If you’re over the age of 50, it’s likely your doctor will order blood tests for your routine checkup.
If your cholesterol is dangerously high, it’s also likely your doctor will prescribe a statin.
However, if you’re under the age of 40, there’s a pretty good chance you won’t have blood work done.
And, if your cholesterol is dangerously high, there’s less than a 50-50 chance you will be given a statin.
That’s the conclusion reached in a published today in the journal JAMA Cardiology.
Researchers said they were surprised by how few young adults are prescribed statins after a lipid analysis showed their low-density lipoprotein (LDL) cholesterol was higher than 190 mg/dL, a condition known as dyslipidemia.
Researchers told Healthline this is particularly concerning because the cause of these elevated LDL levels in most younger people is probably genetic as opposed to lifestyle factors.
The genetic factors increase the need to prescribe statins.
In their study, the researchers noted dyslipidemia can go undetected in younger adults for many years, leading to serious heart and other cardiovascular diseases.
Percentages by age
For their study, the researchers looked at inpatient and outpatient records at 360 medical centers in all 50 states from July 2013 to July 2016.
The patients were between 20 and 75 years of age.
Of the 2.8 million people with a qualifying lipid analysis, about 4 percent had an elevated LDL level of 190 or above.
Overall, the statin prescription rate for patients with severe dyslipidemia, but without diabetes or established atherosclerotic cardiovascular disease (ASCVD), was 66 percent.
That percentage, however, decreased as patients got younger.
About 61 percent of these patients in their 50s with elevated LDL levels were prescribed statins.
For patients in their 40s, it was 47 percent, while for patients in their 30s it was 32 percent.
These numbers don’t include people who have dyslipidemia but haven’t been diagnosed, so the percentage of patients needing statins who get them is probably even lower.
Researchers said it’s not only important to diagnose and treat these patients, but since the problem is likely genetic it’s also important to have blood work done on close relatives.
“We often find more instances within the family,” Dr. David Zidar, Ph.D., of the cardiology division at University Hospitals Cleveland Medical Center, and a study co-author, told Healthline.
Why no prescriptions
It might seem that once an LDL level of 190 or above is detected, it would be standard operating procedure to prescribe a statin.
With younger people, that’s not always the case … for a variety of reasons.
Zidar said younger adults often will have blood work done after a checkup and then not check back with their doctor. Many are busy with careers or raising children.
“The follow-up with younger people might be less than complete,” said Zidar.
He added that doctors will sometimes advise younger adults with high LDL to adjust their diets and exercise routines rather than prescribe a statin.
“There might be some opportunities lost here,” Zidar said.
Dr. Andrew Freeman, director of cardiovascular prevention and wellness for National Jewish Health, said there is also the problem of younger adults not being screened for cholesterol levels.
Freeman told Healthline there is sometimes a cost factor involved.
A lot of younger people may be on health plans with high deductibles or copayments, so routine blood tests for those who are active and healthy might seem unnecessary.
In addition, doctors may not order blood work for younger, healthier patients.
“By and large, it’s part of what I do,” said Freeman, a cardiologist in Colorado, who is also chair of the nutrition and lifestyle program for the American College of Cardiology. “But it’s not something that is always thought of.”
He added that statins have received some “bad press” over the past few years and that might deter both physicians and younger patients from choosing them.
What can be done
Freeman said this latest study points out the need for more consistent cholesterol diagnosis for patients under the age of 40.
He said awareness of the dangers of high cholesterol is important, especially since many younger adults feel they are invincible and sometimes avoid preventative care.
Zidar added standard practices can be changed, such as having blood work ordered before a patient visits the doctor.
He said University Hospitals is putting together discussion groups with family members to “drill down” and find out what discourages people from having their cholesterol levels checked.
“Our tack is to know what we don’t know,” Zidar said.
Dr. Sadeer Al-Kindi, a resident physician in internal medicine at University Hospitals, and a co-author of the study, said raising awareness is a key to reducing cases of dyslipidemia.
He told Healthline that medical facilities also need to make use of electronic medical records to keep track of patients and their families.
Freeman said the overall emphasis for the medical profession is to treat these high LDL cases before they reach the life-threatening stage.
“The bottom line is,” he said, “people with LDL levels above 190 are at an extremely high risk.”