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High Prevalence of Coronary Atherosclerosis in Asymptomatic Teenagers and Young Adults
Methods and Results—Intravascular ultrasound was performed in 262 heart transplant recipients 30.9±13.2 days after transplantation to investigate coronary arteries in young asymptomatic subjects. The donor population consisted of 146 men and 116 women (mean age of 33.4±13.2 years). Extensive imaging of all possible (including distal) coronary segments was performed. Sites with the greatest and least intimal thickness in each CASS segment were measured in multiple coronary arteries. Sites with intimal thickness ?0.5 mm were defined as atherosclerotic. A total of 2014 sites within 1477 segments in 574 coronary arteries (2.2 arteries per person) were analyzed. An atherosclerotic lesion was present in 136 patients, or 51.9%. The prevalence of atherosclerosis varied from 17% in individuals <20 years old to 85% in subjects ?50 years old. In subjects with atherosclerosis, intimal thickness and area stenosis averaged 1.08±0.48 mm and 32.7±15.9%, respectively. For all age groups, the average intimal thickness was greater in men than women, although the prevalence of atherosclerosis was similar (52% in men and 51.7% in women).
Conclusions—This study demonstrates that coronary atherosclerosis begins at a young age and that lesions are present in 1 of 6 teenagers. These findings suggest the need for intensive efforts at coronary disease prevention in young adults.
All donors in the study were free of known heart disease, the mean age was 33±13.2 years, and 56% were male. Other donor characteristics are listed in the Table?. In the 262 subjects, 574 major epicardial coronary arteries other than the left main trunk were imaged (2.2 arteries per patient). The left anterior descending coronary artery (LAD) was visualized in 238 patients (90% of the cohort), the left circumflex (LCx) in 180 (69%), and the right coronary artery (RCA) in 156 (56%). All 3 arteries were imaged in 97 patients (37% of subjects), 2 arteries in 118 (45%), and only 1 vessel in 47 (18%). From these arteries, ultrasound images were analyzed for a total of 2014 sites within 1477 CASS segments.
Of 262 individuals, 136 (51.9%) had ?1 atherosclerotic site (intimal thickness >0.5 mm). In these 136 subjects, the intimal thickness at the lesion was 1.08±0.48 mm, and percent stenosis averaged 32.7±15.9%. Figure 3? shows the frequency distribution of greatest intimal thickness in each patient for different age groups, demonstrating that intimal thickness increases progressively with advancing age. In all age groups, a portion of the cohort had ?1 site with intimal thickness exceeding the 0.3-mm or 0.5-mm thresholds used for the definition of atherosclerosis. Strikingly, when the more stringent definition of >0.5 mm was used, even the 12- to 19-year-old age group showed atherosclerosis in 17% of subjects. By age 40 years, >70% of individuals showed ?1 coronary site with an intimal thickness >0.5 mm. With a less conservative threshold of 0.3 mm, 21% of teenagers and 91% of individuals >40 years old had ?1 atherosclerotic lesion.
Atherosclerotic coronary disease is the leading cause of death and a major source of morbidity in developed countries, resulting in nearly 1 million deaths and $100 billion in annual costs in the United States alone.16 Necropsy studies have demonstrated that atherosclerosis begins at a very early stage in life. The present study provides unequivocal in vivo evidence of atherosclerosis in young asymptomatic individuals with no evidence of clinical coronary artery disease (Figure 3?). This study is unique because it provides detailed, clinically relevant, quantitative, in vivo information on early atherosclerosis from an asymptomatic young population.
High Prevalence of Coronary Atherosclerosis in Asymptomatic Teenagers and Young Adults
Methods and Results—Intravascular ultrasound was performed in 262 heart transplant recipients 30.9±13.2 days after transplantation to investigate coronary arteries in young asymptomatic subjects. The donor population consisted of 146 men and 116 women (mean age of 33.4±13.2 years). Extensive imaging of all possible (including distal) coronary segments was performed. Sites with the greatest and least intimal thickness in each CASS segment were measured in multiple coronary arteries. Sites with intimal thickness ?0.5 mm were defined as atherosclerotic. A total of 2014 sites within 1477 segments in 574 coronary arteries (2.2 arteries per person) were analyzed. An atherosclerotic lesion was present in 136 patients, or 51.9%. The prevalence of atherosclerosis varied from 17% in individuals <20 years old to 85% in subjects ?50 years old. In subjects with atherosclerosis, intimal thickness and area stenosis averaged 1.08±0.48 mm and 32.7±15.9%, respectively. For all age groups, the average intimal thickness was greater in men than women, although the prevalence of atherosclerosis was similar (52% in men and 51.7% in women).
Conclusions—This study demonstrates that coronary atherosclerosis begins at a young age and that lesions are present in 1 of 6 teenagers. These findings suggest the need for intensive efforts at coronary disease prevention in young adults.
All donors in the study were free of known heart disease, the mean age was 33±13.2 years, and 56% were male. Other donor characteristics are listed in the Table?. In the 262 subjects, 574 major epicardial coronary arteries other than the left main trunk were imaged (2.2 arteries per patient). The left anterior descending coronary artery (LAD) was visualized in 238 patients (90% of the cohort), the left circumflex (LCx) in 180 (69%), and the right coronary artery (RCA) in 156 (56%). All 3 arteries were imaged in 97 patients (37% of subjects), 2 arteries in 118 (45%), and only 1 vessel in 47 (18%). From these arteries, ultrasound images were analyzed for a total of 2014 sites within 1477 CASS segments.
Of 262 individuals, 136 (51.9%) had ?1 atherosclerotic site (intimal thickness >0.5 mm). In these 136 subjects, the intimal thickness at the lesion was 1.08±0.48 mm, and percent stenosis averaged 32.7±15.9%. Figure 3? shows the frequency distribution of greatest intimal thickness in each patient for different age groups, demonstrating that intimal thickness increases progressively with advancing age. In all age groups, a portion of the cohort had ?1 site with intimal thickness exceeding the 0.3-mm or 0.5-mm thresholds used for the definition of atherosclerosis. Strikingly, when the more stringent definition of >0.5 mm was used, even the 12- to 19-year-old age group showed atherosclerosis in 17% of subjects. By age 40 years, >70% of individuals showed ?1 coronary site with an intimal thickness >0.5 mm. With a less conservative threshold of 0.3 mm, 21% of teenagers and 91% of individuals >40 years old had ?1 atherosclerotic lesion.
Atherosclerotic coronary disease is the leading cause of death and a major source of morbidity in developed countries, resulting in nearly 1 million deaths and $100 billion in annual costs in the United States alone.16 Necropsy studies have demonstrated that atherosclerosis begins at a very early stage in life. The present study provides unequivocal in vivo evidence of atherosclerosis in young asymptomatic individuals with no evidence of clinical coronary artery disease (Figure 3?). This study is unique because it provides detailed, clinically relevant, quantitative, in vivo information on early atherosclerosis from an asymptomatic young population.
