儿童低密度和高密度脂蛋白胆固醇血脂异常分类以及血脂异常状态变化与成年期颈动脉内膜中层厚度的关联：来自芬兰青年人心血管风险研究、博加卢萨心脏研究和成人健康儿童决定因素（CDAH）研究的证据
The association of pediatric low- and high-density lipoprotein cholesterol dyslipidemia classifications and change in dyslipidemia status with carotid intima-media thickness in adulthood evidence from the cardiovascular risk in Young Finns study, the Bogalusa Heart study, and the CDAH (Childhood Determinants of Adult Health) study.
作者信息
Magnussen Costan G, Venn Alison, Thomson Russell, Juonala Markus, Srinivasan Sathanur R, Viikari Jorma S A, Berenson Gerald S, Dwyer Terence, Raitakari Olli T
机构信息
Menzies Research Institute, University of Tasmania, Hobart, Australia.
出版信息
J Am Coll Cardiol. 2009 Mar 10;53(10):860-9. doi: 10.1016/j.jacc.2008.09.061.
OBJECTIVES
This study was designed to determine which of the National Cholesterol Education Program or National Health and Nutrition Examination Survey low- and high-density lipoprotein cholesterol classifications of dyslipidemia status in adolescents is most effective at predicting high common carotid artery intima-media thickness (IMT) in adulthood.
BACKGROUND
Two classifications of pediatric dyslipidemia status have been proposed. No study has assessed which of these is most effective for predicting adolescents who will develop preclinical atherosclerosis in adulthood.
METHODS
Three population-based, prospective cohort studies collected lipoprotein measurements on 1,711 adolescents age 12 to 18 years who were remeasured as young adults age 29 to 39 years. Lipoproteins in adolescence were classified according to National Cholesterol Education Program and National Health and Nutrition Examination Survey cut points, and high IMT in adulthood was defined as those at or above the age-, sex-, race-, and cohort-specific 90th percentile of IMT.
RESULTS
Independent of the classification employed, adolescents with dyslipidemia were at significantly increased risk of having high IMT in adulthood (relative risks from 1.6 to 2.5). Differences in predictive capacity between both classifications were minimal. Overweight or obese adolescents with dyslipidemia had increased carotid IMT (males: 0.11 mm; females: 0.08 mm) in adulthood compared with those who did not have both risk factors. Adolescent dyslipidemia status was more strongly associated with high IMT in adulthood than change in dyslipidemia status.
CONCLUSIONS
Pediatric dyslipidemia classifications perform equally in the prediction of adolescents who are at increased risk of high IMT in young adulthood. Our data suggest that dyslipidemia screening could be limited to overweight or obese adolescents.
目的
本研究旨在确定美国国家胆固醇教育计划（National Cholesterol Education Program）和美国国家健康与营养检查调查（National Health and Nutrition Examination Survey）中，哪一种青少年血脂异常状态的低密度和高密度脂蛋白胆固醇分类在预测成年后颈总动脉内膜中层厚度（IMT）升高方面最有效。
背景
已提出两种儿童血脂异常状态的分类方法。尚无研究评估哪种分类方法在预测成年后会发生临床前期动脉粥样硬化的青少年方面最有效。
方法
三项基于人群的前瞻性队列研究收集了1711名12至18岁青少年的脂蛋白测量数据，这些青少年在29至39岁时作为青年成人再次接受测量。青少年时期的脂蛋白根据美国国家胆固醇教育计划和美国国家健康与营养检查调查的切点进行分类，成年后IMT升高定义为达到或高于IMT的年龄、性别、种族和队列特异性第90百分位数。
结果
无论采用哪种分类方法，血脂异常的青少年成年后IMT升高的风险均显著增加（相对风险为1.6至2.5）。两种分类方法在预测能力上的差异极小。与没有这两种风险因素的青少年相比，超重或肥胖且血脂异常的青少年成年后颈动脉IMT增加（男性：0.11毫米；女性：0.08毫米）。青少年血脂异常状态与成年后IMT升高的关联比血脂异常状态的变化更强。
结论
儿童血脂异常分类在预测成年早期IMT升高风险增加的青少年方面表现相当。我们的数据表明，血脂异常筛查可局限于超重或肥胖的青少年。
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