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CLINICAL RESEARCH: CHILDHOOD LIPIDS AND HEART DISEASE

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

Costan G. Magnussen, BHM^_*,_*, Alison Venn, PhD^_*, Russell Thomson, PhD^_*, Markus Juonala, MD, PhD, Sathanur R. Srinivasan, PhD^||, Jorma S.A. Viikari, MD, PhD, Gerald S. Berenson, MD^||, Terence Dwyer, MD, MPH^¶ and Olli T. Raitakari, MD, PhD

^_* Menzies Research Institute, University of Tasmania, Hobart, Australia
Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
Department of Clinical Physiology, University of Turku, Turku, Finland
Department of Medicine, University of Turku, Turku, Finland
^|| Department of Epidemiology, Tulane Center for Cardiovascular Health, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
^¶ Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Melbourne, Australia

Manuscript received July 15, 2008; revised manuscript received September 29, 2008, accepted September 29, 2008.

^_* Reprint requests and correspondence: Mr. Costan G. Magnussen, Menzies Research Institute, Private Bag 23, Hobart, Tasmania 7001, Australia (Email: cmagnuss{at}utas.edu.au).

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.

Key Words: pediatrics • dyslipidemia • carotid atherosclerosis • epidemiology • screening

Abbreviations and Acronyms   ASCVD = atherosclerotic cardiovascular disease   AUC = area under the receiver-operator characteristic curve   BMI = body mass index   HDL-C = high-density lipoprotein cholesterol   IMT = intima-media thickness   LDL-C = low-density lipoprotein cholesterol   NCEP = National Cholesterol Education Program   NHANES = National Health and Nutrition Examination Survey

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