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

Abstract

Objectives: 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.

Figure 1. Relative Risks for High IMT (≥90^th percentile) in Adulthood According to NCEP and NHANES for: A) LDL-cholesterol dyslipidemia status, B) HDL-cholesterol dyslipidemia status in normal weight adolescents, and C) HDL-cholesterol dyslipidemia status in overweight/obese adolescents

Relative risks and 95% confidence intervals adjusted for age, sex, cohort, and length of follow-up. LDL = low-density lipoprotein; HDL = high-density lipoprotein; NCEP = National Cholesterol Education Program; NHANES = National Health and Nutrition Examination Survey.

Figure 1. Relative Risks for High IMT (≥90^th percentile) in Adulthood According to NCEP and NHANES for: A) LDL-cholesterol dyslipidemia status, B) HDL-cholesterol dyslipidemia status in normal weight adolescents, and C) HDL-cholesterol dyslipidemia status in overweight/obese adolescents

Relative risks and 95% confidence intervals adjusted for age, sex, cohort, and length of follow-up. LDL = low-density lipoprotein; HDL = high-density lipoprotein; NCEP = National Cholesterol Education Program; NHANES = National Health and Nutrition Examination Survey.

Figure 1. Relative Risks for High IMT (≥90^th percentile) in Adulthood According to NCEP and NHANES for: A) LDL-cholesterol dyslipidemia status, B) HDL-cholesterol dyslipidemia status in normal weight adolescents, and C) HDL-cholesterol dyslipidemia status in overweight/obese adolescents

Relative risks and 95% confidence intervals adjusted for age, sex, cohort, and length of follow-up. LDL = low-density lipoprotein; HDL = high-density lipoprotein; NCEP = National Cholesterol Education Program; NHANES = National Health and Nutrition Examination Survey.

Figure 2. Regression Coefficients for Associations of Adolescent LDL-C, Change in LDL-C Between Adolescence and Adulthood, Adolescent HDL-C, and Change in HDL-C with Carotid IMT in Adulthood for Normal Weight (A) and Overweight or Obese (B) Adolescents

Regression coefficients and their 95% confidence intervals are adjusted for age at baseline, sex, cohort, length of follow-up, systolic blood pressure at baseline, and smoking status at baseline. Regression coefficients expressed in millimeters for a one standard deviation change in the continuous variables. Adolescent LDL-C, HDL-C, and change in LDL-C and HDL-C variables were included in the same multivariable model. LDL-C = low-density lipoprotein cholesterol; HDL-C = high-density lipoprotein cholesterol.

Figure 2. Regression Coefficients for Associations of Adolescent LDL-C, Change in LDL-C Between Adolescence and Adulthood, Adolescent HDL-C, and Change in HDL-C with Carotid IMT in Adulthood for Normal Weight (A) and Overweight or Obese (B) Adolescents

Regression coefficients and their 95% confidence intervals are adjusted for age at baseline, sex, cohort, length of follow-up, systolic blood pressure at baseline, and smoking status at baseline. Regression coefficients expressed in millimeters for a one standard deviation change in the continuous variables. Adolescent LDL-C, HDL-C, and change in LDL-C and HDL-C variables were included in the same multivariable model. LDL-C = low-density lipoprotein cholesterol; HDL-C = high-density lipoprotein cholesterol.

Figure 3. Least Square Means of Carotid IMT at age 35 years for Males and Females by BMI Status and Dyslipidemia Status at age 15 years

Adjusted for length of follow-up, cohort, change in LDL-C, change in HDL-C, baseline smoking status, and baseline systolic blood pressure. LDL-C = low-density lipoprotein cholesterol; HDL-C = high-density lipoprotein cholesterol; IMT = intima-media thickness.