Research Article 
Coronary heart disease risk factors and atherosclerosis in young people
C. Alex McMahan, Samuel S. Gidding and Henry C. McGill
Journal of Clinical Lipidology, 2008, 2(3), 118-126. DOI: 10.1016/j.jacl.2008.02.006
Abstract
Atherosclerosis begins in childhood or adolescence and progresses during the young adult years to cause clinical coronary heart disease (CHD) in middle-aged and older individuals. This article reviews evidence regarding the association of the major established CHD risk factors with atherosclerosis in adolescents and young adults, with emphasis on the findings of the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study. Age, non-high-density lipoprotein cholesterol concentration, smoking, hypertension, obesity, and hyperglycemia are positively associated with atherosclerotic lesions, whereas female gender and high-density lipoprotein cholesterol concentration are negatively associated with lesions. The PDAY study developed a risk score that provides a weighted summary of the risk factor effects on advanced atherosclerosis. Although developed to predict advanced atherosclerotic lesions, the risk score is also associated with all stages of lesion severity, including the transition from normal tissue to the earliest anatomically detectable lesion. Application of the PDAY risk score to data from longitudinal studies of risk factors in young adults shows that early measurement of risk factors predicts atherosclerosis assessed noninvasively up to 15 years later, and that subsequent change in risk score during the 15-year interval also predicts atherosclerosis. These findings provide strong support for maintaining a low lifetime risk and for focusing on preventing atherosclerosis as the most effective way to prevent CHD. Risk-factor control beginning in the late teenage years will retard development of the earliest stage of atherosclerosis and its progression, and will reduce or delay occurrence of CHD.
ASCI-ID: 2746-25
Similar Articles
High-density lipoprotein, sphingosine 1-phosphate, and atherosclerosis
Journal of Clinical Lipidology, 2008, 2(1), 4-11. DOI: 10.1016/j.jacl.2007.11.002
Getting the word out: Teaching middle-school children about cardiovascular diseaseJournal of Clinical Lipidology, 2008, 2(3), 179-188. DOI: 10.1016/j.jacl.2008.03.004
Flushing and the HDL-C response to extended-release niacinJournal of Clinical Lipidology, 2008, 2(4), 285-288. DOI: 10.1016/j.jacl.2008.05.002
Medical management of patients before the incidence of a cardiovascular eventJournal of Clinical Lipidology, 2009, 3(5), 315-321. DOI: 10.1016/j.jacl.2009.08.002
Prevention of atherosclerosis with low-density lipoprotein cholesterol lowering-lipoprotein changes and interactions: the SANDS studyJournal of Clinical Lipidology, 2009, 3(5), 322-331. DOI: 10.1016/j.jacl.2009.09.001
High plasma high-density lipoprotein levels, very low cardiovascular risk profile, and subclinical carotid atherosclerosis in postmenopausal womenJournal of Clinical Lipidology, 2009, 3(5), 345-350. DOI: 10.1016/j.jacl.2009.08.003
Atherosclerosis in a managed care plan: hypercholesterolemia treatment patterns and low-density lipoprotein cholesterol monitoringJournal of Clinical Lipidology, 2009, 3(6), 385-392. DOI: 10.1016/j.jacl.2009.10.004
High-density lipoproteins: Marker of cardiovascular risk and therapeutic targetJournal of Clinical Lipidology, 2010, 4(5), 359-364. DOI: 10.1016/j.jacl.2010.08.002
Functions of cholesterol ester transfer protein and relationship to coronary artery disease riskJournal of Clinical Lipidology, 2010, 4(5), 389-393. DOI: 10.1016/j.jacl.2010.08.006
Update on CETP inhibitionJournal of Clinical Lipidology, 2010, 4(5), 394-398. DOI: 10.1016/j.jacl.2010.08.003
Emerging high-density lipoprotein infusion therapies: Fulfilling the promise of epidemiology?Journal of Clinical Lipidology, 2010, 4(5), 399-404. DOI: 10.1016/j.jacl.2010.08.018
Associations among smoking status, lifestyle and lipoprotein subclassesJournal of Clinical Lipidology, 2010, 4(6), 522-530. DOI: 10.1016/j.jacl.2010.09.003
Predictors of anterior and posterior wall carotid intima media thickness progression in men and women at moderate risk of coronary heart diseaseJournal of Clinical Lipidology, 2011, 5(3), 141-151. DOI: 10.1016/j.jacl.2011.02.003
Carotid intima-media thickness for the practicing lipidologistJournal of Clinical Lipidology, 2010, 4(1), 24-35. DOI: 10.1016/j.jacl.2009.11.004
Impact of lipid profile and high blood pressure on endothelial damageJournal of Clinical Lipidology, 2011, 5(6), 460-466. DOI: 10.1016/j.jacl.2011.06.005
Effect of Aggressive Cardiovascular Risk Factor Treatment on Progression of Carotid Intima-Media Thickness: Experience of an Atherosclerosis CenterJournal of Clinical Lipidology, 2012, 6(3), 262-263. DOI: 10.1016/j.jacl.2012.04.027
Serum apolipoprotein A-V in patients with coronary artery disease and its association with triglycerideJournal of Clinical Lipidology, 2012, 6(5), 462-468. DOI: 10.1016/j.jacl.2012.02.004
Relationships between alcohol intake and atherogenic indices in womenJournal of Clinical Lipidology, 2013, 7(5), 454-462. DOI: 10.1016/j.jacl.2013.03.009
An International Atherosclerosis Society Position Paper: Global recommendations for the management of dyslipidemiaJournal of Clinical Lipidology, 2013, 7(6), 561-565. DOI: 10.1016/j.jacl.2013.10.001
A kindred with fish eye disease, corneal opacities, marked high-density lipoprotein deficiency, and statin therapyJournal of Clinical Lipidology, 2014, 8(2), 223-230. DOI: 10.1016/j.jacl.2013.11.005
Prolonged combination lipid therapy is associated with reduced carotid intima-media thickness: A case-control study of the 20-year Familial Atherosclerosis Treatment - Observational Study (FATS-OS)Journal of Clinical Lipidology, 2014, 8(5), 489-493. DOI: 10.1016/j.jacl.2014.07.004
Efficacy of simvastatin therapy in attainment of LDL-C and TG goal levels in patients with type 2 diabetic dyslipidemiaJournal of Clinical Lipidology, 2008, 2(1), 12-18. DOI: 10.1016/j.jacl.2007.12.001
Clinical presentation, laboratory values, and coronary heart disease risk in marked high-density lipoprotein-deficiency statesJournal of Clinical Lipidology, 2008, 2(4), 237-247. DOI: 10.1016/j.jacl.2008.06.002
High levels of urinary F2-isoprostanes predict cardiovascular mortality in postmenopausal womenJournal of Clinical Lipidology, 2008, 2(4), 298-303. DOI: 1016/j.jacl.2008.06.004
“Atherogenic index of plasma” (log10 triglyceride/high-density lipoprotein-cholesterol) predicts high blood pressure, diabetes, and vascular eventsJournal of Clinical Lipidology, 2010, 4(2), 89-98. DOI: 10.1016/j.jacl.2010.02.005
Evaluation of a pharmacist-managed lipid clinic that uses point-of-care lipid testingJournal of Clinical Lipidology, 2010, 4(2), 120-125. DOI: 10.1016/j.jacl.2010.02.001
Loss of early gains in low-density lipoprotein cholesterol goal attainment among high-risk patientsJournal of Clinical Lipidology, 2010, 4(2), 126-132. DOI: 10.1016/j.jacl.2010.01.007
Ezetimibe/simvastatin 10/20 mg versus simvastatin 40 mg in coronary heart disease patientsJournal of Clinical Lipidology, 2010, 4(4), 272-278. DOI: 10.1016/j.jacl.2010.05.002
Differences in lipoprotein particle subclass distribution for Japanese Americans in Hawaii and Japanese in Japan: The INTERLIPID StudyJournal of Clinical Lipidology, 2011, 5(1), 30-36. DOI: 10.1016/j.jacl.2010.11.007
Fatty acids in cardiovascular health and disease: A comprehensive updateJournal of Clinical Lipidology, 2012, 6(3), 216-234. DOI: 10.1016/j.jacl.2012.04.077
A meta-analysis of randomized controlled trials that compare the lipid effects of beef versus poultry and/or fish consumptionJournal of Clinical Lipidology, 2012, 6(4), 352-361. DOI: 10.1016/j.jacl.2012.01.001
Risk of coronary heart disease is associated with triglycerides and high-density lipoprotein cholesterol in women and non-high-density lipoprotein cholesterol in menJournal of Clinical Lipidology, 2012, 6(4), 374-381. DOI: 10.1016/j.jacl.2012.02.011
Treatment options for the management of hypertriglyceridemia: Strategies based on the best-available evidenceJournal of Clinical Lipidology, 2012, 6(5), 413-426. DOI: 10.1016/j.jacl.2012.04.003
Discordance between high non-HDL cholesterol and high LDL-cholesterol among US adultsJournal of Clinical Lipidology, 2014, 8(1), 86-93. DOI: 10.1016/j.jacl.2013.11.001
Risk of coronary heart disease associated with metabolic syndrome and its individual components in Iranian subjects: A matched cohort studyJournal of Clinical Lipidology, 2014, 8(3), 279-286. DOI: 10.1016/j.jacl.2014.02.002
Effect of fatty and lean fish intake on lipoprotein subclasses in subjects with coronary heart disease: A controlled trialJournal of Clinical Lipidology, 2014, 8(1), 126-133. DOI: 10.1016/j.jacl.2013.09.007
National Lipid Association recommendations for patient-centered management of dyslipidemia: Part 1 - executive summaryJournal of Clinical Lipidology, 2014, 8(5), 473-488. DOI: 10.1016/j.jacl.2014.07.007
The population effects of the global cardiovascular risk model in United States Adults: Findings from the National Health and Nutrition Surveys, 2005-2006Journal of Clinical Lipidology, 2011, 5(3), 166-172. DOI: 10.1016/j.jacl.2011.02.007
Age is positively associated with high-density lipoprotein cholesterol among African Americans in cross-sectional analysis: The Jackson Heart StudyJournal of Clinical Lipidology, 2011, 5(3), 173-178. DOI: 10.1016/j.jacl.2011.02.002
Pregnancy during adolescence has lasting adverse effects on blood lipids: A 10-year longitudinal study of black and white femalesJournal of Clinical Lipidology, 2012, 6(2), 139-149. DOI: 10.1016/j.jacl.2011.12.004
Discordance between high non-HDL cholesterol and high LDL-cholesterol among US adultsJournal of Clinical Lipidology, 2014, 8(1), 86-93. DOI: 10.1016/j.jacl.2013.11.001
Risk of coronary heart disease associated with metabolic syndrome and its individual components in Iranian subjects: A matched cohort studyJournal of Clinical Lipidology, 2014, 8(3), 279-286. DOI: 10.1016/j.jacl.2014.02.002
Hypothyroidism as a risk factor for statin intoleranceJournal of Clinical Lipidology, 2014, 8(4), 401-407. DOI: 10.1016/j.jacl.2014.05.005
Comparison of cardiovascular disease risk associated with 3 lipid measures in Japanese adultsJournal of Clinical Lipidology, 2014, 8(5), 501-509. DOI: 10.1016/j.jacl.2014.06.005
Why is non-high-density lipoprotein cholesterol a better marker of the risk of vascular disease than low-density lipoprotein cholesterol?Journal of Clinical Lipidology, 2010, 4(3), 152-155. DOI: 10.1016/j.jacl.2010.03.005
Prevalence of dyslipidemia in normoglycemic subjects with newly diagnosed high blood pressure in Abuja, NigeriaJournal of Clinical Lipidology, 2009, 3(1), 51-56. DOI: 10.1016/j.jacl.2008.12.001
The population effects of the global cardiovascular risk model in United States Adults: Findings from the National Health and Nutrition Surveys, 2005-2006Journal of Clinical Lipidology, 2011, 5(3), 166-172. DOI: 10.1016/j.jacl.2011.02.007
Smoking intensity and lipoprotein abnormalities in active smokersJournal of Clinical Lipidology, 2009, 3(6), 372-378. DOI: 10.1016/j.jacl.2009.10.008
Biographical notes on Ancel Keys and Salim Yusuf: Origins and significance of the Seven Countries Study and the INTERHEART StudyJournal of Clinical Lipidology, 2011, 5(6), 434-440. DOI: 10.1016/j.jacl.2011.09.003
The relationship between subclinical atherosclerosis, non-high-density lipoprotein cholesterol, exercise, and diet among male participants of the PACC ProjectJournal of Clinical Lipidology, 2012, 6(2), 174-179. DOI: 10.1016/j.jacl.2011.11.005
Apolipoproteins A-I, B, and C-III in young adult Cherokee with metabolic syndrome with or without type 2 diabetesJournal of Clinical Lipidology, 2013, 7(1), 38-42. DOI: 10.1016/j.jacl.2012.06.007
Postprandial lipemia is not increased in patients with previous unprovoked venous thromboembolismJournal of Clinical Lipidology, 2013, 7(1), 48-55. DOI: 10.1016/j.jacl.2012.06.001
Dyslipidemia and associated risk factors in a resettlement colony of DelhiJournal of Clinical Lipidology, 2013, 7(6), 653-660. DOI: 10.1016/j.jacl.2013.06.003
Benefits associated with achieving optimal risk factor levels for the primary prevention of cardiovascular disease in older menJournal of Clinical Lipidology, 2012, 6(1), 58-65. DOI: 10.1016/j.jacl.2011.10.019
Exercise-Promoting healthy lifestyles in children and adolescentsJournal of Clinical Lipidology, 2008, 2(3), 162-168. DOI: 10.1016/j.jacl.2008.03.001