Curbing LDL Cholesterol Early Pays Off

March 22, 2006 -- Limiting LDL 'bad' cholesterol from a young age might pay off in less heart disease later on, new research shows.

The finding is based on people with a rare genetic mutation that results in low LDL cholesterol levels. But the results could also be important for people without that mutation, note researcher Jonathan Cohen, PhD, and colleagues.

Cohen's team report that those mutations moderately cut LDL cholesterol and were linked to substantially less risk of heart disease. The study "strongly suggests" benefits from lowering LDL cholesterol at an early age, states an editorial.

The study and editorial appear in The New England Journal of Medicine. Cohen works at the University of Texas Southwestern Medical Center at Dallas.

Gene Mutation Lowered LDL

Cohen and colleagues studied 9,524 whites and 3,363 blacks. All were adults who weren't taking cholesterol-lowering statin drugs and had no history of heart disease.

Participants were 45-64 years old when the study started in 1987. They were followed for 15 years and lived in four communities: Jackson, Miss.; Minneapolis; Forsyth County, N.C.; and Washington County, Md.

Nearly 3% of blacks and whites had mutations of the PCSK9 gene. Those mutations were linked to a 28% drop in average LDL cholesterol for blacks and a 15% drop in LDL cholesterol for whites.

Hearty Perks

Blacks and whites tended to have different PCSK9 gene mutations. All resulted in lower LDL levels and a drop in heart disease risk.

Blacks with the gene mutations were 88% less likely to develop heart disease than their peers without the mutations. Whites with the mutations were nearly half as likely to develop heart disease as those lacking the mutations.

Participants weren't necessarily in tip-top shape. Smokers, overweight people, and those with diabetes or high blood pressure were included in the study. No one was asked to upgrade their diets or lifestyles.

The PCSK9 gene might make a good target for new cholesterol drugs, the researchers note. They add that cholesterol-lowering statin drugs might counter the mutations' effects, but Cohen's team didn't test that theory in this study.

Other genes are also important in handling LDL levels, the researchers note in a news release.

Lifelong Effort

What about people without those gene mutations? The take-home message for them may be to curb LDL starting early in life, states a journal editorial.

"The new findings suggest the need to redouble our efforts to reduce LDL cholesterol levels in younger persons by promoting healthy diets and reducing obesity," writes editorialist Allan Tall, MB, BS.

"Even small successes will probably be leveraged for later gains in lowering the risk of cardiovascular disease," he adds.

Tall, who didn't work on Cohen's study, directs the Specialized Center of Research in Molecular Medicine and Atherosclerosis at New York's Columbia University Medical Center.