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Adolescents and young adults - markers of risk of future cardiovascular disease (CVD)

Authoring team

Data from cohort studies indicate that risk factor levels in adolescents and young adulthood could be better predictors for cardiovascular disease (CVD)

  • elevated carotid intima-media thickness and coronary artery calcification (CAC)) in mid to later life than subsequent levels later in life (1,2)

Use of non-HDL cholesterol in adolescents for assessing future risk of CVD:

  • non-HDL-cholesterol (non-HDL-c)
    • encompasses a greater number of atherogenic lipids and lipoproteins, may be more closely associated with heart disease risk (3,4)

    • studies among children and adults have demonstrated that non-HDL-c is at least as good as LDL-c for the prediction of subclinical atherosclerosis (5,6)

    • recommendation by the National Heart, Lung, and Blood Institute (NHLBI) to use non-HDL-c for primary screening of dyslipidemia in childhood (7)

    • an analysis of Cardiovascular Risk in Young Finns Study data where a CT coronary artery calcification score (CAC) was undertaken when the cohort (recruited into the trial at 6-12 years) were aged 40-46 years (8)
      • showed that increased non-HDL-c exposure during adolescence, young adulthood, and mid-adulthood was associated with the presence of CAC in mid-adulthood
      • elevated non-HDL-c levels in adolescence were most strongly associated with CAC in mid-adulthood compared to elevated non-HDL-c during young- and mid-adulthood

Reference:

  • Loria CM, Liu K, Lewis CE, et al. Early adult risk factor levels and subsequent cororary artery calcification: the CARDIA study. J Am Coll Cardiol. 2007;49:2013-2020.
  • Raitakari OTet al. Cardiovascular risk factors in childhood and carotid artery initima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. JAMA 2003;290:2277-2283.
  • Arsenault BJ, Rana JS, Stroes ESG, et al. Beyond low-density lipoprotein cholesterol: respective contributions of non-high-density lipoprotein cholesterol levels, triglycerides, and the total cholesterol/high-density lipoprotein cholesterol ratio to coronary heart disease risk in apparently healthy men and women. J Am Coll Cardiol. 2009;55:35-41.
  • Robinson JG. Are you targeting non-high-density lipoprotein cholesterol? J Am Coll Cardiol 2009;55:42-44.
  • Frontini MG, Srinivassan SR, Xu J, et al. Usefulness of childhood non-high density lipoprotein cholesterol levels versus other lipoprotein measures in predicting adult subclinical atherosclerosis: the Bogalusa Heart Study. Pediatrics. 2008;121:924-929.
  • Harari G, Green MS, Magid A, Zelber-Sagi S. Usefulness of non-high-density lipoprotein cholesterol as a predictor of cardiovascular disease mortality in men in 22-year follow-up. Am J Cardiol 2017;119:1193-1198
  • Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents; National Heart, Lung, and Blood Institute: Summary Report. Pediatrics. 2011;128 Suppl 5:S213-256.
  • Armstrong MK, Fraser BJ, Hartiala O, et al. Association of Non-High-Density Lipoprotein Cholesterol Measured in Adolescence, Young Adulthood, and Mid-Adulthood With Coronary Artery Calcification Measured in Mid-Adulthood JAMA Cardiol. 2021 Jan 27;e207238. doi: 10.1001/jamacardio.2020.7238.

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