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Risk Scores Predict Atherosclerotic Lesions in Young People
C. Alex McMahan, PhD;
Samuel S. Gidding, MD;
Zahi A. Fayad, PhD;
Arthur W. Zieske, MD;
Gray T. Malcom, PhD;
Richard E. Tracy, MD, PhD;
Jack P. Strong, MD;
Henry C. McGill, Jr, MD; for the Pathobiological Determinants of Atherosclerosis in Youth Research Group
Arch Intern Med. 2005;165:883-890.
Background Atherosclerosis begins in childhood and progresses through young adulthood to form the lesions that cause coronary heart disease. These preclinical lesions are associated with coronary heart disease risk factors in young persons.
Methods The Pathobiological Determinants of Atherosclerosis in Youth study collected arteries and samples of blood and other tissues from persons aged 15 to 34 years who died of external causes and underwent autopsy in forensic laboratories. We measured the coronary heart disease risk factors and atherosclerotic lesions in the coronary arteries (CAs) (n = 1117) and the abdominal aorta (n = 1458).
Results We developed risk scores, normalized so that a 1-unit increase was equivalent to a 1-year increase in age, to estimate the probability of advanced atherosclerotic lesions in the CAs and the abdominal aorta from age, sex, serum lipoprotein concentrations, smoking, hypertension, obesity, and hyperglycemia. Odds ratios for a 1-unit increase in the risk scores were 1.18 (95% confidence interval, 1.14-1.22) for the CAs and 1.29 (95% confidence interval, 1.23-1.35) for the abdominal aorta. These risk scores had good discrimination (c-indexes: 0.78 for the CAs and 0.84 for the abdominal aorta) and were calibrated. The presence of abdominal aortic lesions increased the likelihood of having CA lesions.
Conclusion Risk scores calculated from traditional coronary heart disease risk factors provide a tool for identifying young individuals with a high probability of having advanced atherosclerotic lesions.
Author Affiliations: Department of Pathology, The University of Texas Health Science Center at San Antonio (Drs McMahan and McGill); Outreach Services, Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Del, and Department of Pediatrics, Jefferson Medical College, Philadelphia, Pa (Dr Gidding); Departments of Radiology and Medicine, Mount Sinai School of Medicine, New York, NY (Dr Fayad); Department of Pathology, Louisiana State University Health Sciences Center, New Orleans (Drs Zieske, Malcom, Tracy, and Strong); and the Department of Physiology and Medicine, Southwest Foundation for Biomedical Research, San Antonio (Dr McGill).
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