Background: Data suggest that the prediction of adult cardiovascular disease using a model comprised entirely of adult nonlaboratory-based risk factors is equivalent to an approach that additionally incorporates adult lipid measures. We assessed and compared the utility of a risk model based solely on nonlaboratory risk factors in adolescence versus a lipid model based on nonlaboratory risk factors plus lipids for predicting high-risk carotid intima-media thickness (cIMT) in adulthood.

Methods: The study comprised 2893 participants 12 to 18 years of age from 4 longitudinal cohort studies from the United States (Bogalusa Heart Study and the Insulin Study), Australia (Childhood Determinants of Adult Health Study), and Finland (The Cardiovascular Risk in Young Finns Study) and followed into adulthood when cIMT was measured (mean follow-up, 23.4 years). Overweight status was defined according to the Cole classification. Hypertension was defined according to the Fourth Report on High Blood Pressure in Children and Adolescents from the National High Blood Pressure Education Program. High-risk plasma lipid levels were defined according to the National Cholesterol Education Program Expert Panel on Cholesterol Levels in Children. High cIMT was defined as a study-specific value ≥90th percentile. Age and sex were included in each model.

Results: In univariate models, all risk factors except for borderline high and high triglycerides in adolescence were associated with high cIMT in adulthood. In multivariable models (relative risk [95% confidence interval]), male sex (2.7 [2.0–2.6]), prehypertension (1.4 [1.0–1.9]), hypertension (1.9 [1.3–2.9]), overweight (2.0 [1.4–2.9]), obesity (3.7 [2.0–7.0]), borderline high low-density lipoprotein cholesterol (1.6 [1.2–2.2]), high low-density lipoprotein cholesterol (1.6 [1.1–2.1]), and borderline low high-density lipoprotein cholesterol (1.4 [1.0–1.8]) remained significant predictors of high cIMT (P<0.05). The addition of lipids into the nonlaboratory risk model slightly but significantly improved discrimination in predicting high cIMT compared with nonlaboratory-based risk factors only (C statistics for laboratory-based model 0.717 [95% confidence interval, 0.685–0.748] and for nonlaboratory 0.698 [95% confidence interval, 0.667–0.731]; P=0.02).

Conclusions: Nonlaboratory-based risk factors and lipids measured in adolescence independently predicted preclinical atherosclerosis in young adulthood. The addition of lipid measurements to traditional clinic-based risk factor assessment provided a statistically significant but clinically modest improvement on adolescent prediction of high cIMT in adulthood.

背景：数据表明，使用完全由成人基于非实验室的危险因素组成的模型来预测成人心血管疾病等同于另外纳入成人脂质测量方法的方法。我们评估并比较了仅基于青春期非实验室风险因素的风险模型与基于非实验室风险因素加脂质的脂质模型预测成人高危颈动脉内膜中层厚度（cIMT）的效用。

方法：这项研究由来自美国（Bogalusa心脏研究和胰岛素研究），澳大利亚（成人健康的儿童决定因素）和芬兰（年轻芬兰人的心血管风险研究）的4项纵向队列研究中的2893名12至18岁的参与者参加），然后在测量cIMT时进入成年期（平均随访23.4年）。根据Cole分类定义了超重状态。高血压是根据来自国家高血压教育计划的《关于儿童和青少年高血压的第四次报告》定义的。根据国家胆固醇教育计划儿童胆固醇水平专家小组确定了高危血浆脂质水平。高cIMT定义为研究特定值≥90％。年龄和性别都包括在每个模型中。

结果：在单变量模型中，除临界高甘油三酸酯和青春期高甘油三酸酯外，所有危险因素均与成年期高cIMT相关。在多变量模型中（相对风险[95％置信区间]），男性（2.7 [2.0-2.6]），高血压前期（1.4 [1.0-1.9]），高血压（1.9 [1.3-2.9]），超重（2.0 [1.4] –2.9]），肥胖症（3.7 [2.0–7.0]），低密度脂蛋白胆固醇（1.6 [1.2–2.2]）临界值，低密度脂蛋白胆固醇（1.6 [1.1–2.1]）高和临界值高（低）密度脂蛋白胆固醇（1.4 [1.0–1.8]）仍是高cIMT（P<0.05）。与仅基于非实验室的风险因素相比，在非实验室的风险模型中添加脂质稍有改善，但显着改善了预测高cIMT的辨别力（基于实验室模型0.717 [95％置信区间，0.685-0.748]和非实验室0.698 [C统计] [ 95％置信区间，0.667-0.731]；P = 0.02）。

结论：基于非实验室的危险因素和在青春期测量的血脂可独立预测年轻成人的临床前动脉粥样硬化。在传统的基于临床的危险因素评估中增加血脂测量值可以提供对青少年成年期高cIMT预测的统计学上显着但临床上适度的改善。