Early-Life Cardiovascular Risk Factor Trajectories and Coronary Artery Calcium Progression in Midlife

To examine 25-year trajectories of body mass index (BMI), low-density lipoprotein cholesterol (LDL-C), and metabolic syndrome (MetS) score, and their composite score in relation to coronary artery calcium (CAC) progression from young adulthood to midlife.

We analyzed 2652 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study who completed coronary computed tomography at year 15 (March 1, 2000, to August 31, 2001) and at least one follow-up at year 20 (March 1, 2005, to August 31, 2006) or 25 (March 1, 2010, to August 31, 2011). Latent class trajectory modeling identified long-term patterns of BMI, LDL-C, and MetS score. A composite risk factor score (0-3) was created by counting the number of high-risk trajectories. The primary outcome was CAC progression. Adjusted Cox models were used to assess the relationships between different metabolic trajectories and CAC progression.

Over a mean 8.9±2.1 years, 694 participants (26.2%) exhibited CAC progression. After multivariable adjustment, high-risk trajectories of BMI, LDL-C, and MetS score were independently associated with CAC progression risk. Compared with a score of 0, adjusted HRs (95% CIs) were 1.710 (95% CI, 1.341 to 2.180), 2.368 (95% CI, 1.877 to 2.989), and 3.733 (95% CI, 2.847 to 4.895) for scores of 1, 2, and 3, respectively. Findings were consistent across subgroups and sensitivity analyses.

Adverse trajectories of BMI, LDL-C, and MetS score from early adulthood to midlife are predictors of CAC progression. A trajectory-based composite score may help identify individuals at risk for CAC progression.