(Circulation. 2001;103:1546.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Effects of Nonlipid Risk Factors on Atherosclerosis in Youth With a Favorable Lipoprotein Profile
From The University of Texas Health Science Center at San Antonio (H.C.M, C.A.M), San Antonio, Tex; Southwest Foundation for Biomedical Research (H.C.M.), San Antonio, Tex; and the Louisiana State University Medical Center (A.W.Z., G.T.M., R.E.T., J.P.S.), New Orleans, La.
Correspondence to Henry C. McGill, Jr, MD, Southwest Foundation for Biomedical Research, PO Box 760549, San Antonio, TX 78245-0549. E-mail jstron{at}lsumc.edu
Background—The strong association between coronary heart disease and dyslipoproteinemia has often overshadowed the effects of the nonlipid risk factors–smoking, hypertension, obesity, and diabetes and impaired glucose tolerance–and even led to questioning the importance of these risk factors in the presence of a favorable lipoprotein profile.
Methods and Results—A
cooperative multicenter study, the Pathobiological Determinants of
Atherosclerosis in Youth (PDAY), examined the relation
of the nonlipid risk factors to atherosclerosis in 629
men and 227 women 15 to 34 years of age who died of external causes and
who had a favorable lipoprotein profile (non-HDL
cholesterol <4.14 mmol/L [<160 mg/dL] and HDL
cholesterol 
0.91 mmol/L [35 mg/dL]). In the
abdominal aorta, smokers had more extensive fatty streaks and raised
lesions than nonsmokers, and hypertensive blacks had more raised
lesions than normotensive blacks. In the right coronary artery,
hypertensive blacks had more raised lesions than normotensive blacks,
obese men (body mass index 30 kg/m2) had
more extensive fatty streaks and raised lesions than nonobese men, and
individuals with impaired glucose intolerance had more extensive fatty
streaks. Obese men had more severe lesions (American Heart Association
grade 2 through 5) of the left anterior descending coronary
artery.
Conclusions—These substantial effects of the nonlipid risk factors on the extent and severity of coronary and aortic atherosclerosis, even in the presence of a favorable lipoprotein profile, support the need to control all cardiovascular risk factors.
Key Words: coronary disease • risk factors • atherosclerosis
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