High cholesterol is known to be one of the primary risk factors for heart disease, since it can contribute to plaque buildup in the arteries. But even though the U.S. Centers for Disease Control and Prevention recommends regular cholesterol testing starting around age 20, many Americans don’t give cholesterol—or heart disease, for that matter—much thought until later in life.

A new modeling study published in the Lancet gives extra reason not to put off cholesterol screening and treatment. It confirms that high blood levels of “bad” (or non-HDL) cholesterol are associated with a greater risk of developing cardiovascular issues including stroke and heart disease.

The researchers collected data from 38 studies conducted in North America, Europe and Australia, comprising about 400,000 people without cardiovascular disease, a third of whom were younger than 45. At the start of each study, participants’ cholesterol levels were measured, and they answered questions about their medical histories, lifestyle and demographics. During a follow-up period of up to 43 years, almost 55,000 of the study participants developed heart disease or stroke.

The researchers used that information both to find connections between baseline cholesterol levels and later heart issues, and to create a model for predicting a person’s risk of heart problems based on their sex, age and common risk factors, including smoking status, blood pressure, body mass index, diabetes diagnosis and medication regimens.

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