Abstract 3482: Prevalence and Progression of Subclinical Atherosclerosis in Younger Adults with Low 10-Year Risk but High Lifetime Risk for Cardiovascular Disease: Findings from the CARDIA and MESA Studies

Abstract

Objective : The Adult Treatment Panel (ATP) III recommends estimating 10-year risk for cardiovascular disease (CVD), but this strategy identifies few individuals age ≤ 50 years as high risk. Many individuals have a lifetime risk up to 70% despite a low 10-year risk (<10%) for CVD. We hypothesized that individuals with low 10-year/high lifetime risk would have a greater burden of subclinical atherosclerosis compared to individuals with low 10-year/low lifetime risk. Methods : We included individuals age ≤ 50 from two multiethnic NHLBI-sponsored studies designed to assess the importance of risk factors in the development of CVD [2988 from Coronary Artery Risk Development in Young Adults (CARDIA) study;1076 individuals from the Multi-Ethnic Study of Atherosclerosis (MESA)]. The ATP III 10-year risk and lifetime risk for CVD were estimated for each participant, permitting stratification into three groups: low 10-year (<10%)/low lifetime (<39%) risk, low 10-year (<10%)/high lifetime risk (≥ 39%), and high 10-year risk (≥ 10%). Diabetics were considered to have high 10-year (≥ 10%) risk in all analyses. Baseline levels (CAC, IMT) and change in levels of subclinical atherosclerosis (CAC progression) were compared across the 3 risk strata for both cohorts. Results : As expected, those with high 10-year risk (≥ 10%) had the greatest burden of subclinical atherosclerosis in both studies. Among individuals with low 10-year risk (91% of all participants) in CARDIA, individuals with a high lifetime risk had significantly greater carotid IMT, higher CAC prevalence, and greater incidence of CAC progression compared to individuals with low lifetime risk (see table ). A remarkably similar pattern of results was observed in MESA. Conclusions : Individuals with low 10-year but high lifetime risk for CVD have a greater subclinical disease burden and greater incidence of atherosclerotic progression compared to individuals with low 10-year but low lifetime risk. Baseline Carotid Intima-Media Thickness (IMT), Coronary Artery Calcium (CAC) Prevalence and Progression among CARDIA Participants