Early-Life Cardiovascular Risk Factor Trajectories and Coronary Artery Calcium Progression in Midlife.

Abstract

To examine 25-year trajectories of body mass index (BMI), low-density lipoprotein cholesterol (LDL-C), and metabolic syndrome (MetS) score, and their composite score in relation to coronary artery calcification (CAC) progression from young adulthood to midlife. We analyzed 2652 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study who completed coronary computed tomography at year 15 (March 1, 2000 to August 31, 2001) and at least one follow-up at year 20 (March 1, 2005 to August 31, 2006) or 25 (March 1, 2010 to August 31, 2011). Latent class trajectory modeling identified long-term patterns of BMI, LDL-C, and MetS score. A composite risk factor score (0-3) was created by counting the number of high-risk trajectories. CAC progression was defined as CAC>0 at follow-up among participants with baseline CAC of 0, an annualized increase ≥10 Agatston units for 0<baseline CAC<100, and an annualized percent increase ≥10% for baseline CAC≥100. Cox models assessed associations. Over a mean 8.9±2.1 years, 694 participants (26.2%) exhibited CAC progression. High-risk trajectories of BMI, LDL-C, and MetS score were independently associated with CAC progression risk. Compared with a score of 0, adjusted hazard ratios (95% confidence interval) were 1.710 (1.341-2.180), 2.368 (1.877-2.989), and 3.733 (2.847-4.895) for scores of 1, 2, and 3. Findings were consistent across subgroups and sensitivity analyses. Adverse trajectories of BMI, LDL-C, and MetS score from early adulthood to midlife are predictors of CAC progression. A trajectory-based composite score may help identify individuals at risk for CAC progression.