Impact of Lipid Measurements in Youth in Addition to Conventional Clinic-Based Risk Factors on Predicting Preclinical Atherosclerosis in Adulthood
Year: 2017
Type: article
Abstract: Background: Data suggest that the prediction of adult cardiovascular disease using a model comprised entirely of adult nonlaboratory-based risk factors is equivalent to an approach that additionally incorporates adult lipid measures. We assessed and compared the utility of a risk model based solely on nonlaboratory risk factors in adolescence versus a lipid model based on nonlaboratory risk factors plus lipids for predicting high-risk carotid intima-media thickness (cIMT) in adulthood. Methods: The study comprised 2893 participants 12 to 18 years of age from 4 longitudinal cohort studies from the United States (Bogalusa Heart Study and the Insulin Study), Australia (Childhood Determinants of Adult Health Study), and Finland (The Cardiovascular Risk in Young Finns Study) and followed into adulthood when cIMT was measured (mean follow-up, 23.4 years). Overweight status was defined according to the Cole classification. Hypertension was defined according to the Fourth Report on High Blood Pressure in Children and Adolescents from the National High Blood Pressure Education Program. High-risk plasma lipid levels were defined according to the National Cholesterol Education Program Expert Panel on Cholesterol Levels in Children. High cIMT was defined as a study-specific value ≥90th percentile. Age and sex were included in each model. Results: In univariate models, all risk factors except for borderline high and high triglycerides in adolescence were associated with high cIMT in adulthood. In multivariable models (relative risk [95% confidence interval]), male sex (2.7 [2.0–2.6]), prehypertension (1.4 [1.0–1.9]), hypertension (1.9 [1.3–2.9]), overweight (2.0 [1.4–2.9]), obesity (3.7 [2.0–7.0]), borderline high low-density lipoprotein cholesterol (1.6 [1.2–2.2]), high low-density lipoprotein cholesterol (1.6 [1.1–2.1]), and borderline low high-density lipoprotein cholesterol (1.4 [1.0–1.8]) remained significant predictors of high cIMT ( P <0.05). The addition of lipids into the nonlaboratory risk model slightly but significantly improved discrimination in predicting high cIMT compared with nonlaboratory-based risk factors only (C statistics for laboratory-based model 0.717 [95% confidence interval, 0.685–0.748] and for nonlaboratory 0.698 [95% confidence interval, 0.667–0.731]; P =0.02). Conclusions: Nonlaboratory-based risk factors and lipids measured in adolescence independently predicted preclinical atherosclerosis in young adulthood. The addition of lipid measurements to traditional clinic-based risk factor assessment provided a statistically significant but clinically modest improvement on adolescent prediction of high cIMT in adulthood.
Source: Circulation
Authors: Juha Koskinen, Markus Juonala, Terence Dwyer, Alison Venn, Russell Thomson, Lydia Bazzano, Gerald S. Berenson, Matthew A. Sabin, Trudy L. Burns, Jorma S.A. Viikari, Jessica G. Woo, Elaine M. Urbina, Ronald Prineas, Nina Hutri-Kähönen, Alan Sinaiko, David Jacobs, Julia Steinberger, Stephen Daniels, Olli T. Raitakari, Costan G. Magnussen
Institutions: University of Turku, University of Tasmania, University of Oxford, Menzies Institute for Medical Research, Western Sydney University, Tulane University, Royal Children's Hospital, The University of Melbourne, Murdoch Children's Research Institute, University of Iowa, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Wake Forest University Health Sciences, Wake Forest University, Tampere University Hospital, University of Tampere, University of Minnesota, Children's Hospital Colorado, University of Colorado Anschutz, Turku University Hospital
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2768226150