November 11, 2022Atherosclerosis38 citationsOpen Access
Cumulative dyslipidemia with arterial stiffness and carotid IMT progression in asymptomatic adolescents: A simulated intervention longitudinal study using temporal inverse allocation model
Key Result
Persistently elevated total cholesterol was associated with carotid intima-media thickness progression (effect estimate 0.026 mm; 95% CI 0.004-0.049; p=0.024) over 9 years in adolescents.
Study Design
Type
Cohort (n=1,779)
Structured PICO
Does cumulative dyslipidemia increase carotid intima-media thickness and arterial stiffness progression in asymptomatic adolescents?
P
Population
1,779 asymptomatic 15-year-old adolescents from a UK birth cohort, followed for 9 years to assess the impact of cumulative dyslipidemia on preclinical atherosclerosis progression.
E
Exposure
Cumulative dyslipidemia (elevated TC, non-HDL-C, LDL-C, low HDL-C, triglycerides) and simulated intervention of treating dyslipidemia at age 17
C
Comparator
Normal lipid levels
O
Outcome
Carotid-femoral pulse wave velocity (cfPWV) and carotid intima-media thickness (cIMT) progression between ages 17 and 24 yearssurrogate
Cumulative dyslipidemia in adolescence is associated with preclinical atherosclerosis progression, supporting the rationale for universal lipid screening in pediatric populations.
Main Result
Mean Difference: 0.026 (95% CI 0.004–0.049)
p-value: p=0.024
Abstract
BACKGROUND AND AIMS: We aimed to examine the longitudinal associations of total cholesterol (TC), non-high-density lipoprotein cholesterol (non-HDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride, and low-density lipoprotein cholesterol (LDL-C) with carotid-femoral pulse wave velocity (cfPWV) and carotid intima-media thickness (cIMT) progression. METHODS: We studied 1779, 15-year-old participants from the Avon Longitudinal Study of Parents and Children, UK birth cohort, followed up for 9 years. Fasting TC, non-HDL-C, HDL-C, triglyceride, and LDL-C were measured at 15, 17, and 24 years and age-categorized as normal, elevated, and dyslipidemia based on National Heart, Lung, and Blood Institute lipid guidelines. cfPWV and cIMT were measured at 17 and 24 years. Associations were examined using linear mixed-effect models. To simulate the treatment of dyslipidemia we conducted temporal inverse allocation model analyses. RESULTS: Among 1779 49.9% female participants, mean lipid levels and proportions at elevated or dyslipidemia categories increased from ages 15 through 24 years. Persistently elevated TC: effect estimate 0.026 mm; 95% CI 0.004 to 0.049; p = 0.024, elevated non-HDL-C, and elevated LDL-C were cumulatively associated with cIMT progression. Persistent borderline-low HDL-C: -0.027 mm; -0.050 to -0.005; p = 0.019 and very-low HDL-C -0.035 mm; -0.057 to -0.013; p = 0.002 levels were associated with cIMT progression. A temporal inverse allocation of elevated and dyslipidemic levels with normal lipid levels at age 17 years attenuated the associations of cumulative elevated TC, non-HDL-C, LDL-C, and low HDL-C with cIMT progression. Cumulative elevated lipids or dyslipidemia were not associated with cfPWV progression. CONCLUSIONS: Late adolescence is key to preventing, halting, and reversing dyslipidemic-related preclinical atherosclerosis progression, warranting universal lipid screening in the general pediatric population.