Young adult lipid levels and middle-aged coronary calcium

January 01, 0001

Young adult lipid levels and middle-aged coronary calcium

These US authors assessed whether nonoptimal lipid levels during young adulthood are associated with atherosclerotic changes that persist into middle age in a prospective cohort study. Participants were 3258 adults from the 5115 black and white men and women recruited at age 18 to 30 years in 1985 to 1986 for the CARDIA (Coronary Artery Risk Development in Young Adults) study. They measured ow-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, triglycerides, and coronary calcium. Time-averaged cumulative exposures to lipids between age 20 and 35 years were estimated by using repeated serum lipid measurements over 20 years. Coronary calcium scores were assessed later in life at mean 45 years of age.

They found: "2824 participants (87%) had nonoptimal levels of LDL cholesterol ( at least 2.59 mmol/L {100 mg/dL}), HDL cholesterol (less than 1.55 mmol/L {60 mg/dL}), or triglycerides (at least 1.70 mmol/L {150 mg/dL}) during young adulthood. Coronary calcium prevalence 2 decades later was 8% in participants who maintained optimal LDL levels (less than 1.81 mmol/L {70 mg/dL}), and 44% in participants with LDL cholesterol levels of 4.14 mmol/L (160 mg/dL) or greater. The association was similar across race and sex and strongly graded, with odds ratios for coronary calcium of 1.5 for LDL cholesterol levels of 1.81 to 2.56 mmol/L (70 to 99 mg/dL), 2.4 for levels of 2.59 to 3.34 mmol/L (100 to 129 mg/dL), 3.3 for levels of 3.37 to 4.12 mmol/L (130 to 159 mg/dL), and 5.6 for levels of 4.14 mmol/L (160 mg/dL) or greater, compared with levels less than 1.81 mmol/L (70 mg/dL), after adjustment for lipid exposure after age 35 years and other coronary risk factors. Both LDL and HDL cholesterol levels were independently associated with coronary calcium after participants who were receiving lipid-lowering medications or had clinically abnormal lipid levels were excluded."

The authors concluded: "Nonoptimal levels of LDL and HDL cholesterol during young adulthood are independently associated with coronary atherosclerosis 2 decades later."

This study supports a goal of striving for optimal lipid levels in young adults, but note that individuals receiving lipid-lowering medications were excluded.

For the full abstract, click here.

Annals of Internal Medicine 153(3):137-146, 3 August 2010
© 2010 to the American College of Physicians
Nonoptimal Lipids Commonly Present in Young Adults and Coronary Calcium Later in Life: The CARDIA (Coronary Artery Risk Development in Young Adults) Study. Mark J. Pletcher, Kirsten Bibbins-Domingo, Kiang Liu et al. Correspondence to Dr. Pletcher:

Category: T. Endocrine/Metabolic/Nutritional, K. Circulatory. Keywords: lipids, cholesterol, triglicerides, coronary artery calcium, cohort study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 20 August 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.