title: Prevalence and progression of subclinical atherosclerosis in younger adults with low short-term but high lifetime estimated risk for cardiovascular disease: the coronary artery risk development in young adults study and multi-ethnic study of atherosclerosis.
abstract: BACKGROUND
  We hypothesized that individuals with low 10-year but high lifetime cardiovascular disease risk would have a greater burden of subclinical atherosclerosis than those with low 10-year but low lifetime risk.
  
  
  RESULTS
  We included 2988 individuals < or = 50 years of age at examination year 15 from the Coronary Artery Risk Development in Young Adults (CARDIA) study and 1076 individuals < or = 50 of age at study entry from the Multi-Ethnic Study of Atherosclerosis (MESA). The 10-year risk and lifetime risk for cardiovascular disease were estimated for each participant, permitting stratification into 3 groups: low 10-year (<10%)/low lifetime (<39%) risk, low 10-year (<10%)/high lifetime risk (> or = 39%), and high 10-year risk (> or = 10%) or diagnosed diabetes mellitus. Baseline levels and change in levels of subclinical atherosclerosis (coronary artery calcium or carotid intima-media thickness) were compared across risk strata. Among participants with low 10-year risk (91% of all participants) in CARDIA, those with a high lifetime risk compared with low lifetime risk had significantly greater common (0.83 versus 0.80 mm in men; 0.79 versus 0.75 mm in women) and internal (0.85 versus 0.80 mm in men; 0.80 versus 0.76 mm in women) carotid intima-media thickness, higher coronary artery calcium prevalence (16.6% versus 9.8% in men; 7.1% versus 2.3% in women), and significantly greater incidence of coronary artery calcium progression (22.3% versus 15.4% in men; 8.7% versus 5.3% in women). Similar results were observed in MESA.
  
  
  CONCLUSIONS
  Individuals with low 10-year but high lifetime risk have a greater subclinical disease burden and greater incidence of atherosclerotic progression compared with individuals with low 10-year and low lifetime risk, even at younger ages.
authors.affiliation: UT Southwestern Medical Center, Department of Medicine, Dallas, TX 75390-9047, USA. jarett.berry@utsouthwestern.edu
authors.forename: Jarett D
authors.initials: JD
authors.lastname: Berry
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Folsom
authors.forename: Cora E
authors.initials: CE
authors.lastname: Lewis
authors.forename: J Jeffrey
authors.initials: JJ
authors.lastname: Carr
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Polak
authors.forename: Steven
authors.initials: S
authors.lastname: Shea
authors.forename: Stephen
authors.initials: S
authors.lastname: Sidney
authors.forename: Daniel H
authors.initials: DH
authors.lastname: O'Leary
authors.forename: Cheeling
authors.initials: C
authors.lastname: Chan
authors.forename: Donald M
authors.initials: DM
authors.lastname: Lloyd-Jones
mesh_terms: D000328:Adult; D000367:Age Factors; D050197:Atherosclerosis / Q000453:epidemiology / Q000208:ethnology* / Q000473:pathology*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000208:ethnology / Q000473:pathology; D003324:Coronary Artery Disease / Q000208:ethnology* / Q000473:pathology*; D018450:Disease Progression; D005006:Ethnicity / Q000208:ethnology*; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications / Q000208:ethnology / Q000473:pathology; D006973:Hypertension / Q000150:complications / Q000208:ethnology / Q000473:pathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000208:ethnology / Q000473:pathology; D013997:Time Factors