Lipid screening in Adolescence fails to Improve Cardiovascular Risk Prediction, reveals research

Data analysis was carried out on all 11,550 participants: who had their risk factors assessed during their adolescent periods with non laboratory factors being among them including, body mass index, blood pressure and smoking status while lipid factors included among others, total cholesterol, and triglycerides. Participants were then followed into adulthood; cardiovascular events, including fatal and nonfatal events, were monitored after age 25. All events were medically adjudicated to ensure proper diagnosis.

The primary aim was to find whether the introduction of lipid measurements (total cholesterol and triglycerides) increased the predictability of the occurrence of future cardiovascular events by nonlaboratory factors which include age, sex, blood pressure, BMI, and smoking. Hazard ratios for all these risk factors were estimated based on multivariable Cox regression models and the discrimination ability of every model was assessed through the use of C-statistics.

• Of the 11,550 participants, 513 people (4.4%) had a confirmed cardiovascular event during adulthood.

• Non-laboratory-based risk factors that included high blood pressure (hazard ratio [HR] 1.25; 95% confidence interval [CI], 1.03–1.52), being overweight (HR 1.76; 95% CI, 1.42–2.18), obese (HR 2.19; 95% CI, 1.62–2.98), smoking (HR 1.63; 95% CI, 1.37–1.95), and high total cholesterol (HR 1.79; 95% CI, 1.39–2.31) had all emerged as significant predictors of cardiovascular events (P < .05).

• Adding lipid measures (total cholesterol and triglycerides) to the non laboratory-based model was not associated with a significant improvement in the ability to predict cardiovascular events. The C-statistic for the model including lipids was 0.75 (SD 0.07), the same as for the non laboratory model without lipids 0.75 [SD 0.07]; P = .82). That is, adding lipid measurements did not improve discriminatory power.

This study reports that adolescent non laboratory-based risk factors, such as blood pressure, BMI, and smoking, independently predict cardiovascular events in adulthood. The addition of lipid measurements, including total cholesterol and triglycerides, failed to improve the accuracy of predictions. These data suggest what is required is inclusion of non laboratory-based risk models for predicting long-term cardiovascular risk, and routine lipid testing may be less than clearly indicated for cardiovascular risk assessment in adolescence.

Reference:

Nuotio, J., Laitinen, T. T., Magnussen, C. G., Sinaiko, A. R., Bazzano, L. A., Daniels, S. R., Jacobs, D. R., Jr, Kartiosuo, N., Koskinen, J., Burgner, D. P., Kähönen, M., Raitakari, O. T., Steinberger, J., Urbina, E. M., Venn, A. J., Viikari, J. S. A., Woo, J. G., Dwyer, T., & Juonala, M. (2024). Predictors in youth of adult cardiovascular events. Pediatrics. https://doi.org/10.1542/peds.2024-066736