High Cholesterol in Your 20s and 30s: Causes, Symptoms and Treatment Options
A cardiologist explains why some young adults develop high cholesterol and discusses treatment options.
High cholesterol is often thought of as a condition that affects people over 40, and for good reason: Low-density (LDL) lipoprotein (or “bad” cholesterol, which can increase the risk of heart attack and stroke) tends to rise with age. But for about 6% of adults, LDL can rise much earlier, in their 20s and 30s.
Earlier this year, the American Heart Association announced new guidelines, saying people as young as 30 — down from age 40 — should consider statins and other measures to manage cholesterol.
“Many young people with high cholesterol believe they should wait to start treatment until they're older,” says Dr. Corey Bradley, a cardiologist at NewYork-Presbyterian/Columbia University Irving Medical Center. “But I'd like them to understand that you’re never too young to take your high cholesterol seriously — the sooner you start treating it, the more benefit you stand to gain over time.”
Health Matters spoke with Dr. Bradley about the causes of high cholesterol in young people, treatment options and lifestyle strategies that can help lower cholesterol numbers.
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What causes high cholesterol in younger people?
Dr. Bradley: Genetics is by far the most common reason that an otherwise healthy young adult would develop high cholesterol. However, high cholesterol in younger patients is also associated with:
- Thyroid disease
- Polyendocrine metabolic ovarian syndrome (PMOS)
- Pregnancy (though that typically returns to baseline about 6 weeks postpartum)
- Hypertensive disorder of pregnancy
- Weight fluctuations, especially in women
- Diabetes
- Certain medications, including oral retinoids and some psychiatric medications
Are there signs or symptoms of high cholesterol?
Dr. Bradley: High cholesterol tends to be asymptotic. This makes it harder to catch in young people, and many people do not grasp the gravity of the disorder since they feel otherwise fine.
In extreme cases, people can develop what we call xanthomas — small bumps of fat, or cholesterol deposits, that appear under the skin. They are common in children who have inherited cholesterol disorders and are often the reason that they are initially diagnosed.
When should people start getting their cholesterol checked?
Dr. Bradley: Beginning at age 19, adults should get their cholesterol tested every five years, based on American Heart Association guidelines. Your doctor may recommend more frequent screening depending on individual risk factors.
For children, we recommend universal screening between the ages of nine and 11, and sometimes as young as two if there’s a family history of cholesterol disorders or early-onset heart disease.
What’s the best treatment for high cholesterol?
Dr. Bradley: Lipid-lowering therapy in the form of statins is the first line of treatment. Statins are prescription medications that lower cholesterol, and the risk of heart attack and stroke, by slowing the production of LDL cholesterol in the body.
Is treatment life-long?
Dr. Bradley: Some patients, particularly younger ones, become anxious at the idea of taking a medication for the rest of their lives. I try to shift the narrative away from "you have to be treated for this condition forever" and focus on the fact that this is an investment in your future — in your healthy self 20, 30, 40 years from now.
When is the best age to start treating high cholesterol?
Dr. Bradley: The age at which your doctor might recommend you start on lipid lowering therapy depends on the degree of high cholesterol that you have. Our recommendation for all adults is to have an LDL cholesterol below 100 milligrams per deciliter; that does not necessarily mean that if your LDL cholesterol is higher than 100 you need medications immediately. However, if you have above 190 milligrams per deciliter, it means you need to be on lipid-lowering therapy, with a target of getting your LDL below 100.
However, if your LDL falls into a middle range, whether to recommend treatment right away depends on the patient’s overall risk profile; it’s based on a much more comprehensive evaluation than just the number alone
3 Lifestyle Changes to Lower Your Cholesterol
- Adjust two factors in your diet. I tell my patients to focus on two things: eating enough fiber (25 grams a day for women, up to 38 grams for men) and swapping saturated fats for healthy fats (such as olive oil, avocado oil, nuts, chia seeds, and oily fish like salmon, trout, mackerel, sardines, and oysters). A Mediterranean-style diet that is rich in fruits, vegetables and whole grains, and low in red meat, processed foods and saturated fat is the general goal.
- Combine cardio and strength training. It’s about finding a mix between activity that gets your heart rate up and resistance and strength training. You don't have to be a marathon runner; just look for ways to incorporate movement and build muscle mass and strength.
Aim for at least seven hours of sleep. While sleep isn't directly related to your cholesterol, it’s certainly related to your heart health. Getting adequate sleep (seven to eight hours for most adults) is going to set you up for success when it comes to preventing heart disease.
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