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Strong JP, Malcom GT, McMahan CA, et al. Prevalence and Extent of Atherosclerosis in Adolescents and Young Adults: Implications for Prevention From the Pathobiological Determinants of Atherosclerosis in Youth Study. JAMA. 1999;281(8):727–735. doi:https://doi.org/10.1001/jama.281.8.727
Author Affiliations: Department of Pathology, Louisiana State University Medical Center, New Orleans (Drs Strong, Malcom, Tracy, and Newman); Department of Pathology, University of Texas Health Science Center, San Antonio (Dr McMahan); Biomedical Engineering Center, Ohio State University, Columbus (Mr Herderick); and Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, Ohio (Dr Cornhill). A list of the PDAY Investigators appears at the end of this article.
Context Atherosclerosis, the underlying cause of coronary
heart disease, has been shown to be present even in young adults.
Objective To document the extent and severity of atherosclerosis
in adolescents and young adults in the United States.
Design and Setting The Pathobiological Determinants of
Atherosclerosis in Youth Study, a multi-institutional autopsy study
conducted in US medical centers.
Subjects A total of 2876 study subjects, between 15 and 34 years
old, black and white, men and women, who died of external causes and
underwent autopsy between June 1, 1987, and August 31, 1994.
Main Outcome Measures Extent, prevalence, and topography of
Results Intimal lesions appeared in all the aortas and more than
half of the right coronary arteries of the youngest age group (15-19
years) and increased in prevalence and extent with age through the
oldest age group (30-34 years). Fatty streaks were more extensive in
black subjects than in white subjects, but raised lesions did not
differ between blacks and whites. Raised lesions in the aortas of women
and men were similar, but raised lesions in the right coronary arteries
of women were less than those of men. The prevalence of total lesions
was lower in the right coronary artery than in the aorta, but the
proportion of raised lesions among total lesions was higher in the
right coronary artery than in the aorta.
Conclusions Atherosclerosis begins in youth. Fatty streaks and
clinically significant raised lesions increase rapidly in prevalence
and extent during the 15- to 34-year age span. Primary prevention of
atherosclerosis, as contrasted with primary prevention of clinically
manifest atherosclerotic disease, must begin in childhood or
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