The combination of a child’s low-density lipoprotein cholesterol level and body mass index predicts risk for signs of atherosclerosis in young adults, according to an article in the November 5th issue of The Journal of the American Medical Association.

In the current work, researchers chose ultrasound measurement of intima-media thickness in the carotid artery as surrogate end point for atherosclerosis and related risk of coronary artery disease. Previous studies employing carotid thickness have primarily been performed in middle-aged and elderly populations.

Shengxu Li, M.D., M.P.H., and his American colleagues examined the association between carotid thickness measured in young adults and traditional cardiovascular risk factors measured since childhood. The study included 486 adults aged 25 to 37 years from a single community (71 percent white, 39 percent male) who had at least three measurements of traditional risk factors during and after childhood.

"We found that carotid intima-media thickness in asymptomatic healthy young adults is associated with traditional cardiovascular risk factors measured since childhood," the authors wrote. "The low-density lipoprotein cholesterol level and body mass index in childhood; low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and systolic blood pressure in adulthood; and cumulative burden of low- and high-density lipoprotein cholesterol levels since childhood were independent risk factors for having increased carotid intima-media thickness in young adulthood. Among the risk factors we examined, low-density lipoprotein level in childhood, adulthood, or as a cumulative burden was the most consistent and independent predictor of carotid intima-media thickness in young adults."

"The fact that body fatness, as measured by body mass index, is also a significant childhood predictor in this regard points to the potential usefulness of low-density lipoprotein cholesterol level along with body mass index, both modifiable and interrelated risk factors, in coronary artery disease risk assessment and intervention in childhood," the researchers added.

In an accompanying editorial, Henry C. McGill, Jr., M.D., and C. Alex McMahan, Ph.D., wrote that assessment of cardiovascular risk factors in youth is easy and inexpensive.

"There is little cost and much benefit in assessing obesity, smoking, and blood pressure at all ages. The guidelines of the Adult Treatment Panel III recommend measuring lipids and lipoproteins beginning at age 20 years. Screening for dyslipidemia in younger persons is not widely recommended unless there is a family history of precocious coronary heart disease. With the evidence now emerging that shows that cholesterol and other risk factors do matter during adolescence, it may now be time to reconsider the age at which measurement of cholesterol levels should begin."

"The available evidence indicates that it is time to move forward to start earlier to prevent coronary heart disease. From a public health perspective, it is essential to promote a culture in which young persons are encouraged to maintain safe and healthy lifestyles. The difficulty of modifying lifestyles of teenagers in the current environment of the industrialized societies should not be underestimated, and success may require decades, perhaps even generations. Meanwhile, in clinical medicine, physicians and other health professionals caring for adolescents should be sure their patients and their parents know it is a good (and safe) bet that promoting and maintaining a healthy lifestyle in youth will reduce the risk of precocious cardiovascular disease in adulthood," they concluded.