Non-HDL Cholesterol Levels in Childhood and Carotid Intima-Media Thickness in Adulthood

Author:

Juonala Markus12,Wu Feitong32,Sinaiko Alan4,Woo Jessica G.5,Urbina Elaine M.6,Jacobs David7,Steinberger Julia8,Prineas Ronald9,Koskinen Juha10,Sabin Matthew A.11,Burgner David P.11,Burns Trudy L.1213,Bazzano Lydia14,Venn Alison3,Viikari Jorma S.A.1,Hutri-Kähönen Nina15,Daniels Stephen R.16,Dwyer Terence17,Raitakari Olli T.1819,Magnussen Costan G.319

Affiliation:

1. Department of Medicine, University of Turku and Division of Medicine, Turku University Hospital,

2. Contributed equally as co-first authors

3. Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia;

4. Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota;

5. Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and College of Medicine, University of Cincinnati and

6. Division of Cardiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio;

7. Division of Epidemiology and Community Health, School of Public Health and

8. Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota;

9. Division of Public Health Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina;

10. Heart Center, Kymenlaakso Central Hospital, Kotka, Finland;

11. Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia;

12. Department of Pediatrics, University of Melbourne, Parkville, Australia;

13. Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa;

14. Departments of Epidemiology and Biostatistics and Bioinformatics, Tulane University Health Sciences Center, Tulane University, New Orleans, Louisiana;

15. Department of Pediatrics, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland;

16. Department of Pediatrics, Children’s Hospital Colorado and School of Medicine, University of Colorado, Aurora, Colorado; and

17. The George Institute for Global Health, University of Oxford, Oxford, United Kingdom

18. Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, and

19. Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland;

Abstract

BACKGROUND: Elevated non–high-density lipoprotein cholesterol (HDL-C) levels are used to identify children at increased cardiovascular risk, but the use of non–HDL-C in childhood to predict atherosclerosis is unclear. We examined whether the National Heart, Lung, and Blood Institute classification of youth non–HDL-C status predicts high common carotid artery intima-media thickness in adulthood. METHODS: We analyzed data from 4 prospective cohorts among 4582 children aged 3 to 19 years who were remeasured as adults (mean follow-up of 26 years). Non–HDL-C status in youth and adulthood was classified according to cut points of the National Heart, Lung, and Blood Institute and the National Cholesterol Education Program Adult Treatment Panel III. High carotid intima-media thickness (cIMT) in adulthood was defined as at or above the study visit-, age-, sex-, race-, and cohort-specific 90th percentile of intima-media thickness. RESULTS: In a log-binomial regression analysis adjusted with age at baseline, sex, cohort, length of follow-up, baseline BMI, and systolic blood pressure, children with dyslipidemic non–HDL-C were at increased risk of high cIMT in adulthood (relative risk [RR], 1.29; 95% confidence interval [CI], 1.07–1.55). Compared with the persistent normal group, the persistent dyslipidemia group (RR, 1.80; 95% CI, 1.37–2.37) and incident dyslipidemia (normal to dyslipidemia) groups (RR, 1.45; 95% CI, 1.07–1.96) had increased risk of high cIMT in adulthood, but the risk was attenuated for the resolution (dyslipidemia to normal) group (RR, 1.17; 95% CI, 0.97–1.41). CONCLUSIONS: Dyslipidemic non–HDL-C levels predict youth at risk for developing high cIMT in adulthood. Those who resolve their non–HDL-C dyslipidemia by adulthood have normalized risk of developing high cIMT in adulthood.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology and Child Health

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