The Association of Pediatric Low- and High-Density Lipoprotein Cholesterol Dyslipidemia Classifications and Change in Dyslipidemia Status With Carotid Intima-Media Thickness in Adulthood
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Magnussen, CG and Venn, A and Thomson, R and Juonala, M and Srinavasan, SR and Viikari, JSA and Berenson, GS and Dwyer, T and Raitakari, OT, The Association of Pediatric Low- and High-Density Lipoprotein Cholesterol Dyslipidemia Classifications and Change in Dyslipidemia Status With Carotid Intima-Media Thickness in Adulthood , American College of Cardiology. Journal, 53, (10) pp. 860-869. ISSN 0735-1097 (2009) [Refereed Article]
Objectives This study was designed to determine which of the National Cholesterol Education Program or National Health and
Nutrition Examination Survey low- and high-density lipoprotein cholesterol classifications of dyslipidemia status in adolescents
is most effective at predicting high common carotid artery intima-media thickness (IMT) in adulthood.
Background Two classifications of pediatric dyslipidemia status have been proposed. No study has assessed which of these
is most effective for predicting adolescents who will develop preclinical atherosclerosis in adulthood.
Methods Three population-based, prospective cohort studies collected lipoprotein measurements on 1,711 adolescents
age 12 to 18 years who were remeasured as young adults age 29 to 39 years. Lipoproteins in adolescence were
classified according to National Cholesterol Education Program and National Health and Nutrition Examination
Survey cut points, and high IMT in adulthood was defined as those at or above the age-, sex-, race-, and cohortspecific
90th percentile of IMT.
Results Independent of the classification employed, adolescents with dyslipidemia were at significantly increased risk of having
high IMT in adulthood (relative risks from 1.6 to 2.5). Differences in predictive capacity between both classifications
were minimal. Overweight or obese adolescents with dyslipidemia had increased carotid IMT (males: 0.11 mm;
females: 0.08 mm) in adulthood compared with those who did not have both risk factors. Adolescent dyslipidemia
status was more strongly associated with high IMT in adulthood than change in dyslipidemia status.
Conclusions Pediatric dyslipidemia classifications perform equally in the prediction of adolescents who are at increased risk of
high IMT in young adulthood. Our data suggest that dyslipidemia screening could be limited to overweight or obese
adolescents. (J Am Coll Cardiol 2009;53:860–9) © 2009 by the American College of Cardiology Foundation
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