Primordial dyslipidemia prevention in childhood critical for reducing atherosclerosis development

The study found that the risk for atherosclerosis remains elevated even in people whose dyslipidaemia does not last beyond childhood.

The researchers wrote, "even if resolved by adulthood, childhood dyslipidemia is a risk factor for adult carotid plaque. Also, childhood lipids are associated with plaque size in people with carotid plaque." The findings underscore the importance of primordial dyslipidemia prevention in childhood to reduce atherosclerosis development.

Previous studies have shown an association between childhood exposure to dyslipidemia and adult atherosclerosis. Still, there is no clarity on whether the long-term risk tied to dyslipidemia is attenuated on its resolution by adulthood. Juhani S. Koskinen, University of Turku, Turku, Finland, and colleagues aimed to address this question by assessing the links between childhood and adult dyslipidemia on carotid atherosclerotic plaques in adulthood.

The Cardiovascular Risk in Young Finns Study is a prospective follow‐up of children initiated in 1980; since then, follow-up studies have been regularly conducted. Carotid ultrasounds were performed on 2643 participants in 2001 and 2007 at the mean age of 36 years to identify plaque areas and carotid plaques.

They exploited various risk factor measurements for childhood lipids to determine each lipid's cumulative burden during childhood. Participants were categorized into four groups based on their adult and childhood dyslipidemia status: persistent, resolved, incident, and no dyslipidemia (reference). Linear regression models were used to study the association of serum lipids with plaque area among individuals with carotid plaque.

The study led to the following findings:

• The prevalence of plaque was 3.3% (N=88). In models adjusted for sex, age and nonlipid cardiovascular risk factors, the relative risk for the carotid plaque was 2.34 for incident adult dyslipidemia, 3.00 for dyslipidemia resolved by adulthood, and 5.23 for persistent dyslipidemia.
• Carotid plaque area was correlated with childhood total, low‐density lipoprotein, and non–high‐density lipoprotein cholesterol levels.

The findings show that even if resolved by adulthood, childhood dyslipidemia is a risk factor for carotid artery plaque. Childhood lipids are also independently associated with the level of adulthood atherosclerosis observed decades later.

"The results emphasize the role of childhood exposures for adult cardiovascular health," the researchers conclude.

"They indicate the importance of primordial prevention targeted to lipids from an early age, as subsequent prevention left to adulthood is likely too late to limit the risk that has accumulated earlier in life."

Reference:

Koskinen JS, Kytö V, Juonala M, Viikari JSA, Nevalainen J, Kähönen M, Lehtimäki T, Hutri-Kähönen N, Laitinen TP, Tossavainen P, Jokinen E, Magnussen CG, Raitakari OT. Childhood Dyslipidemia and Carotid Atherosclerotic Plaque in Adulthood: The Cardiovascular Risk in Young Finns Study. J Am Heart Assoc. 2023 Mar 16:e027586. doi: 10.1161/JAHA.122.027586. Epub ahead of print. PMID: 36927037.