Risk scores may identify young individuals with atherosclerosis

Young people with atherosclerotic lesions may be identified by a risk score calculated from coronary heart disease factors like obesity, sex, age, cholesterol, and smoking, according to an article in the April 25 issue of Archives of Internal Medicine.

An article published in 1953 described a high rate of advanced coronary atherosclerosis (thickening and hardening of artery walls from fat deposits) in young Korean War casualties, and fifty years of study has supported the finding of the disease in young Americans, according to background information in the article. "These results from autopsied and living individuals indicate that dyslipidemia, hypertension, smoking, hyperglycemia, and obesity damage arteries during youth and suggest that long-range prevention of CHD [coronary heart disease] should begin early in life," the authors write.

C. Alex McMahan, Ph.D., from the University of Texas Health Science Center, San Antonio, and colleagues analyzed data from the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study to determine whether a coronary heart disease (CHD) risk score can identify young people with advanced atherosclerotic disease. Study patients were people aged 15 through 34 years who died of external causes (accidents, homicides, and suicides).

The researchers developed a risk score from CHD factors like age, sex, smoking, and obesity to identify young individuals with a high probability of having advanced atherosclerotic lesions, with a one-unit increase being equal to a one-year increase in age. A one-unit rise in risk score was associated with an 82 percent increased likelihood of lesions in the coronary artery (CA) and a 71 percent increased likelihood of lesions in the abdominal aorta. The presence of abdominal aortic lesions also increased the likelihood of CA lesions. In the study patients, the prevalence of lesions increased with age and was higher in men than in women for the CAs, the left anterior descending coronary artery (LADCA), and the right coronary artery (RCA).

"Previous PDAY studies showed that many young people have advanced atherosclerotic lesions, and these studies support the public health strategy of encouraging young people to adopt a healthy lifestyle," the authors write. "The present study shows that a risk score, based on simple and inexpensive measurements, has sufficient discrimination that physicians could identify and advise high-risk adolescents and young adults concerning their risk factors (hyperlipidemia, hypertension, smoking, obesity, and hyperglycemia) and their long-term risk of CHD."