More than half of American Indian teens and young adults have high cholesterol

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The majority of American Indian teens and young adults have high cholesterol, according to a new study that researchers say is the first to examine cholesterol levels in this specific population.

The study, published this week in the Journal of the American Heart Association, also found few of those with high cholesterol – a well-established risk factor for heart disease and stroke – were being treated for it.

The study's lead researcher, Dr. Ying Zhang, said the findings, especially among adolescents, were surprising.

"The high cholesterol in this population will likely lead to subtle damage in blood vessels and to premature heart disease," Zhang said in a news release. She is an associate professor of biostatistics and director of the Center for American Indian Health Research at the University of Oklahoma Health Sciences Center in Oklahoma City. "There is a need for care, including early screening and treatment, for high cholesterol levels."

Researchers analyzed data for 1,440 teens and adults enrolled in the Strong Heart Family Study, which looked at risk factors for heart disease and stroke among tribal communities in central Arizona, southwest Oklahoma and North and South Dakota. Participants were 15 to 39 years old during their first exam between 2001 and 2003.

Among American Indians 15 to 19 years old, 55% had high cholesterol. About 74% in their 20s had it, as did 78% of those in their 30s. By comparison, prior studies have shown about 25% of adolescents overall in the U.S. and about 30% of young adults have high cholesterol.

Plaque in the neck arteries, which can result from high cholesterol, was measured using ultrasound at the beginning of the study and after a median 5.5 years of follow-up. Nearly 10% of study participants showed signs of plaque development in their arteries, and 11% had more plaque than at the start of the study.

Over a median 18.5 years of follow-up through 2020, 9% of participants experienced or died from a heart attack, stroke, heart failure or other cardiovascular event.

Although they met the threshold for taking cholesterol-lowering medications, none of the participants under 20 years old were doing so at the start of the study or after up to eight years of follow-up. Across age groups, less than 2% of participants were taking such medications at the start of the study and only 8% at follow-up.

Heart disease rates among American Indians and Alaska Natives are about 50% higher than their white peers, according to a 2020 American Heart Association scientific statement. American Indian and Alaska Native adults also develop cardiovascular diseases at younger ages.

"It is our hope that our study's results attract attention within the health care community," Zhang said. "It would be beneficial for American Indian youth and young adults to get recommendations from their physicians about regularly checking cholesterol levels."