Abstract 19558: Cardiovascular Risk Factor Accumulation in Young Adults Over 20 Years of Follow-Up: the Coronary Artery Risk Development in Young Adults (CARDIA) study
Background: Clustering of cardiovascular disease (CVD) risk factors is a well-described phenomenon, but data are sparse regarding the sequence in which risk factors develop through young adulthood. Such knowledge may advance understanding of the biologic relationships between RFs and suggest priorities for primordial prevention.
Methods: Using data from 3204 CARDIA participants with known risk factor status during 20 years of follow-up, we examined the order in which CVD risk factors (diabetes, hypertension, high cholesterol, and high adiposity by body mass index or waist circumference) developed. We compared the observed patterns to those expected if risk factors accumulated randomly given the overall distribution in the population.
Results: Participants had a mean baseline age of 25 years, 57% were female, and 46% were African-American. At 20-year follow-up, 35% of participants had no risk factors instead of the expected 25% (p <0.001). As expected, CVD risk factors tended to cluster. Both high adiposity and high cholesterol tended to precede onset of diabetes or hypertension more often than expected (p<0.001 in all cases; Table). Hypertension and diabetes were equally likely to occur before the other, and similarly for high adiposity and high cholesterol (Table). When high cholesterol or high adiposity occurred first in a sequence, they were followed by at least one other risk factor in more participants than expected (46% vs. 34%, p<0.001 for cholesterol; 51% vs. 46% p=0.02 for adiposity).
Conclusions: High cholesterol and high adiposity are potentially modifiable conditions that often precede the development of diabetes and hypertension from young adulthood to middle age. These results support increased prevention efforts to reduce cholesterol and adiposity prior to reaching adulthood.
- © 2010 by American Heart Association, Inc.