• Krishna K Patel, Glen B Taksler, Bo Hu, and Michael B Rothberg.
• From University of Missouri-Kansas City, Kansas City, Missouri, and Cleveland Clinic, Cleveland, Ohio.
• Ann. Intern. Med. 2017 Jun 20; 166 (12): 876-882.

BackgroundThe 2013 cholesterol management guidelines from the American College of Cardiology and American Heart Association (ACC/AHA) recommend lipid screening in all adults older than 20 years to identify those at increased risk for atherosclerotic cardiovascular disease (ASCVD). Statins may be considered for patients with elevated 10-year risk (>5%) or a low-density lipoprotein cholesterol (LDL-C) level of 4.92 mmol/L (190 mg/dL) or greater.ObjectiveTo describe the prevalence of elevated ASCVD risk among nondiabetic adults younger than 50 years.DesignCross-sectional.SettingNHANES (National Health and Nutrition Examination Survey), 1999 to 2000 through 2011 to 2012.ParticipantsAdults aged 30 to 49 years without known ASCVD or diabetes.Measurements10-year ASCVD risk was estimated by using the 2013 ACC/AHA ASCVD risk calculator. Participants were subdivided by age, sex, and history of smoking and hypertension. The percentages of adults in each subgroup with a 10-year ASCVD risk greater than 5% and of those with an LDL-C level of 4.92 mmol/L (190 mg/dL) or greater were estimated. Low-prevalence subgroups were defined as those in which a greater than 1% prevalence of elevated cardiovascular risk could be ruled out (that is, the upper 95% confidence bound for prevalence was ≤1%).ResultsOverall, 9608 NHANES participants representing 67.9 million adults were included, with approximately half (47.12%, representing 32 million adults) in low-prevalence subgroups. In the absence of smoking or hypertension, 0.09% (95% CI, 0.02% to 0.35%) of adult men younger than 40 years and 0.04% (CI, 0.0% to 0.26%) of adult women younger than 50 years had an elevated risk. Among other subgroups, 0% to 75.9% of participants had an increased risk. Overall, 2.9% (CI, 2.3% to 3.5%) had an LDL-C level of 4.92 mmol/L (190 mg/dL) or greater.LimitationNo information was available regarding cardiovascular outcomes.ConclusionIn the absence of risk factors, the prevalence of increased ASCVD risk is low among women younger than 50 and men younger than 40 years.Primary Funding SourceNone.

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