Nonoptimal lipids commonly present in young adults and coronary calcium later in Life: The CARDIA study
A less than optimal serum lipid profile measured during young adulthood is associated with suboptimal lipid levels during middle age as well as the presence of coronary calcification...
Title: Nonoptimal lipids commonly present in young adults and coronary calcium later in life
Authors: M Pletcher, K Bibbins-Domingo, K Liu, S Sidney, et al.
Reference: Ann Intern Med 2010; 153(3):137-146
http://www.annals.org/content/153/3/137.abstract
Reviewer: Robert Goldberg, PhD, Contributing editor, ProCor; Professor of Medicine and Epidemiology, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
Reviewer comments: Elevated serum lipids are a cornerstone feature of coronary heart disease (CHD), especially in persons with early onset or premature CHD. The vast majority of prospective epidemiologic investigations over the past four to five decades have shown that increasing levels of various serum lipids, most notably total and LDL-cholesterol levels, are associated with an increased risk for CHD in middle-aged and older men and women. What remains unclear, however, is whether serum lipid levels measured during the teenage and early adult years are associated with early atherosclerotic changes during the middle-adult years, despite having a low absolute risk of CHD during this period of life.
The results of the present study suggest that a less than optimal serum lipid profile measured during young adulthood is associated with suboptimal lipid levels during middle age as well as the presence of coronary calcification. While some investigators might question whether the presence of coronary calcification in the middle-aged years may be related to the development of CHD later in life, it remains prudent for individuals with less than optimal serum lipids to modify their subsequent risk of CHD.
The present data, obtained from the carefully conducted CARDIA study, demonstrate the early adverse cardiovascular effects associated with less than optimal serum levels of LDL and HDL-cholesterol in young men and women, findings which are consistent with the results of earlier epidemiologic studies in pediatric populations. It is also well known that abnormal lipid levels in young adults are associated with other important coronary risk factors, including diabetes and obesity, and further emphasize the need for preventive measures against CHD at a young age. These tried and proven methods include attention to dietary fat and total caloric intake, maintenance of optimal weight, and engagement in regular exercise throughout all stages of life. As has been repeatedly demonstrated in a variety of prospective epidemiologic studies over the past several decades, CHD is a multi-factorial disease whose roots begin at an early age. It is never too early to engage in heart healthy lifestyle and eating practices to both prevent, and/or at a minimum delay to the latter years of life, the development of CHD.
Purpose of study: To examine whether less than optimal levels of various serum lipids in young adults are associated with an indicator of coronary atherosclerosis later in life, namely coronary calcium.
Location of study: San Francisco, United States
Study design: Prospective cohort
Results: Data for this investigation were derived from the CARDIA (Coronary Artery Risk Development in Young Adults) study. This is a longitudinal investigation of more than 5000 black and white women and men aged 18-30 years who were recruited from four US cities for purposes of examining determinants of CHD in relatively young persons. For purposes of the present study, coronary risk factor data and information about coronary artery calcium and serum lipids were assessed in a standardized manner using well-established techniques. The study population was categorized into those with normal, borderline, and abnormal serum lipid levels during young adulthood based on serum LDL, HDL, and triglyceride findings. Coronary artery calcium was assessed using cardiac computed tomography and a total coronary calcium score was calculated for study participants.
The average age of the more than 3200 study subjects at the time of the coronary calcium scan was 45 years, nearly one half of the participants were black, and slightly more than one half were women. Coronary calcium was present in 17% of study participants. A total of 434 participants (13%) maintained normal or optimal average levels of the serum lipid parameters examined throughout young adulthood and the remainder (n=2824; 87%) had borderline, or less than optimal, serum lipid levels during their young adult years.
A variety of demographic and lifestyle characteristics were associated with abnormal lipid levels and lipid levels during young adulthood were highly correlated with serum lipid levels at the time of the coronary artery scan.
The prevalence rates of coronary calcium were strongly associated with serum lipids prior to age 35 years; approximately 44% of persons with elevated LDL cholesterol levels (greater than 160 mg/dl) during young adulthood had coronary calcium detected as compared with only 8% of those with more optimal levels (less than 70 mg/dl). Similar trends were observed with regards to HDL cholesterol levels (in an inverse manner) and with serum triglyceride levels.
The odds of having coronary calcium present were also higher in persons who did not have what were considered to be clinically abnormal levels of LDL cholesterol as modest increases in LDL cholesterol values were associated with an increased prevalence of coronary calcium. These associations were also noted in persons with lower HDL cholesterol levels but not in those with elevated serum triglycerides. The crude and multivariable adjusted risks of coronary calcium in persons with average exposure to various serum lipids before age 35 years increased most notably in those with elevated LDL cholesterol levels compared to those with low LDL cholesterol levels (less than70 mg/dl). For example, the multivariable adjusted risks of having coronary calcium present were 3.3 and 5.6, respectively, for persons with an LDL cholesterol between 130-159 mg/dl and greater than 160 mg/dl compared to those with a desirable LDL cholesterol level of 70 mg or lower.
Title: Nonoptimal lipids commonly present in young adults and coronary calcium later in life
Authors: M Pletcher, K Bibbins-Domingo, K Liu, S Sidney, et al.
Reference: Ann Intern Med 2010; 153(3):137-146
http://www.annals.org/content/153/3/137.abstract
Reviewer: Robert Goldberg, PhD, Contributing editor, ProCor; Professor of Medicine and Epidemiology, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
Reviewer comments: Elevated serum lipids are a cornerstone feature of coronary heart disease (CHD), especially in persons with early onset or premature CHD. The vast majority of prospective epidemiologic investigations over the past four to five decades have shown that increasing levels of various serum lipids, most notably total and LDL-cholesterol levels, are associated with an increased risk for CHD in middle-aged and older men and women. What remains unclear, however, is whether serum lipid levels measured during the teenage and early adult years are associated with early atherosclerotic changes during the middle-adult years, despite having a low absolute risk of CHD during this period of life.
The results of the present study suggest that a less than optimal serum lipid profile measured during young adulthood is associated with suboptimal lipid levels during middle age as well as the presence of coronary calcification. While some investigators might question whether the presence of coronary calcification in the middle-aged years may be related to the development of CHD later in life, it remains prudent for individuals with less than optimal serum lipids to modify their subsequent risk of CHD.
The present data, obtained from the carefully conducted CARDIA study, demonstrate the early adverse cardiovascular effects associated with less than optimal serum levels of LDL and HDL-cholesterol in young men and women, findings which are consistent with the results of earlier epidemiologic studies in pediatric populations. It is also well known that abnormal lipid levels in young adults are associated with other important coronary risk factors, including diabetes and obesity, and further emphasize the need for preventive measures against CHD at a young age. These tried and proven methods include attention to dietary fat and total caloric intake, maintenance of optimal weight, and engagement in regular exercise throughout all stages of life. As has been repeatedly demonstrated in a variety of prospective epidemiologic studies over the past several decades, CHD is a multi-factorial disease whose roots begin at an early age. It is never too early to engage in heart healthy lifestyle and eating practices to both prevent, and/or at a minimum delay to the latter years of life, the development of CHD.
Purpose of study: To examine whether less than optimal levels of various serum lipids in young adults are associated with an indicator of coronary atherosclerosis later in life, namely coronary calcium.
Location of study: San Francisco, United States
Study design: Prospective cohort
Results: Data for this investigation were derived from the CARDIA (Coronary Artery Risk Development in Young Adults) study. This is a longitudinal investigation of more than 5000 black and white women and men aged 18-30 years who were recruited from four US cities for purposes of examining determinants of CHD in relatively young persons. For purposes of the present study, coronary risk factor data and information about coronary artery calcium and serum lipids were assessed in a standardized manner using well-established techniques. The study population was categorized into those with normal, borderline, and abnormal serum lipid levels during young adulthood based on serum LDL, HDL, and triglyceride findings. Coronary artery calcium was assessed using cardiac computed tomography and a total coronary calcium score was calculated for study participants.
The average age of the more than 3200 study subjects at the time of the coronary calcium scan was 45 years, nearly one half of the participants were black, and slightly more than one half were women. Coronary calcium was present in 17% of study participants. A total of 434 participants (13%) maintained normal or optimal average levels of the serum lipid parameters examined throughout young adulthood and the remainder (n=2824; 87%) had borderline, or less than optimal, serum lipid levels during their young adult years.
A variety of demographic and lifestyle characteristics were associated with abnormal lipid levels and lipid levels during young adulthood were highly correlated with serum lipid levels at the time of the coronary artery scan.
The prevalence rates of coronary calcium were strongly associated with serum lipids prior to age 35 years; approximately 44% of persons with elevated LDL cholesterol levels (greater than 160 mg/dl) during young adulthood had coronary calcium detected as compared with only 8% of those with more optimal levels (less than 70 mg/dl). Similar trends were observed with regards to HDL cholesterol levels (in an inverse manner) and with serum triglyceride levels.
The odds of having coronary calcium present were also higher in persons who did not have what were considered to be clinically abnormal levels of LDL cholesterol as modest increases in LDL cholesterol values were associated with an increased prevalence of coronary calcium. These associations were also noted in persons with lower HDL cholesterol levels but not in those with elevated serum triglycerides. The crude and multivariable adjusted risks of coronary calcium in persons with average exposure to various serum lipids before age 35 years increased most notably in those with elevated LDL cholesterol levels compared to those with low LDL cholesterol levels (less than70 mg/dl). For example, the multivariable adjusted risks of having coronary calcium present were 3.3 and 5.6, respectively, for persons with an LDL cholesterol between 130-159 mg/dl and greater than 160 mg/dl compared to those with a desirable LDL cholesterol level of 70 mg or lower.
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