byAmerican College of Cardiology

Credit: Unsplash/CC0 Public Domain

Fewer than half of young adults with severely high low-density lipoprotein (LDL-C), or "bad" cholesterol, levels start taking a statin within five years of first high LDL-C measurement, according to astudypublished inJournal of the American College of Cardiology (JACC),and presented at theAmerican Heart Association's 2025 Scientific Sessions. The2018 ACC/AHA Cholesterol Guidelinerecommends a statin in patients with LDL-C over 190 mg/dL and these findings highlight significant care gaps in lipid management among adults aged 18 to 39, particularly those at high risk for premature atherosclerotic cardiovascular disease (ASCVD).

People with elevated LDL-C are more likely to have aheart attackor stroke. More than half of U.S.young adultshave elevated LDL-C levels (above 100 mg/dL), yet they are significantly less likely thanolder adultsto be aware of their cholesterol levels or receive recommended treatment. This study is one of the largest to date examining real-world patterns of LDL-C testing andstatininitiation in this age group.

"Within our integrated system in Southern California, we observed that some high-risk young adults were not consistently following up with the LDL-C testing or statin therapy recommended by guidelines." said Teresa N. Harrison, SM, a researcher at Kaiser Permanente Southern California Department of Research & Evaluation and lead author of the study.

"Our findings underscore that early adulthood is a critical window for prevention, and identifying these areas of opportunities for earlier intervention is essential to reducing young adults' lifelong heart risk."

Researchers analyzed data from 771,681 members of Kaiser Permanente Southern California aged 18–39 years who had their first elevated LDL-C measurement between 2008 and 2020. Participants were stratified by LDL-C levels and groups at high-risk of ASCVD, and researchers tracked follow-up LDL-C testing and statin initiation over one, two, and five years.

Key findings include:

"The good news is that health care systems have a potential roadmap to develop next-generation care models," Harrison said. "The promising results from our safety net program, SureNet, suggest that integrating patient outreach and clinician decision support may be an effective strategy to further advance proactive, early cardiovascular prevention."

Harlan M. Krumholz, MD, SM, Editor-in-Chief ofJACC, said the findings highlight how often opportunities for prevention are being missed, and for many young adults, elevated LDL cholesterol marks the start of a decades-long exposure to cardiovascular risk.

"By identifying and addressing these gaps early, we can change the trajectory of heart disease across the lifespan," Krumholz said.

This study was conducted within a large, insured health system population in Southern California, which may limit how broadly the findings apply to uninsured populations or those in different care settings. The researchers did not assess whether patients consistently took their prescribed statins, which could influence long-term cardiovascular outcomes. Additionally, the study did not capture patient or clinician perspectives on why statins weren't started or follow-up testing wasn't complete —factors that may play a key role in real-world treatment decisions.

More information: Follow-up Lipid Testing and Statin Initiation among Young Adults in a US Healthcare System, Journal of the American College of Cardiology (2025). DOI: 10.1016/j.jacc.2025.10.052 Journal information: Journal of the American College of Cardiology

Provided by American College of Cardiology