Zhang Y, Pletcher MJ, Vittinghoff E, et al. - According to findings, the lifetime risk for atherosclerotic cardiovascular disease can be reduced if an optimal level of low-density lipoprotein cholesterol (LDL-C) is maintained throughout young adulthood and middle age. Understanding young adult levels of LDL-C could help inform strategies for preventing coronary heart disease.

• This is a cohort study of 18,288 participants in 4 US cohorts; individuals with 2 or more LDL-C measures that were at least 2 years apart between ages 18 and 60 years, with at least 1 of the LDL-C measures occurring during middle age at 40 to 60 years, were included.

• Cumulative LDL-C exposure during young adulthood and middle age was found to be linked with the risk of incident coronary heart disease events, independent of midlife LDL-C concentration.

• Estimated hazard ratios for coronary heart disease were as follows: 1.57 for cumulative LDL-C level, 1.69 for time-weighted average LDL-C level, and 0.88 for LDL-C slope, in multivariable Cox proportional hazards regression models adjusted for the most recent LDL-C level recorded during middle age and for other cardiovascular disease risk factors.

• None of the LDL-C variables was linked with ischemic stroke or heart failure.