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The Atherosclerosis Risk in Young Adults (ARYA) Study

Anath Oren, MD; Lydia E. Vos, MD; Cuno S. P. M. Uiterwaal, MD, PhD; Diederick E. Grobbee, MD, PhD; Michiel L. Bots, MD, PhD

Arch Intern Med. 2003;163:1787-1792.

Background  The relation between cardiovascular risk factors and extent of atherosclerosis in middle-aged and elderly populations is well established. Autopsy studies have suggested that similar associations may be present at a young age. We evaluated the relationship between conventional risk factors and increased carotid intima-media thickness (CIMT) in 750 healthy young adults, aged 27 to 30 years.

Methods  All participants completed a questionnaire on cardiovascular risk factors, had a fasting blood sample drawn, and underwent an ultrasonographic examination of both common carotid arteries to assess common CIMT (CCIMT).

Results  Age (11.2 µm/SD), body mass index (10.3 µm/SD), pulse pressure (5.0 µm/SD), sex (4.8 µm/SD), and low-density lipoprotein cholesterol level (4.3 µm/SD) were independent determinants of increased CCIMT in young adults (R² = 0.36). Total pack-years of smoking, adjusted for age and sex, showed a linear trend with increased CCIMT (P = .02), which attenuated after further adjustment for body mass index. Common CIMT increased gradually and significantly with the number of cardiovascular risk factors present. The estimated absolute risk, based on the Framingham risk function, for development of coronary heart disease within 20 years was 2.5 times higher in individuals with mean CCIMT in the highest quartile compared with those in the lowest quartile of the distribution.

Conclusions  An unfavorable cardiovascular risk profile is associated with a marked increase in CCIMT in young adulthood. Efforts to change modifiable risk factors early in life may retard atherosclerosis development and hence delay the onset of clinical cardiovascular disease later in life.

From the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands. The authors have no relevant financial interest in this article.

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