Natural History of Atherosclerosis and Abdominal Aortic Intima-Media Thickness: Rationale, Evidence, and Best Practice for Detection of Atherosclerosis in the Young

Figure 1. Components of the arterial wall as captured by ultrasound, including the tunica intima with macrophage foam cells in the subendothelial space, the tunica media, and the tunica adventitia consisting of connective tissue, fibroblasts, vasa vasorum, and nerves.

Figure 2. Ultrasound of abdominal aorta showing intima-media complex in a (a) fetus, (b) newborn, (c) child (8 years), and (d) young adult (20 years). Indicative scale as indicated.

Figure 3. Ideal cardiovascular health in adolescence and abdominal aortic IMT. Ideal cardiovascular health score is the sum of the following health behaviors and factors: never smoked a cigarette; body mass index (BMI) <85th percentile; >60 min of moderate-intensity activity per day; four to five components of a healthy diet (fruit and vegetables ≥450 g/d, fish ≥200 g/wk, whole-grain bread ≥2 oz (28 g)/d, sodium <1500 mg/d, sugar-sweetened beverages ≤450 kcal/wk); total cholesterol <4.4 mmol/L; blood pressure <90th percentile; plasma glucose <5.6 mmol/L [38]. Reproduced with permission from Pahkala, K., Hietalampi, H., Laitinen, T.T., Viikari, J.S.A., Rönnemaa, T., Niinikoski, H., Lagström, H., Talvia, S., Jula, A., Heinonen, O.J., et al., Ideal Cardiovascular Health in Adolescence; published by Circulation, 2013.

Figure 4. Percentiles of abdominal aortic intima-media thickness (IMT) and carotid IMT according to age in males. Female trends were similar but slightly lower (0.03 mm less for abdominal aortic IMT and 0.02 less for carotid IMT). The mean increase in abdominal aortic IMT with age was 0.10 mm/decade as compared to 0.04 mm/decade for carotid IMT [86]. Reproduced with permission from Davis, P.H., Dawson, J.D., Blecha, M.B., Mastbergen, R.K., Sonka, M., Measurement of Aortic Intimal-Medial Thickness in Adolescents and Young Adults, published by Ultrasound in Medicine & Biology, 2010.