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

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.