whole_MagnussenCostanGraham2009_thesis.pdf (31.85 MB)
Paediatric dyslipidemia as a predictor of dyslipidemia and carotid artery thickening in young adults : findings from the Childhood Determinants of Adult Health (CDAH) Study, the Cardiovascular Risk in Young Finns Study, and the Bogalusa Heart Study
thesisposted on 2023-05-26, 18:06 authored by Magnussen, CG
Background: There is growing evidence that atherosclerosis begins at an early age and progresses silently throughout the life span before clinical complications such as myocardial infarction and stroke present. Adverse blood lipid levels (dyslipidemia) are an important contributor to the disease and have been the target of consensus statements for paediatric screening and treatment issued by the American Academy of Pediatrics and the US National Cholesterol Education Program since 1992; the most recent update being July 2008. The basis of these documents is that treatment of lipid disorders beginning in childhood or adolescence may reduce the lifetime risk of atherosclerotic cardiovascular disease. Aims: This study examined: tracking of blood lipid levels from childhood to adulthood; the utility of two paediatric dyslipidemia classifications that define normal-, borderline-, and high-risk lipid blood levels to predict dyslipidemia and a measure of preclinical atherosclerosis (arterial wall thickness) in adulthood; factors that both reduce and improve prediction of those with dyslipidemia or arterial wall thickening in adulthood; whether changes in blood lipid levels between adolescence and adulthood had an effect on the level of arterial thickening measured in adulthood. Methods: This study utilised data from three population-based prospective cohort studies from Australia (Childhood Determinants of Adult Health Study), Finland (Cardiovascular Risk in Young Finns Study), and the United States (Bogalusa Heart Study). Baseline data were collected on children and adolescents aged 9-18 years in 1980-1986. Between 2001 and 2006 participants from the original cohorts, now young adults aged 28-39 years, were re-examined (follow-up). Participants from each cohort had risk factor data (including fasting blood lipids) measured at both time-points. At follow-up, each cohort used carotid artery ultrasound to determine arterial wall thickness. Results: The findings showed that paediatric dyslipidemia classifications predicts dyslipidemia and arterial thickening in young adulthood; that the classifications examined differ marginally in how strongly they predict adult dyslipidemia but perform with equal success in the prediction of arterial thickening in adulthood; that universal (population-wide) or selective screening approaches that use paediatric dyslipidemia classifications would be limited by either high rates of false positives or high rates of false negatives; that adolescent lipid levels are more strongly associated with arterial thickening in adulthood than change in lipid levels; that dyslipidemia in the presence of overweight or obesity places affected adolescents at substantially higher risk of increased arterial thickening as adults; and that participants identified as high-risk in childhood but who adopted positive changes in lifestyle habits in the intervening years were less likely to have dyslipidemia as adults. Conclusions: These findings suggest that paediatric dyslipidemia classifications are useful in predicting adolescents who are at increased risk of having dyslipidemia or preclinical atherosclerosis in young adulthood. While these findings suggest there would be limitations in screening the general paediatric population for dyslipidemia, they underscore the importance of both population-wide and individualised prevention programs to reduce the early development of atherosclerosis associated with paediatric dyslipidemia.
Rights statementCopyright 2009 the author Available for use in the Library but NOT for copying until 1/11/2011. Thesis (PhD)--University of Tasmania, 2009. Includes bibliographical references. Introduction -- Methods -- Factors affecting the tracking of blood lipid and lipoprotein levels from childhood to adulthood: the Childhood Determinants of Adult Health (CDAH) Study -- Utility of two classifications of paediatric dyslipidemia to predict dyslipidemia in adulthood -- The association of paediatric low- and high-density lipoprotein cholesterol dyslipidemia classifications and change in dyslipidemia status with carotid intima-media thickness in adulthood -- Summary, recommendations, and conclusions -- References -- Appendices -- Original communications