To the Editor The finding by Armstrong et al1 that adolescent non–high-density lipoprotein cholesterol (HDL-C) shows the strongest association with the presence of coronary artery calcification in midadulthood is no doubt important. Their results add to the renewed effort to focus on early-life risk factors of cardiovascular diseases, but they ignore a potential confounding factor that might influence the association between non–HDL-C and coronary artery calcification. Extensive data have documented that not breastfeeding is associated with high concentrations of non–HDL-C in adolescents and consequently with the development of coronary artery disease in adulthood.
Aguilo G, Vinuela I, Verd S. Early-Life Initiation of Primary Prevention Strategies to Reduce Atherosclerosis Risk. JAMA Cardiol. 2021;6(12):1466–1467. doi:10.1001/jamacardio.2021.3954
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