Above-Optimal CVD Risk Factors Measured Early in Life Predictive of Future Disease

Above-normal levels of modifiable risk factors for cardiovascular disease for young adults between the ages of 18 and 30 years significantly increases the risk for later developing coronary calcification. The early levels of risk factors were equally or more informative than concurrent risk factor levels, average 15-year levels, or changes in risk factor levels during 15 years, investigators report.
"Thus, early adult levels of modifiable cardiovascular risk factors, albeit relatively low, may be more informative than generally recognized by young adults and their clinicians," writes Catherine Loria, MD, of the National Heart, Lung, and Blood Institute in Bethesda, Maryland, and colleagues in the April 17 online issue of the Journal of the American College of Cardiology. "Young adults with above-optimal risk factor levels at baseline, who were 2 or 3 times more likely to have coronary artery calcium (CAC), and those with a family history of cardiovascular disease, which predicted CAC independently of established risk factors in the CARDIA [Coronary Artery Risk Development in Young Adults] study, could be targeted for preventive efforts."
In an interview with heartwire, Dr. Loria said that while young adults often have their weight and height recorded, fewer are screened for high blood pressure or abnormal lipid levels.
"Even young adults don't visit their physician as frequently as older adults do," said Dr. Loria. "We're trying to urge young adults and physicians to pay more attention because, while their risk factor levels are generally low, and they might think we don't need to measure these risk factors because they feel they're not at risk, we probably do."
Results From the CARDIA Study
The CARDIA study initially measured risk factor levels in 1985 in 5115 African American and white adults aged 18 to 30 years. These subjects were then followed up for 15 years, and because the study involved young adults, investigators were able to examine the development of cardiovascular disease, as well as the development of risk factors for cardiovascular disease.
Of the more than 3000 participants who were scanned at year 15, when the participants were aged between 33 and 45 years, 9.6% had coronary calcification as assessed by 2 computed tomography (CT) scans. The presence of coronary artery calcium was defined as having a positive non-zero Agatston score using the average of the 2 scans.
For those with blood glucose greater than 110 mg/dL at baseline, there was a 3-fold risk in developing coronary calcium, a 2-fold risk for those with low-density lipoprotein (LDL) cholesterol greater than 130 mg/dL at baseline, and 1.5-fold risk for those with systolic blood pressures above 120/80 mm Hg at baseline. Multivariate-adjusted odds ratios of having coronary artery calcium by ages 33 to 45 years were 1.5 per 10 cigarettes smoked, 1.5 per 30 mg/dL of LDL cholesterol, 1.3 per 10-mmHg systolic blood pressure, and 1.2 per 15 mg/dL glucose, all measured at baseline.