Why it's not just older people who may need their blood pressure checked
New research has found that a third of under-35s have high or above-average cholesterol levels, which can lead to high blood pressure and conditions such as heart attack and stroke, writes Thea Jourdan. Is it time to routinely test younger people?
YOUNG people don't need to worry about high cholesterol and high blood pressure – right? Wrong. Startling new data has found that a third of people under 35 have high or above-average cholesterol levels.
Too much of this fatty substance can narrow and block blood vessels, leading to cardiovascular disease and issues such as angina and heart attack.
The study results, from tests conducted in pharmacies on 140,000 people across the UK over a year, also showed 66 per cent of under-35s have high or pre-high blood pressure.
"This is definitely worrying," says Katharine Jenner, chief executive of the charity Blood Pressure UK.
The results are especially concerning as another study, published last month, found that those whose blood pressure increased most during their 30s tended to have smaller brains in their 70s and may be at increased risk of dementia.
The new research, by LloydsPharmacy, was based on standard blood pressure checks using an arm cuff, and cholesterol tests.
For those under the age of 80, blood pressure should be less than 140/90. Cholesterol readings are given as a ratio of ‘good' cholesterol, known as HDL, to the total of ‘bad' cholesterol, known as LDL. A ratio of under four is normally regarded as healthy.
So why do so many young people have high readings?
Professor Kausik Ray, a consultant cardiologist at Imperial College London, says the problem may have been previously overlooked, as NHS guidelines recommend that people have their cholesterol checked between the ages of 40 and 74, not before.
Blood pressure checks are only recommended in the over-40s. Furthermore, he says, these latest figures may be skewed, as they are based on results from people visiting a pharmacy – who may have a health condition anyway.
"That said, it is a large study and the results shouldn't be ignored," he adds. "And what you do in the first half of your life has an impact on health later.
"Each two-point rise in systolic blood pressure [the top number, the pressure in the arteries when the heart pumps blood around the body] is associated with a 7 per cent increased risk of death from heart disease and a 10 per cent increased risk of death from stroke. So being aware of these elevations means you get the chance to change your lifestyle."
IS DIET TO BLAME?
So what is to blame for these results? One theory points the finger at diet. In the new study, only 28 per cent of those tested had a healthy BMI and 70 per cent were classed as overweight or obese. The average participant ate only three portions of fruit and vegetables a day, and one in 20 admitted they ate no vegetables at all.
The takeaway culture among young people, who rely heavily on food delivery services, could also be contributing to the problem.
"These meals come with no nutritional information and may be high in saturated fat and salt," says Dr Laura Corr, a consultant cardiologist at Guy's and St Thomas' Foundation Trust, in London. She adds that eating fresh, non-processed foods including fresh vegetables and fibre can prevent LDL cholesterol being absorbed into the bloodstream.
Meanwhile, high blood pressure may be linked to excess salt, as this increases the sodium in our blood, which can reduce the ability of our kidneys to remove water from our bodies. Too much fluid puts the system under strain and can speed up your heart rate.
Katharine Jenner says even though salt intake is "one of the leading causes of high blood pressure", this has not been prioritised in recent public health messages.
WOMEN AT RISK?
Younger women are protected to some degree from high cholesterol and high blood pressure because of their levels of circulating oestrogen, which can raise good HDL levels.
Most HDL is made in the liver but some comes from dietary sources such as olive oil, whole grains and oily fish. Good HDL removes bad LDL cholesterol from the blood, taking it to the liver where it can be processed.
But the new research suggested women of all ages were more prone to high cholesterol, with 63 per cent having elevated levels, compared with 38 per cent of men.
Prof Ray says no-one is sure why younger women are developing high cholesterol when they still have protective circulating oestrogen. "It could be because smoking is higher in younger women than young men," he adds.
"Smoking can also contribute to stiffening of arteries and in turn affect blood pressure. Meanwhile, contraceptive use increases blood pressure in some women."
BEST TO TEST EARLY?
Currently, you can only request a cholesterol test on the NHS after the age of 40, unless you are obese or have a family history that puts you at risk of having dangerously high levels.
Yet the American Heart Association recommends those aged 20 and over should have their cholesterol (and other heart disease risk factors such as blood pressure) checked every four to six years.
Critics argue that the UK approach means many of the symptoms of high blood pressure and high cholesterol remain hidden until permanent damage has been done. Chris Gale, a cardiologist and a professor of cardiovascular medicine at the University of Leeds, says there are arguments for and against this.
"On the one hand, we might be able to identify and treat cardiovascular risk factors much earlier," he says. "But it also means increased costs to the NHS. Moreover, the NHS Long-Term Plan has committed to expanding genetic testing for familial hypercholesterolaemia [a genetic condition that causes very high cholesterol levels from birth] – through the NHS health check at 40, and cascade testing [testing close family of patients identified as having the condition].'
However, British health secretary Matt Hancock recently announced he may scrap the one-size-fits-all health check in favour of more targeted checks.
Some believe cholesterol testing should start in childhood. Prof David Wald, an interventional cardiologist at the Wolfson Institute of Preventive Medicine, advocates testing year-old youngsters to make sure the one person in 250 with familial hypercholesterolaemia is identified and treated as early as possible.
START ON STATINS?
While lifestyle changes can help lower cholesterol, some experts believe young people with high cholesterol and other risk factors such as a sedentary lifestyle should be offered cholesterol-lowering statins too.
Prof Ray says statins are usually only given to younger people who have familial hypercholesterolaemia and whose LDL is greater than 4.9mml/l.
"A level of four in a young person is a challenge, as their short-term risk is very low but 40 years of levels of 4 does increase the risk of heart disease," he says.
At the moment, under-30s with elevated cholesterol are given lifestyle advice and may be offered imaging of their coronary artery build-up, but only in rare cases are they offered statins.
However, people may not want to take statins as they can cause side-effects such as headaches, difficulty sleeping and dizziness.
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