TY - JOUR
T1 - Time Course of LDL Cholesterol Exposure and Cardiovascular Disease Event Risk
AU - Domanski, Michael J.
AU - Tian, Xin
AU - Wu, Colin O.
AU - Reis, Jared P.
AU - Dey, Amit K.
AU - Gu, Yuan
AU - Zhao, Lihui
AU - Bae, Sejong
AU - Liu, Kiang
AU - Hasan, Ahmed A.
AU - Zimrin, David
AU - Farkouh, Michael E.
AU - Hong, Charles C.
AU - Lloyd-Jones, Donald M.
AU - Fuster, Valentin
N1 - Publisher Copyright:
© 2020 American College of Cardiology Foundation
PY - 2020/9/29
Y1 - 2020/9/29
N2 - Background: Incident cardiovascular disease (CVD) increases with increasing low-density lipoprotein cholesterol (LDL-C) concentration and exposure duration. Area under the LDL-C versus age curve is a possible risk parameter. Data-based demonstration of this metric is unavailable and whether the time course of area accumulation modulates risk is unknown. Objectives: Using CARDIA (Coronary Artery Risk Development in Young Adults) study data, we assessed the relationship of area under LDL-C versus age curve to incident CVD event risk and modulation of risk by time course of area accumulation—whether risk increase for the same area increment is different at different ages. Methods: This prospective study included 4,958 asymptomatic adults age 18 to 30 years enrolled from 1985 to 1986. The outcome was a composite of nonfatal coronary heart disease, stroke, transient ischemic attack, heart failure hospitalization, cardiac revascularization, peripheral arterial disease intervention, or cardiovascular death. Results: During a median 16-year follow-up after age 40 years, 275 participants had an incident CVD event. After adjustment for sex, race, and traditional risk factors, both area under LDL-C versus age curve and time course of area accumulation (slope of LDL-C curve) were significantly associated with CVD event risk (hazard ratio: 1.053; p < 0.0001 per 100 mg/dl × years; hazard ratio: 0.797 per mg/dl/year; p = 0.045, respectively). Conclusions: Incident CVD event risk depends on cumulative prior exposure to LDL-C and, independently, time course of area accumulation. The same area accumulated at a younger age, compared with older age, resulted in a greater risk increase, emphasizing the importance of optimal LDL-C control starting early in life.
AB - Background: Incident cardiovascular disease (CVD) increases with increasing low-density lipoprotein cholesterol (LDL-C) concentration and exposure duration. Area under the LDL-C versus age curve is a possible risk parameter. Data-based demonstration of this metric is unavailable and whether the time course of area accumulation modulates risk is unknown. Objectives: Using CARDIA (Coronary Artery Risk Development in Young Adults) study data, we assessed the relationship of area under LDL-C versus age curve to incident CVD event risk and modulation of risk by time course of area accumulation—whether risk increase for the same area increment is different at different ages. Methods: This prospective study included 4,958 asymptomatic adults age 18 to 30 years enrolled from 1985 to 1986. The outcome was a composite of nonfatal coronary heart disease, stroke, transient ischemic attack, heart failure hospitalization, cardiac revascularization, peripheral arterial disease intervention, or cardiovascular death. Results: During a median 16-year follow-up after age 40 years, 275 participants had an incident CVD event. After adjustment for sex, race, and traditional risk factors, both area under LDL-C versus age curve and time course of area accumulation (slope of LDL-C curve) were significantly associated with CVD event risk (hazard ratio: 1.053; p < 0.0001 per 100 mg/dl × years; hazard ratio: 0.797 per mg/dl/year; p = 0.045, respectively). Conclusions: Incident CVD event risk depends on cumulative prior exposure to LDL-C and, independently, time course of area accumulation. The same area accumulated at a younger age, compared with older age, resulted in a greater risk increase, emphasizing the importance of optimal LDL-C control starting early in life.
KW - CARDIA
KW - cardiovascular disease
KW - cholesterol lowering
KW - coronary heart disease
KW - low-density lipoprotein
KW - preventive cardiology
UR - http://www.scopus.com/inward/record.url?scp=85090825709&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2020.07.059
DO - 10.1016/j.jacc.2020.07.059
M3 - Article
C2 - 32972526
AN - SCOPUS:85090825709
SN - 0735-1097
VL - 76
SP - 1507
EP - 1516
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 13
ER -