June 24, 1996

Usefulness of Childhood Low-Density Lipoprotein Cholesterol Level in Predicting Adult Dyslipidemia and Other Cardiovascular RisksThe Bogalusa Heart Study

Author Affiliations

From the Tulane National Center for Cardiovascular Health, Tulane School of Public Health and Tropical Medicine, New Orleans, La.

Arch Intern Med. 1996;156(12):1315-1320. doi:10.1001/archinte.1996.00440110083011

Objective:  To examine the usefulness of childhood low-density lipoprotein cholesterol (LDL-C) measurement for predicting future dyslipidemia and other cardiovascular risk in adulthood.

Methods:  A longitudinal cohort over 15 years was identified from a community study of the natural course of arteriosclerosis: 1169 individuals (34% black), aged 5 to 14 years, were included at initial study.

Results:  Levels of lipoprotein variables in childhood were associated with levels in adulthood, more strongly for total cholesterol (r=.4-.6) and LDL-C (r=.4-.6) than for high-density lipoprotein cholesterol (r=.2-.4) and triglycerides (r=.1-.4). In a stepwise multiple regression, the childhood level was most predictive of the adulthood level, followed by change in body mass index (weight in kilograms/height in meters squared) from childhood to adulthood, with explained variability (R2) of.29,.30,.27, and.19 for total cholesterol, LDL-C, high-density lipoprotein cholesterol, and triglycerides, respectively. Adulthood dyslipidemia, as defined by the National Cholesterol Education Program criterion, was best predicted by childhood LDL-C level among other lipoprotein variables. Compared with subjects with acceptable childhood risk (LDL-C level, <2.84 mmol/L [<110 mg/dL]), those (6%) with high childhood risk (LDL-C level, ≥3.36 mmol/L [≥130 mg/dL]) not only had a higher prevalence of dyslipidemic total cholesterol level (24%, 8.3-fold), LDL-C level (28%, 5.4-fold), triglyceride level (7%, sevenfold) and lower HDL-C level (14% 2.1-fold), but also had a significantly higher (P<.05) prevalence of obesity (43%, 1.6-fold) and hypertension (19%, 2.4-fold). In addition, if the childhood LDL-C elevation (>90th percentile) was persistent, the prevalence of adult dyslipidemia would be markedly increased (P<.001).

Conclusions:  Adverse levels of LDL-C in childhood persist over time, progress to adult dyslipidemia, and relate to obesity and hypertension as well. National Cholesterol Education Program guidelines to classify cardiovascular risk on the basis of LDL-C level are helpful in targeting individuals at risk early in life.(Arch Intern Med. 1996;156:1315-1320)