Adult dyslipidemia prediction is improved by repeated measurements in childhood and young adulthood. The Cardiovascular Risk in Young Finns Study
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.
References (33)
- et al.
Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the global burden of disease study 2010
Lancet
(2012) - et al.
Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the global burden of disease study 2010
Lancet
(2012) - et al.
Tracking of serum lipid levels, blood pressure, and body mass index from childhood to adulthood: the cardiovascular risk in young finns Study
J. Pediatr.
(2011) Evidence that triglycerides are an independent coronary heart disease risk factor
Am. J. Cardiol.
(2000)Multiple risk factors for cardiovascular disease and diabetes mellitus
Am. J. Med.
(2007)Hypertriglyceridemia, atherogenic dyslipidemia, and the metabolic syndrome
Am. J. Cardiol.
(1998)- et al.
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
J. Am. Coll. Cardiol.
(2009) - et al.
Effect of long-term exposure to lower low-density lipoprotein cholesterol beginning early in life on the risk of coronary heart disease: a mendelian randomization analysis
J. Am. Coll. Cardiol.
(2012) - et al.
Origin of atherosclerosis in childhood and adolescence
Am. J. Clin. Nutr.
(2000) - et al.
Natural history and risk factors of atherosclerosis in children and youth: the PDAY study
Pediatr. Pathol. Mol. Med.
(2002)
Tracking of serum lipids and lipoproteins from childhood to adulthood. The Bogalusa heart study
Am. J. Epidemiol.
Tracking and predictiveness of serum lipid and lipoprotein measurements in childhood: a 12-year follow-up. The cardiovascular risk in young finns study
Am. J. Epidemiol.
Factors affecting tracking of coronary heart disease risk factors in children. The Muscatine Study
Ann. N. Y. Acad. Sci.
European guidelines on cardiovascular disease prevention in clinical practice (version 2012). The fifth joint task force of the European society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts)
Eur. Heart J.
Utility of currently recommended pediatric dyslipidemia classifications in predicting dyslipidemia in adulthood: evidence from the childhood determinants of adult health (CDAH) study, cardiovascular risk in young finns study, and Bogalusa heart study
Circulation
Associations of dyslipidemias from childhood to adulthood with carotid intima-media thickness, elasticity, and brachial flow-mediated dilatation in adulthood: the cardiovascular risk in young finns study
Arterioscler. Thromb. Vasc. Biol.
Cited by (15)
Tracking of apolipoprotein B levels measured in childhood and adolescence: systematic review and meta-analysis
2024, European Journal of PediatricsMolecular Biomarkers for Cardiometabolic Disease: Risk Assessment in Young Individuals
2023, Circulation ResearchA cohort study on risk factors of high-density lipoprotein cholesterol hypolipidemia among urban Chinese adults
2021, Lipids in Health and DiseaseVascular risk values of metabolic indicators in adolescents and elderlies from Havana
2020, Revista Cubana de Salud PublicaMetabolic-related markers and inflammatory factors as predictors of dyslipidemia among urban Han Chinese adults
2019, Lipids in Health and Disease