Cumulative dyslipidaemia from mid-adolescence through young adulthood with carotid intima-media thickness progression: a 9-year longitudinal study
Authors: Agbaje A O , Lloyd-Jones D M , Magnussen C G , Tuomainen T P 
Published: October 2022

Abstract

Background
Carotid intima-media thickness (cIMT) progression was recently established as a predictor of cardiovascular events among adults. To date, a single cIMT measure has largely been used as a marker of preclinical atherosclerotic changes in the young population and dyslipidaemia has been associated with single measured cIMT. The longitudinal relationship between dyslipidaemia and repeated measure of cIMT in a large apparently healthy young population remains unknown.

Purpose
To investigate 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 cIMT progression in adolescence.

Methods
We studied 1779 British 15-year-olds (50% females) followed up for 9 years. TC, triglyceride, and HDL-C were measured in line with standard protocols at ages 15, 17, and 24 years, respectively. LDL-C and non-HDL-C were estimated. Lipid phenotypes were categorized based on the 2011 National Heart, Lung, and Blood Institute classification into normal (reference), elevated, and dyslipidaemia. cIMT from the right and left common carotid arteries at 17 years was assessed by ultrasound using a linear 12-MHz transducer and cIMT from the right and left common carotid arteries at 24 years was measured using an ultrasound machine (CardioHealth Panasonic and a 13.5 MHz linear array broadband transducer (probe; centre frequency 9.0 MHz). We conducted linear mixed-effect model analyses and adjusted for sex, age, high sensitivity C-reactive protein, glucose, insulin, total fat mass, lean mass, heart rate, systolic blood pressure, diastolic blood pressure, sedentary time, light physical activity, moderate to vigorous physical activity, family history of cardiometabolic disease, socioeconomic status, pubertal attainment, and smoking status, in addition to lipid covariates such as HDL-C, LDL-C, or triglyceride depending on the predictor. However, TC and non-HDL-C analyses were not adjusted for lipids.

Results
Participants mean (SD) age in years at different time points were 15.43 (0.29), 17.69 (0.31), and 24.53 (0.72). Persistently elevated TC: effect estimate 0.026 mm [95% CI 0.004 to 0.049; p=0.024], elevated non–HDL-C: 0.033 mm [0.009 to 0.056; p=0.007], and elevated LDL-C: 0.035 mm [0.003 to 0.067); p=0.034], from 15 through 24 years were cumulatively associated with the 7-year 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. Triglyceride was not associated with cIMT progression.

Conclusion
These findings suggest that elevated lipids from mid-adolescence through young adulthood were associated with the progression of carotid wall thickening, a marker of preclinical atherosclerosis.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Finnish Cultural Foundation