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Original Investigation
January 27, 2021

Association of Non–High-Density Lipoprotein Cholesterol Measured in Adolescence, Young Adulthood, and Mid-Adulthood With Coronary Artery Calcification Measured in Mid-Adulthood

Author Affiliations
  • 1Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
  • 2Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
  • 3Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland
  • 4Department of Medicine, University of Turku, Turku, Finland
  • 5Division of Medicine, Turku University Hospital, Turku, Finland
  • 6Heart Center, Kymenlaakso Central Hospital, Kotka, Finland
  • 7Tampere University Hospital, Department of Pediatrics, Tampere University, Tampere, Finland
  • 8Tampere University Hospital, Department of Clinical Physiology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
  • 9Kuopio University Hospital, Department of Clinical Physiology and Nuclear Medicine, University of Eastern Finland, Kuopio, Finland
  • 10Department of Clinical Chemistry, Fimlab Laboratories and Faculty of Medicine and Health Technology, Finnish Cardiovascular Research Center–Tampere, Tampere University, Tampere, Finland
  • 11Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
JAMA Cardiol. 2021;6(6):661-668. doi:10.1001/jamacardio.2020.7238
Key Points

Question  What is the relative association of non–high-density lipoprotein cholesterol (non–HDL-C) levels in adolescence, young adulthood, and mid-adulthood with coronary artery calcification in mid-adulthood?

Findings  In this 28-year cohort study of 589 participants, the presence of coronary artery calcification in mid-adulthood was associated with exposure to non–HDL-C in adolescence, young adulthood, and mid-adulthood. However, adolescent non–HDL-C levels showed the strongest association with coronary artery calcification.

Meaning  The odds for the presence of coronary atherosclerosis attributable to non–HDL-C begins early in life, and greater awareness of the importance of elevated non–HDL-C in adolescence is needed.

Abstract

Importance  Elevated non–high-density lipoprotein cholesterol (non–HDL-C) is associated with the presence of coronary artery calcification (CAC), a marker of heart disease in adulthood. However, the relative importance of non–HDL-C levels at specific life stages for CAC remains unclear.

Objective  To identify the relative association of non–HDL-C measured at distinct life stages (adolescence, young adulthood, mid-adulthood) with the presence of CAC measured in mid-adulthood.

Design, Setting, and Participants  The Cardiovascular Risk in Young Finns Study is a population-based prospective cohort study that started in 1980 with follow-up over 28 years. Participants from 3 population centers (Kuopio, Tampere, and Turku in Finland) represent a convenience sample drawn from the 3 oldest cohorts at baseline (aged 12-18 years in 1980). Data were collected from September 1980 to August 2008. Analysis began February 2020.

Exposures  Non–HDL-C levels were measured at 3 life stages including adolescence (aged 12-18 years), young adulthood (aged 21-30 years), and mid-adulthood (aged 33-45 years).

Main Outcomes and Measures  In 2008, CAC was determined from computed tomography and dichotomized as 0 (no CAC, Agatston score = 0) and 1 (presence of CAC, Agatston score ≥1) for analysis. Using a bayesian relevant life course exposure model, the relative association was determined between non–HDL-C at each life stage and the presence of CAC in mid-adulthood.

Results  Of 589 participants, 327 (56%) were female. In a model adjusted for year of birth, sex, body mass index, systolic blood pressure, blood glucose level, smoking status, lipid-lowering and antihypertensive medication use, and family history of heart disease, cumulative exposure to non–HDL-C across all life stages was associated with CAC (odds ratio [OR], 1.50; 95% credible interval [CrI], 1.14-1.92). At each life stage, non–HDL-C was associated with CAC and exposure to non–HDL-C during adolescence had the strongest association (adolescence: OR, 1.16; 95% CrI, 1.01-1.46; young adulthood: OR, 1.14; 95% CrI, 1.01-1.43; mid-adulthood: OR, 1.12; 95% CrI, 1.01-1.34).

Conclusions and Relevance  These data suggest that elevated non–HDL-C levels at all life stages are associated with coronary atherosclerosis in mid-adulthood. However, adolescent non–HDL-C levels showed the strongest association with the presence of CAC in mid-adulthood, and greater awareness of the importance of elevated non–HDL-C in adolescence is needed.

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