Early adult risk factor levels and subsequent coronary artery calcification: the CARDIA Study.

@article{citeulike:2208556, abstract = {OBJECTIVES: We sought to determine whether early adult levels of cardiovascular risk factors predict subsequent coronary artery calcium (CAC) better than concurrent or average 15-year levels and independent of a 15-year change in levels. BACKGROUND: Few studies have used multiple measures over the course of time to predict subclinical atherosclerosis. METHODS: African American and white adults, ages 18 to 30 years, in 4 U.S. cities were enrolled in the prospective CARDIA (Coronary Artery Risk Development in Young Adults) study from 1985 to 1986. Risk factors were measured at years 0, 2, 5, 7, 10, and 15, and CAC was assessed at year 15 (n = 3,043). RESULTS: Overall, 9.6\% adults had any CAC, with a greater prevalence among men than women (15.0\% vs. 5.1\%), white than African American men (17.6\% vs. 11.3\%), and ages 40 to 45 years than 33 to 39 years (13.3\% vs. 5.5\%). Baseline levels predicted CAC presence (C = 0.79) equally as well as average 15-year levels (C = 0.79; p = 0.8262) and better than concurrent levels (C = 0.77; p = 0.019), despite a 15-year change in risk factor levels. Multivariate-adjusted odds ratios of having CAC by ages 33 to 45 years were 1.5 (95\% confidence interval [CI] 1.3 to 1.7) per 10 cigarettes, 1.5 (95\% CI 1.3 to 1.8) per 30 mg/dl low-density lipoprotein cholesterol, 1.3 (95\% CI 1.1 to 1.5) per 10 mm Hg systolic blood pressure, and 1.2 (95\% CI 1.1 to 1.4) per 15 mg/dl glucose at baseline. Young adults with above optimal risk factor levels at baseline were 2 to 3 times as likely to have CAC. CONCLUSIONS: Early adult levels of modifiable risk factors, albeit low, were equally or more informative about odds of CAC in middle age than subsequent levels. Earlier risk assessment and efforts to achieve and maintain optimal risk factor levels may be needed.}, address = {Division of Prevention and Population Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland 20892-7936, USA. loriac@mail.nih.gov}, author = {Loria, C. M. and Liu, K. and Lewis, C. E. and Hulley, S. B. and Sidney, S. and Schreiner, P. J. and Williams, O. D. and Bild, D. E. and Detrano, R. }, citeulike-article-id = {2208556}, comment = {This study found ~10\% of those age 25 had detectable coronary artery calcification (CAC) implying the anatomic presence of atherosclerosis. The conventional, modifiable risk factors of LDL-C, HDL-C, blood pressure, glucose, excess adiposity, and smoking accounted for the vast majority of the CAC since these risk factors were measured over the preceeding 15 years. What this study demonstrates is that early control of modifiable risk factors is key to the prevention of coronary atherosclerosis. It is worrisome that rates of overweight/obese doubled from adolescence to age 25 in this study sample. These data would predict a large swell of individuals with premature coronary atherosclerosis over the next 10-20 years.--Peter A. McCullough, MD, MPH }, doi = {10.1016/j.jacc.2007.03.009}, issn = {1558-3597}, journal = {J Am Coll Cardiol}, keywords = {chd, epidemiology}, month = {May}, number = {20}, pages = {2013--2020}, posted-at = {2008-01-08 18:45:46}, priority = {2}, title = {Early adult risk factor levels and subsequent coronary artery calcification: the CARDIA Study.}, url = {http://dx.doi.org/10.1016/j.jacc.2007.03.009}, volume = {49}, year = {2007} }

TY - JOUR ID - citeulike:2208556 L3 - citeulike-article-id:2208556 TI - Early adult risk factor levels and subsequent coronary artery calcification: the CARDIA Study. JF - J Am Coll Cardiol VL - 49 IS - 20 SP - 2013 EP - 2020 AD - Division of Prevention and Population Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland 20892-7936, USA. loriac@mail.nih.gov SN - 1558-3597 N2 - OBJECTIVES: We sought to determine whether early adult levels of cardiovascular risk factors predict subsequent coronary artery calcium (CAC) better than concurrent or average 15-year levels and independent of a 15-year change in levels. BACKGROUND: Few studies have used multiple measures over the course of time to predict subclinical atherosclerosis. METHODS: African American and white adults, ages 18 to 30 years, in 4 U.S. cities were enrolled in the prospective CARDIA (Coronary Artery Risk Development in Young Adults) study from 1985 to 1986. Risk factors were measured at years 0, 2, 5, 7, 10, and 15, and CAC was assessed at year 15 (n = 3,043). RESULTS: Overall, 9.6% adults had any CAC, with a greater prevalence among men than women (15.0% vs. 5.1%), white than African American men (17.6% vs. 11.3%), and ages 40 to 45 years than 33 to 39 years (13.3% vs. 5.5%). Baseline levels predicted CAC presence (C = 0.79) equally as well as average 15-year levels (C = 0.79; p = 0.8262) and better than concurrent levels (C = 0.77; p = 0.019), despite a 15-year change in risk factor levels. Multivariate-adjusted odds ratios of having CAC by ages 33 to 45 years were 1.5 (95% confidence interval [CI] 1.3 to 1.7) per 10 cigarettes, 1.5 (95% CI 1.3 to 1.8) per 30 mg/dl low-density lipoprotein cholesterol, 1.3 (95% CI 1.1 to 1.5) per 10 mm Hg systolic blood pressure, and 1.2 (95% CI 1.1 to 1.4) per 15 mg/dl glucose at baseline. Young adults with above optimal risk factor levels at baseline were 2 to 3 times as likely to have CAC. CONCLUSIONS: Early adult levels of modifiable risk factors, albeit low, were equally or more informative about odds of CAC in middle age than subsequent levels. Earlier risk assessment and efforts to achieve and maintain optimal risk factor levels may be needed. KW - chd KW - epidemiology N1 - This study found ~10% of those age 25 had detectable coronary artery calcification (CAC) implying the anatomic presence of atherosclerosis. The conventional, modifiable risk factors of LDL-C, HDL-C, blood pressure, glucose, excess adiposity, and smoking accounted for the vast majority of the CAC since these risk factors were measured over the preceeding 15 years. What this study demonstrates is that early control of modifiable risk factors is key to the prevention of coronary atherosclerosis. It is worrisome that rates of overweight/obese doubled from adolescence to age 25 in this study sample. These data would predict a large swell of individuals with premature coronary atherosclerosis over the next 10-20 years.--Peter A. McCullough, MD, MPH AU - Loria, CM AU - Liu, K AU - Lewis, CE AU - Hulley, SB AU - Sidney, S AU - Schreiner, PJ AU - Williams, OD AU - Bild, DE AU - Detrano, R PY - 2007/05/22/ UR - http://dx.doi.org/10.1016/j.jacc.2007.03.009 ER -