Impact of Lipid Measurements in Youth in Addition to Conventional Clinic-Based Risk Factors on Predicting Preclinical Atherosclerosis in Adulthood

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Abstract

Data suggest that the prediction of adult cardiovascular disease using a model comprised entirely of adult nonlaboratory-based risk factors is equivalent to an approach that additionally incorporates adult lipid measures. We assessed and compared the utility of a risk model based solely on nonlaboratory risk factors in adolescence versus a lipid model based on nonlaboratory risk factors plus lipids for predicting high-risk carotid intima-media thickness (cIMT) in adulthood.

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Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987-1993.

L E Chambless, G Heiss, A Folsom … (1997)

Few studies have determined whether greater carotid artery intima-media thickness (IMT) in asymptomatic individuals is associated prospectively with increased risk of coronary heart disease (CHD). In the Atherosclerosis Risk in Communities Study, carotid IMT, an index of generalized atherosclerosis, was defined as the mean of IMT measurements at six sites of the carotid arteries using B-mode ultrasound. The authors assessed its relation to CHD incidence over 4-7 years of follow-up (1987-1993) in four US communities (Forsyth County, North Carolina; Jackson, Mississippi; Minneapolis, Minnesota; and Washington County, Maryland) from samples of 7,289 women and 5,552 men aged 45-64 years who were free of clinical CHD at baseline. There were 96 incident events for women and 194 for men. In sex-specific Cox proportional hazards models adjusted only for age, race, and center, the hazard rate ratio comparing extreme mean IMT (> or = 1 mm) to not extreme (< 1 mm) was 5.07 for women (95% confidence interval 3.08-8.36) and 1.85 for men (95% confidence interval 1.28-2.69). The relation was graded (monotonic), and models with cubic splines indicated significant nonlinearity. The strength of the association was reduced by including major CHD risk factors, but remained elevated at higher IMT. Up to 1 mm mean IMT, women had lower adjusted annual event rates than did men, but above 1 mm their event rate was closer to that of men. Thus, mean carotid IMT is a noninvasive predictor of future CHD incidence.

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Laboratory-based versus non-laboratory-based method for assessment of cardiovascular disease risk: the NHANES I Follow-up Study cohort.

J. Michael Gaziano, Andrew M J Young, Sidney Atwood … (2008)

Around 80% of all cardiovascular deaths occur in developing countries. Assessment of those patients at high risk is an important strategy for prevention. Since developing countries have limited resources for prevention strategies that require laboratory testing, we assessed if a risk prediction method that did not require any laboratory tests could be as accurate as one requiring laboratory information. The National Health and Nutrition Examination Survey (NHANES) was a prospective cohort study of 14 407 US participants aged between 25-74 years at the time they were first examined (between 1971 and 1975). Our follow-up study population included participants with complete information on these surveys who did not report a history of cardiovascular disease (myocardial infarction, heart failure, stroke, angina) or cancer, yielding an analysis dataset N=6186. We compared how well either method could predict first-time fatal and non-fatal cardiovascular disease events in this cohort. For the laboratory-based model, which required blood testing, we used standard risk factors to assess risk of cardiovascular disease: age, systolic blood pressure, smoking status, total cholesterol, reported diabetes status, and current treatment for hypertension. For the non-laboratory-based model, we substituted body-mass index for cholesterol. In the cohort of 6186, there were 1529 first-time cardiovascular events and 578 (38%) deaths due to cardiovascular disease over 21 years. In women, the laboratory-based model was useful for predicting events, with a c statistic of 0.829. The c statistic of the non-laboratory-based model was 0.831. In men, the results were similar (0.784 for the laboratory-based model and 0.783 for the non-laboratory-based model). Results were similar between the laboratory-based and non-laboratory-based models in both men and women when restricted to fatal events only. A method that uses non-laboratory-based risk factors predicted cardiovascular events as accurately as one that relied on laboratory-based values. This approach could simplify risk assessment in situations where laboratory testing is inconvenient or unavailable.

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On the use of a continuous metabolic syndrome score in pediatric research

Joey Eisenmann (2008)

Background The constellation of elevated levels of abdominal adiposity, blood pressure, glucose, and triglycerides and lowered high-density lipoprotein-cholesterol has been termed the metabolic syndrome. Given the current pediatric obesity epidemic, it is perhaps not surprising that recent reports suggest the emergence of the metabolic syndrome during childhood and adolescence. The aim of this paper is to provide an overview of the derivation and utility of the continuous metabolic syndrome score in pediatric epidemiologic research. Methods/Design Data were generated from published papers related to the topic. Conclusion Although there is no universal definition in children or adolescence, recent estimates indicate that approximately 2–10% of youth possess the metabolic syndrome phenotype. Since there is no clear definition and the prevalence rate is relatively low, several authors have derived a continuous score representing a composite risk factor index (i.e., the metabolic syndrome score). This paper provides an overview of the derivation and utility of the continuous metabolic syndrome score in pediatric epidemiological research.

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Author and article information

Journal

Title: Circulation

Abbreviated Title: Circulation

Publisher: Ovid Technologies (Wolters Kluwer Health)

ISSN (Print): 0009-7322

ISSN (Electronic): 1524-4539

Publication date Created: March 20 2018

Publication date (Print): March 20 2018

Volume: 137

Issue: 12

Pages: 1246-1255

Affiliations

[1 ]Research Center of Applied and Preventive Cardiovascular Medicine (J.K., O.T.R., C.G.M.)

[2 ]Heart Center (J.K.)

[3 ]Department of Medicine (M.J., J.S.A.V.), University of Turku, Finland

[4 ]Division of Medicine (M.J., J.S.A.V.)

[5 ]George Institute, University of Oxford, United Kingdom (T.D.)

[6 ]Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (T.D., A.V., C.G.M.)

[7 ]Centre for Research in Mathematics, School of Computing, Engineering and Mathematics, Western Sydney University, Australia (R.T.)

[8 ]Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (L.B., G.S.B.)

[9 ]Murdoch Children’s Research Institute, The Royal Children’s Hospital and University of Melbourne, Australia (M.A.S.)

[10 ]Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (T.L.B.)

[11 ]Department of Pediatrics, Division of Biostatistics and Epidemiology (J.G.W.)

[12 ]Department of Medicine, University of Cincinnati, OH (J.G.W.)

[13 ]Department of Pediatrics, Division of Cardiology (E.M.U.), Cincinnati Children’s Hospital Medical Center and University of Cincinnati, OH

[14 ]Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (R.P.)

[15 ]Department of Pediatrics, University of Tampere School of Medicine and Tampere University Hospital, Finland (N.H.-K.)

[16 ]Department of Pediatrics (A.S., J.S.)

[17 ]Division of Epidemiology and Community Health (D.J.), University of Minnesota, Minneapolis

[18 ]Department of Pediatrics, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora (S.D.)

[19 ]Department of Clinical Physiology (O.T.R.), Turku University Hospital, Finland

Article

DOI: 10.1161/CIRCULATIONAHA.117.029726

PMC ID: 5860965

PubMed ID: 29170152

SO-VID: a52af4c7-4e31-4524-86a8-b76e86719766

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Impact of Lipid Measurements in Youth in Addition to Conventional Clinic-Based Risk Factors on Predicting Preclinical Atherosclerosis in Adulthood : International Childhood Cardiovascular Cohort Consortium

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Most cited references 23

Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987-1993.

Laboratory-based versus non-laboratory-based method for assessment of cardiovascular disease risk: the NHANES I Follow-up Study cohort.

On the use of a continuous metabolic syndrome score in pediatric research

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