyslipidemia screening and management to help reduce the burden of CVD and improve cardiovascular outcomes among American Indian and Alaska Native adolescents and young adults.

“It is our hope that our study’s results attract attention within the healthcare community,” Zhang concludes. “It would be beneficial for American Indian youth and young adults to get recommendations from their physicians about regularly checking cholesterol levels and following the AHA’s Life’s Essential 8 to help improve their cardiovascular health and prevent heart disease and stroke.”

On the heels of the study, the Biden administration announced a plan to improve the quality of life in tribal communities. The proposed initiatives will enhance community infrastructure, focusing on expanding high-speed internet access and upgrading water systems.

Edited by William Bradford Nichols