For a proportion of people, achieving the required cholesterol reduction will not be achieved with statins alone. In addition, some people cannot take statins at adequate doses or at all, due to contra-indications or adverse effects.

Further therapies will therefore be required, as an add on to statins, or as an alternative where statins are unsuitable or not tolerated. A simplified version of the secondary prevention lipid modification pathway has been developed to support implementation.

Early identification and intensification for patients who are not achieving adequate cholesterol control will significantly reduce cardiovascular events. In order to deliver the best possible outcomes for people with or at risk of CVD it is important that, alongside lipid lowering, we identify and address other risk factors.

Behavioural change is essential where there are lifestyle factors such as smoking, increased body weight, poor diet, lack of physical activity and excess alcohol consumption.

The importance of this element of holistic care has been increasingly recognised in primary care and community settings. In introducing any of these therapies, including lipid lowering, it is important to support the patient in a shared decision regarding their treatment options. Improving cholesterol management presents a huge opportunity to save lives, prevent disability and reduce health inequalities.

Dr Shahed Ahmad is an NHS England Medical Director in the South East Region where he is the Responsible Officer for over GPs. Shahed was educated at Corpus Christi College, Cambridge and University College and Middlesex School of Medicine. Shahed did his MSc in Public Health at the London School of Hygiene and Tropical Medicine and his leadership training at the London Business School.

Before working for NHS England and NHS Improvement, Shahed was a Director of Public Health and led on cardiovascular risk reduction in a number of boroughs.

Since joining NHS England, Shahed developed the NHS programme for GPs in South Central a number of whom are now clinical directors of primary care networks and developed the Hampshire Thames Valley Leadership Forum.

Helen Williams has worked as a CVD specialist pharmacist for the past 25 years in hospital, community and primary care settings. She has spearheaded a wide range of activities across South London and beyond to improve the care of patients with or at risk of cardiovascular disease CVD.

For the past three years she has provided clinical advice to inform the delivery of local and national AF health innovation network programmes to optimise the detection and management of AF with the aim of reducing AF-related stroke.

She developed the pharmacist-led virtual clinic model to optimise uptake of anticoagulation in AF in Lambeth and Southwark CCGs, which is now being spreads nationally through the NHSE AF demonstrator programme.

Helen has supported the commissioning and delivery of CVD new models of care to address the CVD ABCs, — AF, blood pressure and cholesterol. In , the mean LDL-C level among US young adults was An estimated The age-adjusted prevalence of the 3 studied LDL-C levels decreased between and and and Figure 2.

In each period, Younger age, male sex, lack of insurance, and lack of routine place to go for health care were associated with a lower likelihood of cholesterol screening. Younger age and lack of insurance or routine place for health care were also associated with lower awareness of high cholesterol.

These findings may help guide prevention efforts. Limitations include that LDL-C level was measured during a single visit, which may result in misclassification. We were unable to assess the prevalence of statin use owing to the small number of young adults taking this medication.

Published Online: August 24, Corresponding Author: Yiyi Zhang, PhD, Columbia University Medical Center, Division of General Medicine, W. Author Contributions : Dr Zhang had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Acquisition, analysis, or interpretation of data: Zhang, An, Reynolds, Muntner. Critical revision of the manuscript for important intellectual content: An, Reynolds, Safford, Muntner, Moran.

Conflict of Interest Disclosures: Dr An reported receiving grants from AstraZeneca, Novartis, and Merck outside the submitted work. Dr Reynolds reported receiving grants from Amgen Inc, Novartis, and Merck outside the submitted work. Dr Safford reported receiving grants from Amgen Inc outside the submitted work and being the founder of the Patient-Activated Learning System, an independent company focusing on providing patient-centered health information.

Dr Muntner reported receiving grants from Amgen Inc and personal fees from Amgen Inc outside the submitted work. Dr Moran reported receiving grants from National Heart, Lung, and Blood Institute R01HL and R01HL during the conduct of the study.

No other disclosures were reported. full text icon Full Text. Download PDF Comment. Top of Article Methods Results Discussion Article Information References. Figure 1. Distribution of Low-Density Lipoprotein Cholesterol LDL-C Among US Young Adults From to View Large Download.

Figure 2. Age-Adjusted Prevalence of Elevated Low-Density Lipoprotein Cholesterol LDL-C Level, Cholesterol Screening, and Awareness of High Cholesterol Among Young Adults From to Zhang Y, Vittinghoff E, Pletcher MJ, et al.

Associations of blood pressure and cholesterol levels during young adulthood with later cardiovascular events. doi: US Centers for Disease Control and Prevention.

National Health and Nutrition Examination Survey. Accessed March 28, Martin SS, Blaha MJ, Elshazly MB, et al. Comparison of a novel method vs the Friedewald equation for estimating low-density lipoprotein cholesterol levels from the standard lipid profile.

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