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Association of non-high-density lipoprotein cholesterol measured in adolescence, young adulthood, and mid-adulthood with coronary artery calcification measured in mid-adulthood


Armstrong, MK and Fraser, B and Hartiala, O and Buscot, M-J and Juonala, M and Wu, F and Koskinen, J and Hutri-Kahonen, N and Kahonen, M and Laitinen, TP and Lehtimaki, T and Viikari, JSA and Raitakari, OT and Magnussen, CG, Association of non-high-density lipoprotein cholesterol measured in adolescence, young adulthood, and mid-adulthood with coronary artery calcification measured in mid-adulthood, JAMA Cardiology, 6, (6) pp. 661-668. ISSN 2380-6583 (2021) [Refereed Article]

DOI: doi:10.1001/jamacardio.2020.7238


Importance: Elevated non-high-density lipoprotein cholesterol (non-HDL-C) is associated with the presence of coronary artery calcification (CAC), a marker of heart disease in adulthood. However, the relative importance of non-HDL-C levels at specific life stages for CAC remains unclear.

Objective: To identify the relative association of non-HDL-C measured at distinct life stages (adolescence, young adulthood, mid-adulthood) with the presence of CAC measured in mid-adulthood.

Design, setting, and participants: The Cardiovascular Risk in Young Finns Study is a population-based prospective cohort study that started in 1980 with follow-up over 28 years. Participants from 3 population centers (Kuopio, Tampere, and Turku in Finland) represent a convenience sample drawn from the 3 oldest cohorts at baseline (aged 12-18 years in 1980). Data were collected from September 1980 to August 2008. Analysis began February 2020.

Exposures: Non-HDL-C levels were measured at 3 life stages including adolescence (aged 12-18 years), young adulthood (aged 21-30 years), and mid-adulthood (aged 33-45 years).

Main outcomes and measures: In 2008, CAC was determined from computed tomography and dichotomized as 0 (no CAC, Agatston score = 0) and 1 (presence of CAC, Agatston score ≥1) for analysis. Using a bayesian relevant life course exposure model, the relative association was determined between non-HDL-C at each life stage and the presence of CAC in mid-adulthood.

Results: Of 589 participants, 327 (56%) were female. In a model adjusted for year of birth, sex, body mass index, systolic blood pressure, blood glucose level, smoking status, lipid-lowering and antihypertensive medication use, and family history of heart disease, cumulative exposure to non-HDL-C across all life stages was associated with CAC (odds ratio [OR], 1.50; 95% credible interval [CrI], 1.14-1.92). At each life stage, non-HDL-C was associated with CAC and exposure to non-HDL-C during adolescence had the strongest association (adolescence: OR, 1.16; 95% CrI, 1.01-1.46; young adulthood: OR, 1.14; 95% CrI, 1.01-1.43; mid-adulthood: OR, 1.12; 95% CrI, 1.01-1.34).

Conclusions and relevance: These data suggest that elevated non-HDL-C levels at all life stages are associated with coronary atherosclerosis in mid-adulthood. However, adolescent non-HDL-C levels showed the strongest association with the presence of CAC in mid-adulthood, and greater awareness of the importance of elevated non-HDL-C in adolescence is needed.

Item Details

Item Type:Refereed Article
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Health
Objective Group:Clinical health
Objective Field:Diagnosis of human diseases and conditions
UTAS Author:Armstrong, MK (Mr Matthew Armstrong)
UTAS Author:Fraser, B (Dr Brooklyn Fraser)
UTAS Author:Buscot, M-J (Dr Marie-Jeanne Buscot)
UTAS Author:Wu, F (Dr Feitong Wu)
UTAS Author:Magnussen, CG (Associate Professor Costan Magnussen)
ID Code:146156
Year Published:2021
Web of Science® Times Cited:9
Deposited By:Menzies Institute for Medical Research
Deposited On:2021-08-23
Last Modified:2021-08-23

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