Association between Multiple Cardiovascular Risk Factors and Atherosclerosis in Children and Young Adults
Gerald S. Berenson, M.D., Sathanur R. Srinivasan, Ph.D., Weihang Bao, Ph.D., William P. Newman, M.D., Richard E. Tracy, M.D., Ph.D., Wendy A. Wattigney, M.S., for The Bogalusa Heart Study
Background In adults, cardiovascular risk factors reinforceeach other in their effect on cardiovascular events. However,information is scant on the relation of multiple risk factorsto the extent of asymptomatic atherosclerosis in young people.
Methods We performed autopsies on 204 young persons 2 to 39years of age, who had died from various causes, principallytrauma. Data on antemortem risk factors were available for 93of these persons, who were the focus of this study. We correlatedrisk factors with the extent of atherosclerosis in the aortaand coronary arteries.
Results The extent of fatty streaks and fibrous plaques in theaorta and coronary arteries increased with age. The associationbetween fatty streaks and fibrous plaques was much strongerin 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-massindex, systolic and diastolic blood pressure, and serum concentrationsof total cholesterol, triglycerides, low-density lipoproteincholesterol, and high-density lipoprotein cholesterol, as agroup, were strongly associated with the extent of lesions inthe aorta and coronary arteries (canonical correlation [a measureof the association between groups of variables]: r=0.70; P<0.001).In addition, cigarette smoking increased the percentage of theintimal surface involved with fibrous plaques in the aorta (1.22percent in smokers vs. 0.12 percent in nonsmokers, P=0.02) andfatty streaks in the coronary vessels (8.27 percent vs. 2.89percent, P=0.04). The effect of multiple risk factors on theextent 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 intimalsurface 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, forfatty 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 cardiovascularrisk factors increases, so does the severity of asymptomaticcoronary and aortic atherosclerosis in young people.
Source Information
From the Tulane Center for Cardiovascular Health, Tulane School of Public Health and Tropical Medicine (G.S.B., S.R.S., W.B., W.A.W.); and the Department of Pathology, Louisiana State University Medical Center (W.P.N., R.E.T.) — both in New Orleans.
Address reprint requests to Dr. Berenson at the Tulane Center for Cardiovascular Health, Tulane School of Public Health and Tropical Medicine, 1501 Canal St., 14th Fl., New Orleans, LA 70112-2824.
Psychological Factors and Coronary Artery Disease
Pickering T., Davidson K., Chaplin W., Soteriades E. S., Olson J. C., Edmundowicz D., Orchard T. J., Markovitz J. H., Iribarren C., Bild D. E., O'Malley P. G., Taylor A. J.
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N Engl J Med 2001;
344:608-611, Feb 22, 2001.
Correspondence
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McCrindle, B. W., Urbina, E. M., Dennison, B. A., Jacobson, M. S., Steinberger, J., Rocchini, A. P., Hayman, L. L., Daniels, S. R.
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Pilote, L., Dasgupta, K., Guru, V., Humphries, K. H., McGrath, J., Norris, C., Rabi, D., Tremblay, J., Alamian, A., Barnett, T., Cox, J., Ghali, W. A., Grace, S., Hamet, P., Ho, T., Kirkland, S., Lambert, M., Libersan, D., O'Loughlin, J., Paradis, G., Petrovich, M., Tagalakis, V.
(2007). A comprehensive view of sex-specific issues related to cardiovascular disease. CMAJ
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Osika, W., Dangardt, F., Gronros, J., Lundstam, U., Myredal, A., Johansson, M., Volkmann, R., Gustavsson, T., Ming Gan, L., Friberg, P.
(2007). Increasing Peripheral Artery Intima Thickness From Childhood to Seniority. Arterioscler. Thromb. Vasc. Bio.
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Chiolero, A., Bovet, P., Paradis, G., Paccaud, F.
(2007). Has Blood Pressure Increased in Children in Response to the Obesity Epidemic?. Pediatrics
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Johnson, H. M., Douglas, P. S., Srinivasan, S. R., Bond, M. G., Tang, R., Li, S., Chen, W., Berenson, G. S., Stein, J. H.
(2007). Predictors of Carotid Intima-Media Thickness Progression in Young Adults: The Bogalusa Heart Study. Stroke
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Cho, H.-J., Khang, Y.-H., Yang, S., Harper, S., Lynch, J. W
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Sun, S. S., Grave, G. D., Siervogel, R. M., Pickoff, A. A., Arslanian, S. S., Daniels, S. R.
(2007). Systolic Blood Pressure in Childhood Predicts Hypertension and Metabolic Syndrome Later in Life. Pediatrics
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Belay, B., Belamarich, P. F., Tom-Revzon, C.
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Kavey, R.-E. W., Allada, V., Daniels, S. R., Hayman, L. L., McCrindle, B. W., Newburger, J. W., Parekh, R. S., Steinberger, J.
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Napoli, C., Lerman, L. O., de Nigris, F., Gossl, M., Balestrieri, M. L., Lerman, A.
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