Published Online
on January 12, 2009

A more recent version of this article appeared on January 27, 2009

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Submitted on June 17, 2008
Accepted on October 14, 2008

Prevalence and Progression of Subclinical Atherosclerosis in Younger Adults With Low Short-Term but High Lifetime Estimated Risk For Cardiovascular Disease. The Coronary Artery Risk Development in Young Adults Study and Multi-Ethnic Study of Atherosclerosis

Jarett D. Berry MD, MS^*, Kiang Liu PhD, Aaron R. Folsom MD, Cora E. Lewis MD, MSPH, J. Jeffrey Carr MD, MS, Joseph F. Polak MD, MPH, Steven Shea MD, MS, Stephen Sidney MD, MPH, Daniel H. O'Leary MD, Cheeling Chan MS, and Donald M. Lloyd-Jones MD, ScM

From the UT Southwestern Medical Center, Department of Medicine (J.D.B.), Dallas, Tex; Northwestern University, Departments of Preventive Medicine (K.L., D.M.L.-J., C.C.) and Medicine (K.L., D.M.L.-J.), Chicago, Ill; University of Minnesota, Division of Epidemiology and Community Health, Minneapolis (A.R.F.); University of Alabama at Birmingham, Department of Preventive Medicine (C.E.L.); Wake Forest University School of Medicine, Division of Public Health Sciences and Department of Internal Medicine, Section of Cardiology, Winston-Salem, NC (J.J.C.); Tufts University School of Medicine, Department of Radiology, Boston, Mass (J.F.P., D.H.O.); Departments of Medicine and Epidemiology, Columbia University, New York, NY (S. Shea); and Kaiser Permanente Northern California, Oakland (S. Sidney).

^* To whom correspondence should be addressed. E-mail: jarett.berry{at}utsouthwestern.edu.

Background—We hypothesized that individuals with low 10-year but high lifetime cardiovascular disease risk would have a greater burden of subclinical atherosclerosis than those with low 10-year but low lifetime risk.

Methods and Results—We included 2988 individuals 50 years of age at examination year 15 from the Coronary Artery Risk Development in Young Adults (CARDIA) study and 1076 individuals 50 of age at study entry from the Multi-Ethnic Study of Atherosclerosis (MESA). The 10-year risk and lifetime risk for cardiovascular disease were estimated for each participant, permitting stratification into 3 groups: low 10-year (<10%)/low lifetime (<39%) risk, low 10-year (<10%)/high lifetime risk (39%), and high 10-year risk (10%) or diagnosed diabetes mellitus. Baseline levels and change in levels of subclinical atherosclerosis (coronary artery calcium or carotid intima-media thickness) were compared across risk strata. Among participants with low 10-year risk (91% of all participants) in CARDIA, those with a high lifetime risk compared with low lifetime risk had significantly greater common (0.83 versus 0.80 mm in men; 0.79 versus 0.75 mm in women) and internal (0.85 versus 0.80 mm in men; 0.80 versus 0.76 mm in women) carotid intima-media thickness, higher coronary artery calcium prevalence (16.6% versus 9.8% in men; 7.1% versus 2.3% in women), and significantly greater incidence of coronary artery calcium progression (22.3% versus 15.4% in men; 8.7% versus 5.3% in women). Similar results were observed in MESA.

Conclusions—Individuals with low 10-year but high lifetime risk have a greater subclinical disease burden and greater incidence of atherosclerotic progression compared with individuals with low 10-year and low lifetime risk, even at younger ages.

Key words: epidemiology • prevention • risk estimation • risk factors

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Circulation 2009 119: 359-361. [Extract] [Full Text]

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