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Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The
G S Berenson1, S R Srinivasan, W Bao
1Tulane Center for Cardiovascular Health, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112-2824, USA.
Insights
Multiple cardiovascular risk factors significantly worsen early atherosclerosis in young individuals. Increased risk factors correlate with more severe fatty streaks and fibrous plaques in the aorta and coronary arteries.
Area of Science:
- Cardiovascular Pathology
- Pediatric Cardiology
Background:
- Cardiovascular risk factors synergistically impact cardiovascular events in adults.
- Limited data exists on the cumulative effect of risk factors on subclinical atherosclerosis in youth.
Purpose of the Study:
- To investigate the association between cardiovascular risk factors and the extent of asymptomatic atherosclerosis in young individuals.
Main Methods:
- Autopsy analysis of 204 individuals aged 2-39 years.
- Correlation of available antemortem risk factor data (n=93) with aortic and coronary artery atherosclerosis.
- Assessment of fatty streaks and fibrous plaques.
Main Results:
- Atherosclerotic lesions increased with age in both aorta and coronary arteries.
- Cardiovascular risk factors (BMI, blood pressure, lipids) were strongly associated with lesion extent (r=0.70, P<0.001).
- Cigarette smoking and a higher number of risk factors significantly increased plaque burden in young aortas and coronary arteries.
Conclusions:
- The number of cardiovascular risk factors directly correlates with the severity of asymptomatic coronary and aortic atherosclerosis in young people.
- Early identification and management of risk factors are crucial for preventing advanced atherosclerosis in youth.
Background:
In adults, cardiovascular risk factors reinforce each other in their effect on cardiovascular events. However, information is scant on the relation of multiple risk factors to the extent of asymptomatic atherosclerosis in young people.
Methods:
We performed autopsies on 204 young persons 2 to 39 years of age, who had died from various causes, principally trauma. Data on antemortem risk factors were available for 93 of these persons, who were the focus of this study. We correlated risk factors with the extent of atherosclerosis in the aorta and coronary arteries.
Results:
The extent of fatty streaks and fibrous plaques in the aorta and coronary arteries increased with age. The association between fatty streaks and fibrous plaques was much stronger in the coronary arteries (r=0.60, P<0.001) than in the aorta (r=0.23, P=0.03). Among the cardiovascular risk factors, body-mass index, systolic and diastolic blood pressure, and serum concentrations of total cholesterol, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol, as a group, were strongly associated with the extent of lesions in the aorta and coronary arteries (canonical correlation [a measure of the association between groups of variables]: r=0.70; P<0.001). In addition, cigarette smoking increased the percentage of the intimal surface involved with fibrous plaques in the aorta (1.22 percent in smokers vs. 0.12 percent in nonsmokers, P=0.02) and fatty streaks in the coronary vessels (8.27 percent vs. 2.89 percent, P=0.04). The effect of multiple risk factors on the extent of atherosclerosis was quite evident. Subjects with 0, 1, 2, and 3 or 4 risk factors had, respectively, 19.1 percent, 30.3 percent, 37.9 percent, and 35.0 percent of the intimal surface covered with fatty streaks in the aorta (P for trend=0.01). The comparable figures for the coronary arteries were 1.3 percent, 2.5 percent, 7.9 percent, and 11.0 percent, respectively, for fatty streaks (P for trend=0.01) and 0.6 percent, 0.7 percent, 2.4 percent, and 7.2 percent for collagenous fibrous plaques (P for trend=0.003).
Conclusions:
These findings indicate that as the number of cardiovascular risk factors increases, so does the severity of asymptomatic coronary and aortic atherosclerosis in young people.