Ideal cardiovascular health in adolescence: effect of lifestyle intervention and association with vascular intima-media thickness and elasticity (the Special Turku Coronary Risk Factor Intervention Project for Children [STRIP] study)

Abstract

Background: In the Special Turku Coronary Risk Factor Intervention Project for Children (STRIP) study, repeated dietary counseling introduced in infancy and maintained until 20 years of age has led to lower intakes of saturated fat and serum low-density lipoprotein cholesterol. In this study, we examined prospectively the intervention effects on the ideal cardiovascular health concept recently described by the American Heart Association. Additionally, we investigated the association between the concept and vascular intima-media thickness and elasticity in adolescence.

Methods and results: In adolescents participating in the longitudinal, randomized, atherosclerosis-prevention STRIP study, complete data on ideal cardiovascular health metrics were available at 15 (n=394), 17 (n=376), and 19 (n=298) years of age. Aortic intima-media thickness and elasticity were measured with ultrasonography at the same ages. None of the adolescents had all 7 ideal cardiovascular health metrics. At least 5 ideal metrics was found in 60.2%, 45.5%, and 34.2% of the adolescents at 15, 17, and 19 years of age, respectively. Adolescents in the control group had an increased risk of low ideal cardiovascular health (≤3 metrics) compared with the intervention adolescents (risk ratio=1.35; 95% confidence interval=1.04-1.77). The number of ideal cardiovascular health metrics was inversely associated with aortic intima-media thickness (P<0.0001) and directly associated with elasticity (P=0.045). The risk of having high intima-media thickness (>85th percentile) was nearly 2-fold in adolescents with a low number of metrics (≤3) compared with those with a higher score (risk ratio=1.78; 95% confidence interval=1.31-2.43).

Conclusions: Ideal cardiovascular health as determined by the AHA can be promoted in adolescents. The ideal cardiovascular health concept is beneficially associated with vascular health already in adolescence, supporting the relevance of targeting these metrics as part of primordial prevention.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00223600.

Keywords: atherosclerosis; child; prevention and control; ultrasonography.