Elsevier

Atherosclerosis

Volume 239, Issue 2, April 2015, Pages 350-357
Atherosclerosis

Adult dyslipidemia prediction is improved by repeated measurements in childhood and young adulthood. The Cardiovascular Risk in Young Finns Study

https://doi.org/10.1016/j.atherosclerosis.2015.02.004Get rights and content

Highlights

  • Lipid levels are major modifiable risk factors for atherosclerosis.

  • Lipid levels have a tendency to track from childhood to adulthood.

  • Prediction of adult dyslipidemias is more accurate with two childhood measurements.

Abstract

Background

Prediction of adult dyslipidemia has been suggested to improve with multiple measurements in childhood or young adulthood, but there is paucity of specific data from longitudinal studies.

Methods and results

The sample comprised 1912 subjects (54% women) from the Cardiovascular Risk in Young Finns Study who had fasting lipid and lipoprotein measurements collected at three time-points in childhood/young adulthood and had at least one follow-up in later adulthood. Childhood/young adult dyslipidemia was defined as total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C) or triglycerides (TG) in the highest quintile, or high-density lipoprotein cholesterol (HDL-C) in the lowest quintile. Adult dyslipidemia was defined according to European cut-points (TC > 5.0 mmol/L, LDL-C >3 mmol/L, Non-HDL-C >3.8 mmol/L, HDL-C <1.0 mmol/L (in men)/<1.2 mmol/L (in women) and TG > 1.7 mmol/L). With the exception of triglycerides, Pearson correlation coefficients for predicting adult levels significantly improved when two lipid or lipoprotein measurements in childhood/young adulthood were compared with one measurement (all P < 0.01). For triglycerides, there was significant improvement only when three measurements were considered (P = 0.004). Two measurements significantly improved prediction of dyslipidemia levels in adulthood for non-HDL-C, LDL-C, HDL-C and TG compared with one measurement (P < 0.05 for improved area-under the receiver-operating characteristic curve). Risk of dyslipidemia in adulthood grew according to the number of times a person had been at risk in childhood.

Conclusions

Based on these results, it seems that compared to a single measurement two lipid measures in childhood/early adulthood significantly improve prediction of adult dyslipidemia. A lack of dyslipidemia in childhood does not strongly exclude later development of dyslipidemia. Multiple measurements increase the prediction accuracy, but the incremental prognostic/diagnostic accuracy of especially third measurement is modest.

Introduction

Atherosclerotic cardiovascular disease (CVD) is the leading cause of death and disability in the world [1], [2]. Atherosclerosis begins in childhood with its progression related to the presence and intensity of known CVD risk factors such as an atherogenic diet, high blood pressure and dyslipidemia [3], [4]. Risk factor levels in childhood have a tendency to track [5], [6], [7], [8], resulting in a sustained increase to the risk of experiencing a cardiovascular event later in life [9].

Dyslipidemia, a recognized risk factor for atherosclerotic cardiovascular disease [10], [11], [12], is defined as an abnormal lipid profile: elevated triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (Non-HDL-C) or total cholesterol (TC), or low high-density lipoprotein cholesterol (HDL-C). Childhood dyslipidemias have been associated with adult dyslipidemias [13] and surrogate markers of atherosclerosis such as carotid intima-media thickness [14], [15], which has been shown to predict future cardiovascular events [16].

Current pediatric guidelines [17] for primary prevention of CVD recommend both a selective and a universal approach for screening of lipid and lipoprotein levels. The selective approach suggests that a fasting lipid profile should be obtained from children who have either a positive family history for CVD, dyslipidemia in either parent, or any other risk factors present (e.g. hypertension, obesity and diabetes), from the age of 2 years onward. The universal, population-wide, approach recommends screening of non-fasting lipid profile among all children aged 9–11 years and repeated among young adults aged 17–21 years – with the decision for a fasting lipid profile assigned by non-HDL-C levels above or equal to 3.75 mmol/l (145 mg/dl). However, there is paucity of specific evidence from longitudinal studies demonstrating whether obtaining multiple measurements in childhood and young adulthood improves prediction of adult dyslipidemias. Therefore, our aim was to examine whether prediction of abnormal lipid levels in adulthood becomes more accurate with repeated measurements in childhood or young adulthood compared with a measurement obtained at a single time-point.

Section snippets

Population

Participants were drawn from the Cardiovascular Risk in Young Finns Study (YFS), which is a population-based follow-up study in Finland [18]. The study began in 1980 when 3596 children and adolescents aged 3–18 years were examined. Since then, follow-ups have been performed in 1983, 1986, 2001, 2007 and 2011. The present study is based on 1912 participants (53.9% women, mean age 12.4 years in 1983), who were aged 6–21 years in 1983, had participated in baseline examination in 1980 and child

Results

Clinical characteristics of the study population in childhood and in adulthood are shown in Table 1. Non-participants tended to be older and for females, of higher BMI compared with participants but otherwise we observed no substantial differences in risk factors. Lipid-lowering medication was used by 59 participants (3.1% of the study population) in adulthood. The mean level of LDL-C in 1983 among those who used lipid-lowering medication in adulthood was 3.77 mmol/L. Concurrently, the mean

Discussion

Among the participants of the longitudinal Cardiovascular Risk in Young Finns Study, we observed that multiple lipid measurements in childhood improve both the long-term tracking of lipid levels and the accuracy of predicting dyslipidemia in adulthood from measures obtained in childhood and young adulthood. Importantly, those with elevated non-HDL-C levels at three times in childhood or young adulthood had 1.33 mmol/L higher adult levels compared with those who never had elevated non-HDL-C in

Conclusions

Multiple lipid and lipoprotein measurements in childhood and young adulthood improve both the long-term tracking of lipid levels and the accuracy of predicting dyslipidemias in later adulthood. For the universal screening of serum lipids, our data support the NHLBI's pediatric guidelines that call for measurement both in childhood and early adulthood.

Funding sources

The Young Finns Study has been financially supported by the Academy of Finland, the Social Insurance Institution of Finland, Kuopio, Tampere and Turku University Hospital Medical Funds, Orion-Farmos Research Foundation, Juho Vainio Foundation, Paavo Nurmi Foundation, Finnish Medical Foundation, Maud Kuistila Foundation, Paulo Foundation, Finnish Foundation of Cardiovascular Research, Finnish Cultural Foundation, Sigrid Juselius Foundation, Tampere Tuberculosis Foundation and Emil Aaltonen

Disclosures

None.

Conflict of interest

The authors have no conflict of interest to declare.

Acknowledgments

The expert statistical assistance of Ville Aalto and Irina Lisinen is gratefully acknowledged.

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