High cholesterol at a young age increases cardiovascular risk

The president of the Spanish Atherosclerosis Society (SEA), Dr. José López Miranda, warns that the cumulative exposure to elevated levels of LDL cholesterol (‘bad’ cholesterol) from an early age of life it is associated with a increased risk of developing atherosclerotic cardiovascular disease in later stages. In these terms it has been referred to on the occasion of the International Day of Familial Hypercholesterolemia (FH), a hereditary genetic disorder that causes very high LDL cholesterol levels from birthwhich significantly increases the risk of premature cardiovascular disease.

The recent update of the European Lipid Guidelines 2025 insists on the importance of early treatment. As Miranda, president of the SEA, explains, the guides “emphasize that arteriosclerosis is a chronic and progressive diseasewhich begins early in life and progresses slowly, and that cumulative exposure to high levels of LDL cholesterol from early in life is associated with an increased risk of developing atherosclerotic cardiovascular disease in later stages.

It is important to detect the disease as early as possible, especially in children.

The lower the LDL cholesterol is keptthe sooner you get off, and for as long as possible, far better. These three axes are key, as the Guides reaffirm, for prevent a heart attack and other cardiovascular complications. In this sense, Dr. Daiana Ibarretxe, a specialist at the Sant Joan University Hospital in Reus and the Rovira i Virgili University (Barcelona), explains that “The lipid load and the accumulated time are essential to understand that not all cases of hypercholesterolemia are the same”. “A child born with FH, with a LDL cholesterol of 200 mg/dLwhen I’m 40 years old it will take 40 accumulated years of high cholesterolforks very different from a person whose cholesterol begins to increase in middle age. Therefore, the early detection in childhood guarantees timely treatment and greater cardiovascular prevention,” he says.

Despite alert systems have been increased for its detection“with the data we have, we see that FH continues to be underdiagnosed and undertreated. We must continue working not only on the alert, diagnosis and referral criteria, but also on the continuous training of specialistsincorporating area references. Because The feeling is that too many times these patients arrive late to uswhen they have already suffered a cardiovascular event,” says Ibarretxe.

A lipoprotein may further increase risk

Another aspect that the new 2025 Guides address is the determination of lipoprotein(a) at least once in your life. “It reinforces the message that LP(A) acts as an important modifier of cardiovascular risk and can considerably increase it if its presence in the blood is high.“explains Dr. Javier Delgado Lista, internist at the Reina Sofía University Hospital in Córdoba and co-responsible investigator at the IMIBIC Biomedical Research Institute.

“In the case of people with HF or cardiovascular disease already established, determination of the lp(a) is essential“, he assures. So, LDL cholesterol control is placed at the center of cardiovascular prevention and, to this end, the Guides and SEA specialists maintain that “Therapeutic combinations are usually more effective than a single drug at maximum dosesbecause they add synergistic effects that must be intensified”, in the words of Ibarretxe.