Cardiovascular guidelines advise statin therapy for adults aged 20 to 75 years with low-density lipoprotein cholesterol (LDL-C) levels of 190 mg/dL or greater, with a goal of lowering LDL-C by at least 50%.¹ Early-life accumulation of cholesterol exposure increases future cardiovascular risk independent of midlife² and total cumulative cholesterol exposure,^3,4 highlighting the importance of LDL-C management in young adults. However, contemporary real-world management of hypercholesterolemia in young adults is not well described.

Using clinical registry data from 7 Mass General Brigham hospitals and affiliated practices, we isolated 2 cohorts of patients with cholesterol testing on 2 or more occasions who were 20 to 39 years old at the time of a qualifying LDL-C value between 2005 and 2018: cohort 1 included individuals with an LDL-C value of 190 mg/dL or greater, and cohort 2 included those with an LDL-C value between 160 and less than 190 mg/dL. All follow-up LDL-C values were extracted through December 31, 2019. Prescriptions for lipid-lowering therapy (LLT), including statins, ezetimibe, and proprotein convertase subtilisin/kexin type 9 inhibitors, were additionally extracted. Primary end points were a 50% reduction in LDL-C for cohort 1 and a 30% reduction in cohort 2. The Massachusetts General Hospital institutional review board approved these analyses as non–human subjects research with waived informed consent.

Among 17 591 individuals meeting inclusion criteria, 5438 (30.9%) had severe hypercholesterolemia (cohort 1; 37.9% female; mean age, 32.6 [SD, 5.1] years at qualifying LDL-C measurement), and 12 513 (71.1%) had moderate hypercholesterolemia (cohort 2; 39.8% female; mean age, 32.7 [SD, 5.1] years). In cohort 1, over a median follow-up of 7.8 (IQR, 4.5-11.4) years, 1638 individuals (30.1%) achieved at least a 50% LDL-C reduction (27.2% of women vs 31.9% of men; P < .001) (Figure). Younger individuals were less likely to achieve a 50% LDL-C reduction (eg, age 20-24 years, 24.9%; age 35-39 years, 33.0%; P < .001 for trend) (Table). Mean LDL-C at last follow-up was 152.9 (SD, 51.2) mg/dL, and 1271 patients (23.4%) had a last LDL-C value of 190 mg/dL or greater. Overall, LLT was prescribed for 48.5% of individuals, including 77.5% who achieved at least 50% LDL-C reduction vs 36.0% who did not (P < .001); LLT was less frequently prescribed for women vs men (43.7% vs 51.5%; P < .001).

心血管指南建议对低密度脂蛋白胆固醇 (LDL-C) 水平为 190 mg/dL 或更高的 20 至 75 岁成年人进行他汀类药物治疗，目标是将 LDL-C 降低至少 50%。¹生命早期积累的胆固醇暴露会增加未来的心血管风险，而与中年²和总的累积胆固醇暴露无关，^{3 ,4}突出了年轻人 LDL-C 管理的重要性。然而，当代年轻人高胆固醇血症的现实世界管理没有得到很好的描述。

使用来自 7 家 Mass General Brigham 医院和附属诊所的临床登记数据，我们分离出 2 组在 2005 年至 2018 年间进行了 2 次或更多次胆固醇检测的患者，这些患者在符合条件的 LDL-C 值时年龄在 20 至 39 岁之间：第 1 组包括 LDL-C 值为 190 mg/dL 或更高的个体，第 2 组包括 LDL-C 值为 160 至低于 190 mg/dL 的个体。提取了截至 2019 年 12 月 31 日的所有随访 LDL-C 值。还提取了降脂疗法 (LLT) 的处方，包括他汀类药物、依折麦布和前蛋白转化酶枯草杆菌蛋白酶/克欣 9 型抑制剂。主要终点是队列 1 的 LDL-C 降低 50%，队列 2 降低 30%。

在符合纳入标准的 17591 人中，5438 人 (30.9%) 患有严重的高胆固醇血症（队列 1；37.9% 为女性；符合条件的 LDL-C 测量时的平均年龄为 32.6 [SD，5.1] 岁），12513 人 (71.1%) 患有中度高胆固醇血症（队列 2；39.8% 女性；平均年龄，32.7 [SD, 5.1] 岁）。在队列 1 中，经过 7.8（IQR，4.5-11.4）年的中位随访，1638 人（30.1%）实现了至少 50% 的 LDL-C 降低（27.2% 的女性对 31.9% 的男性；P  < .001）（图）。较年轻的个体不太可能实现 50% 的 LDL-C 降低（例如，年龄 20-24 岁，24.9%；年龄 35-39 岁，33.0%；P < .001 趋势）（表）。最后一次随访时的平均 LDL-C 为 152.9（SD，51.2）mg/dL，1271 名患者（23.4%）的最后一次 LDL-C 值为 190 mg/dL 或更高。总体而言，为 48.5% 的个体开了 LLT，其中 77.5% 的 LDL-C 至少降低了 50%，而 36.0% 的人没有（P  < .001）；LLT 对女性的处方频率低于男性（43.7% 对 51.5%；P  < .001）。