The association of pediatric low- and high-density lipoprotein cholesterol dyslipidemia classifications and change in dyslipidemia status with carotid intima-media thickness in adulthood evidence from the cardiovascular risk in Young Finns study, the Bogalusa Heart study, and the CDAH (Childhood Determinants of Adult Health) study.
OBJECTIVE
This study was designed to determine which of the National Cholesterol Education Program or National Health and Nutrition Examination Survey low- and high-density lipoprotein cholesterol classifications of dyslipidemia status in adolescents is most effective at predicting high common carotid artery intima-media thickness (IMT) in adulthood.


BACKGROUND
Two classifications of pediatric dyslipidemia status have been proposed. No study has assessed which of these is most effective for predicting adolescents who will develop preclinical atherosclerosis in adulthood.


METHODS
Three population-based, prospective cohort studies collected lipoprotein measurements on 1,711 adolescents age 12 to 18 years who were remeasured as young adults age 29 to 39 years. Lipoproteins in adolescence were classified according to National Cholesterol Education Program and National Health and Nutrition Examination Survey cut points, and high IMT in adulthood was defined as those at or above the age-, sex-, race-, and cohort-specific 90th percentile of IMT.


RESULTS
Independent of the classification employed, adolescents with dyslipidemia were at significantly increased risk of having high IMT in adulthood (relative risks from 1.6 to 2.5). Differences in predictive capacity between both classifications were minimal. Overweight or obese adolescents with dyslipidemia had increased carotid IMT (males: 0.11 mm; females: 0.08 mm) in adulthood compared with those who did not have both risk factors. Adolescent dyslipidemia status was more strongly associated with high IMT in adulthood than change in dyslipidemia status.


CONCLUSIONS
Pediatric dyslipidemia classifications perform equally in the prediction of adolescents who are at increased risk of high IMT in young adulthood. Our data suggest that dyslipidemia screening could be limited to overweight or obese adolescents.
Magnussen
Costan G
CG
Menzies Research Institute, University of Tasmania, Hobart, Australia. cmagnuss@utas.edu.au
Venn
Alison
A
Thomson
Russell
R
Juonala
Markus
M
Srinivasan
Sathanur R
SR
Viikari
Jorma S A
JS
Berenson
Gerald S
GS
Dwyer
Terence
T
Raitakari
Olli T
OT
D000293:Adolescent; D000328:Adult; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D002339:Carotid Arteries / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D002648:Child; D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D015331:Cohort Studies; D050171:Dyslipidemias / Q000097:blood / Q000145:classification / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009749:Nutrition Surveys; D050177:Overweight / Q000097:blood / Q000150:complications; D015995:Prevalence; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014280:Triglycerides / Q000097:blood; D017539:Tunica Intima / Q000033:anatomy & histology; D017540:Tunica Media / Q000033:anatomy & histology; D014463:Ultrasonography
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D014280:Triglycerides