Journal article
Impact of Lipid Measurements in Youth in Addition to Conventional Clinic-Based Risk Factors on Predicting Preclinical Atherosclerosis in Adulthood International Childhood Cardiovascular Cohort Consortium
Circulation (New York, N.Y.), Vol.137(12), pp.1246-1255
03/20/2018
DOI: 10.1161/CIRCULATIONAHA.117.029726
PMCID: PMC5860965
PMID: 29170152
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.
Details
- Title: Subtitle
- Impact of Lipid Measurements in Youth in Addition to Conventional Clinic-Based Risk Factors on Predicting Preclinical Atherosclerosis in Adulthood International Childhood Cardiovascular Cohort Consortium
- Creators
- Juha Koskinen - University of TurkuMarkus Juonala - University of TurkuTerence Dwyer - The George Institute for Global HealthAlison Venn - University of TasmaniaRussell Thomson - Western Sydney UniversityLydia Bazzano - Tulane UniversityGerald S. Berenson - Tulane UniversityMatthew A. Sabin - Royal Children's HospitalTrudy L. Burns - University of IowaJorma S. A. Viikari - University of TurkuJessica G. Woo - University of CincinnatiElaine M. Urbina - Cincinnati Children's Hospital Medical CenterRonald Prineas - Wake Forest UniversityNina Hutri-Kahonen - University of TampereAlan Sinaiko - University of MinnesotaDavid Jacobs - University of MinnesotaJulia Steinberger - University of MinnesotaStephen Daniels - Children's Hospital ColoradoOlli T. Raitakari - Turku University HospitalCostan G. Magnussen - University of Turku
- Resource Type
- Journal article
- Publication Details
- Circulation (New York, N.Y.), Vol.137(12), pp.1246-1255
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1161/CIRCULATIONAHA.117.029726
- PMID
- 29170152
- PMCID
- PMC5860965
- ISSN
- 0009-7322
- eISSN
- 1524-4539
- Number of pages
- 10
- Grant note
- Social Insurance Institution of Finland; Kuopio, Tampere 126925; 121584; 124282; 129378; 117787; 41071 / Academy of Finland Finnish Foundation of Cardiovascular Research R01HL121230 / NATIONAL HEART, LUNG, AND BLOOD INSTITUTE; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Heart Lung & Blood Institute (NHLBI) Paavo Nurmi Foundation Yrjo Jahnsson Foundation Finnish Cultural Foundation; Finnish IT center for science Turku University Hospital Medical funds R01 HL121230 / National Institutes of Health/National Heart, Lung and Blood Institute; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Heart Lung & Blood Institute (NHLBI) Juho Vainio Foundation R01AG041200 / NATIONAL INSTITUTE ON AGING; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute on Aging (NIA) APP1098369 / Australian National Health and Medical Research Council; National Health and Medical Research Council (NHMRC) of Australia Sigrid Juselius Foundation 100849 / National Heart Foundation of Australia Future Leader Fellowship; National Heart Foundation of Australia
- Language
- English
- Date published
- 03/20/2018
- Academic Unit
- Epidemiology; Fraternal Order of Eagles Diabetes Research Center
- Record Identifier
- 9984364409502771
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