title: Transitions in Metabolic Risk and Long-Term Cardiovascular Health: Coronary Artery Risk Development in Young Adults (CARDIA) Study.
abstract: Despite evidence suggesting that early metabolic dysfunction impacts cardiovascular disease risk, current guidelines focus on risk assessments later in life, missing early transitions in metabolic risk that may represent opportunities for averting the development of cardiovascular disease.
  
  
  
  In 4420 young adults in the Coronary Artery Risk Development in Young Adults (CARDIA) study, we defined a "metabolic" risk score based on components of the Third Report of the Adult Treatment Panel's definition of metabolic syndrome. Using latent class trajectory analysis adjusted for sex, race, and time-dependent body mass index, we identified 6 distinct metabolic trajectories over time, specified by initial and final risk: low-stable, low-worsening, high-stable, intermediate-worsening, intermediate-stable, and high-worsening. Overall, individuals gained weight over time in CARDIA with statistically but not clinically different body mass index trend over time. Dysglycemia and dyslipidemia over time were highest in initially high or worsening trajectory groups. Divergence in metabolic trajectories occurred in early adulthood (before age 40), with 2 of 3 individuals experiencing an increase in metabolic risk over time. Membership in a higher-risk trajectory (defined as initially high or worsening over time) was associated with greater prevalence and extent of coronary artery calcification, left ventricular mass, and decreased left ventricular strain at year 25. Importantly, despite similar rise in body mass index across trajectories over 25 years, coronary artery calcification and left ventricular structure and function more closely tracked risk factor trajectories.
  
  
  
  Transitions in metabolic risk occur early in life. Obesity-related metabolic dysfunction is related to subclinical cardiovascular phenotypes independent of evolution in body mass index, including coronary artery calcification and myocardial hypertrophy and dysfunction.
authors.affiliation: Cardiovascular Medicine Division, Department of Medicine, University of Michigan, Ann Arbor, MI Nuclear Medicine Division, Department of Radiology, University of Michigan, Ann Arbor, MI rvshah@partners.org vlmurthy@med.umich.edu.
authors.forename: Venkatesh L
authors.initials: VL
authors.lastname: Murthy
authors.affiliation: Providence VA Medical Center and Cardiovascular Institute, Alpert Medical School of Brown University, Providence, RI.
authors.forename: Siddique A
authors.initials: SA
authors.lastname: Abbasi
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Juned
authors.initials: J
authors.lastname: Siddique
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Colangelo
authors.affiliation: Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD.
authors.forename: Jared
authors.initials: J
authors.lastname: Reis
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institute, Johns Hopkins University, Baltimore, MD.
authors.forename: Bharath A
authors.initials: BA
authors.lastname: Venkatesh
authors.affiliation: Vanderbilt University, Nashville, TN.
authors.forename: J Jeffrey
authors.initials: JJ
authors.lastname: Carr
authors.affiliation: Vanderbilt University, Nashville, TN.
authors.forename: James G
authors.initials: JG
authors.lastname: Terry
authors.affiliation: Exercise and Health Sciences Department, College of Nursing and Health Sciences, University of Massachusetts, Boston, MA.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Camhi
authors.affiliation: Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA.
authors.forename: Michael
authors.initials: M
authors.lastname: Jerosch-Herold
authors.affiliation: Preventative Cardiology, Boston Children's Hospital, Boston, MA.
authors.forename: Sarah
authors.initials: S
authors.lastname: de Ferranti
authors.affiliation: Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Saumya
authors.initials: S
authors.lastname: Das
authors.affiliation: Department of Medicine, University of Massachusetts at Worcester, MA.
authors.forename: Jane
authors.initials: J
authors.lastname: Freedman
authors.affiliation: Department of Preventative Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Mercedes R
authors.initials: MR
authors.lastname: Carnethon
authors.affiliation: Division of Preventative Medicine, University of Alabama at Birmingham, AL.
authors.forename: Cora E
authors.initials: CE
authors.lastname: Lewis
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institute, Johns Hopkins University, Baltimore, MD.
authors.forename: Joao A C
authors.initials: JA
authors.lastname: Lima
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, MA rvshah@partners.org vlmurthy@med.umich.edu.
authors.forename: Ravi V
authors.initials: RV
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology; D008076:Cholesterol, HDL / Q000097:blood; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000378:metabolism; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000453:epidemiology*; D009929:Organ Size; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014280:Triglycerides / Q000097:blood; D014481:United States / Q000453:epidemiology; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000453:epidemiology*; D055105:Waist Circumference; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D008076:Cholesterol, HDL; D014280:Triglycerides
keywords: epidemiology; metabolic syndrome; obesity; risk factor