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.
Keywords
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Article info
Publication history
Published online: February 28, 2008
Accepted:
February 24,
2008
Received:
December 12,
2007
Footnotes
Conflicts of interest: None.
Identification
Copyright
© 2008 National Lipid Association. Published by Elsevier Inc. All rights reserved.
