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. 2022 Aug;32(8):1863-1871.
doi: 10.1016/j.numecd.2022.04.024. Epub 2022 May 10.

Subclinical atherosclerosis in adolescents and young adults and the risk of cardiovascular disease: The Strong Heart Family Study (SHFS)

Jessica A Reese  1 , Mary J Roman  2 , Jason F Deen  3 , Tauqeer Ali  1 , Shelley A Cole  4 , Richard B Devereux  2 , Amanda M Fretts  5 , Barbara V Howard  6 , Elisa T Lee  1 , Kimberly Malloy  1 , Parmanand Singh  2 , Jason G Umans  6 , Ying Zhang  7
Affiliations

Subclinical atherosclerosis in adolescents and young adults and the risk of cardiovascular disease: The Strong Heart Family Study (SHFS)

Jessica A Reese et al. Nutr Metab Cardiovasc Dis. 2022 Aug.

Abstract

Background and aims: Rates of cardiovascular disease (CVD) among American Indians (AI) have been increasing. Although we have observed an association between atherosclerosis and CVD in older adults, the potential association among young AI is unclear. Therefore, we aim to describe the prevalence of atherosclerosis among young AI and determine its association with CVD and all-cause mortality.

Methods and results: We evaluated AI participants from the Strong Heart Family Study (SHFS), who were <40 years old and CVD free at the baseline examination, 2001-2003 (n = 1376). We used carotid ultrasound to detect baseline atherosclerotic plaque. We identified CVD events and all-cause mortality through 2019, with a median follow-up of 17.8 years. We used shared frailty Cox Proportional Hazards models to assess the association between atherosclerosis and time to CVD event or all-cause mortality, while controlling for covariates. Among 1376 participants, 71 (5.2%) had atherosclerosis at baseline. During follow-up, 120 (8.7%) had CVD events and 104 (7.6%) died from any cause. CVD incidence was higher in participants who had baseline atherosclerosis (13.51/1000 person-years) than in those who did not (4.95/1000 person-years, p = 0.0003). CVD risk and all-cause mortality were higher in participants with atherosclerosis, while controlling for covariates (CVD HR = 1.85, 95%CI = 1.02-3.37, p = 0.0420; all-cause mortality HR = 2.04, 95%CI = 1.07-3.89, p = 0.0291).

Conclusions: Among young AI, atherosclerosis was independently associated with incident CVD and all-cause mortality later in life. Thus, atherosclerosis begins early in life and interventions in adolescents and young adults to slow the progression of disease could prevent or delay CVD events later in life.

Keywords: Adolescent; American Indian; Atherosclerosis; Cardiovascular disease; Strong Heart Family Study; Young adult.

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Figures

Figure 1:
Figure 1:
CVD free probability for American Indians, ages 14 to <40, with versus without atherosclerotic plaque at baseline. Blue and red lines and corresponding shaded areas represent the times to first fatal or non-fatal cardiovascular disease (CVD) event and 95% confidence intervals for participants with or without baseline atherosclerotic plaque, respectively. The plus symbols (+) represent censored participants.
Figure 2:
Figure 2:
Survival probability for American Indians, ages 14 to <40, with or without atherosclerotic plaque at baseline. The blue and red lines and corresponding shaded areas represent the time to death from any cause and 95% confidence interval for participants with or without atherosclerotic plaque at baseline, respectively. The plus symbols (+) represent censored participants.
See this image and copyright information in PMC

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