The objective of this study was to predict the benefits associated with controlling elevated LDL-cholesterol (LDL-C) in early adulthood, defined as ages 20-39, compared with commencing control at age 40 or older. Benefit was quantified in terms of reduced coronary heart disease (CHD) events, life year gains, and quality-adjusted life year (QALY) gains.

A microsimulation state-transition model estimated individual-level CHD outcomes for a subset of the US population. A sex-balanced cohort of 40,000 US adults with LDL-C ≥ 160 mg/dL at any time in early adulthood was simulated from ages 20-69. Two treatment scenarios were considered: later life LDL-C control, and early plus later life LCD-C control.

Risk of experiencing a CHD event in the model was dependent on multivariate risk factor exposure and accounted for the competing risks of stroke and non-cardiovascular mortality. Risk of first CHD event after age 40 was conditioned on both time-weighted average LDL-C in early adulthood, and present value LDL-C at age ≥ 40.

Early plus later adulthood treatment prevented approximately 1,900 and 2,800 primary and total CHD events, respectively, compared with later life treatment alone. Controlling LDL-C in both early adulthood and later life would produce approximately 5,419 life years gains and 9,600 QALY gains. More than 400,000 additional patient years of treatment would be required to achieve these benefits. One-way sensitivity analyses found that these results were most sensitive to changes in follow-up time, treatment eligibility criteria, and treatment efficacy.

This study quantifies the benefits associated with treating hypercholesterolaemia identified in young adulthood. It is unclear whether LDL-C control should be achieved by lifestyle or pharmacological interventions. This study does not account for screening and other health care-related costs, treatment-related disutility, and the discounting of future outcomes. To establish cost-effectiveness, further research should consider these important factors.