NEW ORLEANS (Nov. 6, 2025) —Fewer than half of young adults with severely high low-density lipoprotein (LDL-C), or "bad" cholesterol, levels start taking a statin within five years of first high LDL-C measurement, according to a study published in JACC, the flagship journal of the American College of Cardiology, and presented at the American Heart Association's 2025 Scientific Sessions. The 2018 ACC/AHA Cholesterol Guideline recommends a statin in patients with LDL-C over 190 mg/dL and these findings highlight significant care gaps in lipid management among adults aged 18 to 39, particularly those at high risk for premature atherosclerotic cardiovascular disease (ASCVD).
People with elevated LDL-C are more likely to have a heart attack or stroke. More than half of U.S. young adults have elevated LDL-C levels (above 100 mg/dL), yet they are significantly less likely than older adults to be aware of their cholesterol levels or receive recommended treatment. This study is one of the largest to date examining real-world patterns of LDL-C testing and statin initiation in this age group.
"Within our integrated system in Southern California, we observed that some high -risk young adults were not consistently following up with the LDL-C testing or statin therapy recommended by guidelines." said Teresa N. Harrison, SM, a researcher at Kaiser Permanente Southern California Department of Research & Evaluation and lead author of the study. "Our findings underscore that early adulthood is a critical window for prevention, and identifying these areas of opportunities for earlier intervention is essential to reducing young adults' lifelong heart risk."
Researchers analyzed data from 771,681 members of Kaiser Permanente Southern California aged 18–39 years who had their first elevated LDL-C measurement between 2008 and 2020. Participants were stratified by LDL-C levels and groups at high-risk of ASCVD, and researchers tracked follow-up LDL-C testing and statin initiation over one, two, and five years.
Key findings include:
- Among those with LDL-C ≥190 mg/dL, only 28.4% initiated a statin within one year, and only 45.7% by five years.
- Among those with LDL-C 160–189 mg/dL and high 30-year ASCVD risk, 25.3% initiated a statin within one year, rising to 46.4% within five years.
- Follow-up LDL-C testing within one year declined from 52.5% in 2008 to 35.4% in 2018 among high-risk individuals.
- Statin initiation within one year also declined from 31.7% to 20.1% for those with LDL-C 160–189 mg/dL and high risk, and from 36.5% to 12.6% for those with LDL-C ≥190 mg/dL.
"The good news is that health care systems have a potential roadmap to develop next-generation care models," Harrison said. "The promising results from our safety net program, SureNet, suggest that integrating patient outreach and clinician decision support may be an effective strategy to further advance proactive, early cardiovascular prevention."
Harlan M. Krumholz, MD, SM, Editor-in-Chief of JACC, said the findings highlight how often opportunities for prevention are being missed, and for many young adults, elevated LDL cholesterol marks the start of a decades-long exposure to cardiovascular risk.
"By identifying and addressing these gaps early, we can change the trajectory of heart disease across the lifespan," Krumholz said.
This study was conducted within a large, insured health system population in Southern California, which may limit how broadly the findings apply to uninsured populations or those in different care settings. The researchers did not assess whether patients consistently took their prescribed statins, which could influence long-term cardiovascular outcomes. Additionally, the study did not capture patient or clinician perspectives on why statins weren't started or follow-up testing wasn't complete —factors that may play a key role in real-world treatment decisions.
