There is controversy in preventive medicine regarding the appropriate age for cholesterol testing. Should it be confined to those at increased cardiovascular risk (e.g. those with obesity, diabetes or a family history of heart disease), or be applied universally in order to identify everyone at increased risk from high cholesterol?
Cholesterol testing is important because high cholesterol increases the risk of future heart attack and stroke. Treatment of high cholesterol can significantly reduce this risk by over 30 per cent within 5 years
Current US guidelines recommend cholesterol testing at age 9-11 years in those with risk factors and universally for those between 20 and 25 years. These recommendations are, however, based on the high prevalence of obesity in children and young adults in the US.
Testing for genetic disorders
One of the most important reasons for universal cholesterol screening of young adults in Australia is to detect people with genetic cholesterol disorders. The most common of these is familial hypercholesterolaemia (FH), which occurs in about 1 in 300 of the population and is more common than type 1 diabetes.
FH exposes the vascular system to high levels of LDL cholesterol which gets deposited early in coronary arteries, resulting in accelerated atherosclerosis, premature heart disease and early death (often before age 50) – if untreated.
Lowering LDL levels in FH (usually with statins) can regress coronary atherosclerosis and reduce the incidence of heart attack and early death in a cost-effective manner
Evidence shows FH is under-diagnosed and under-treated, and this leaves a significant gap in preventive medicine — a gap which is no longer acceptable in a modern society.
The cost of universal screening will save the community money by identifying and treating people early.
Diagnosis of FH is possible at any age, by measuring cholesterol in a blood test that does not require overnight fasting. At age 20-25 years, young adults are legally independent and ready to take responsibility for their own health issues. At that age, damage to the coronary arteries is still reversible, and treatment can give a normal life expectancy.
Universal cholesterol screening at this age can also detect those with high cholesterol from other causes, such as polygenic hypercholesterolaemia, which also increases cardiovascular risk, although to a lesser degree than FH.
The usual method to detect genetic cholesterol disorders — screening of close relatives of an affected person — only picks up 50 per cent of affected relatives. While this is a valid and widely-practised method, early adult universal screening offers a higher rate of diagnosis and treatment.
Screening is a safety precaution
Most of us, when we get into our cars, are unlikely to have an accident. That does not, however, prevent us from having to fasten our seat belts. Wearing them is a preventative tool — a safety precaution.
Universal cholesterol testing is much the same. Not everyone will have high cholesterol, but universal testing will help to identify those Australians in whom cholesterol deposits are putting their arteries on a collision course for heart disease and heart attack.
University students at or nearing the 20-25 year old age group would do well to consider spearheading an Australian campaign for universal early adult cholesterol testing.