CARDIOMETABOLIC RISK FACTORS ASSOCIATED WITH SUBCLINICAL ATHEROSCLEROSIS IN APPARENTLY HEALTHY YOUNG ADULTS

Abstract

Atherosclerosis is a leading cause of morbidity and mortality in developed and developing regions, resulting to overt vascular disease in the later decades of life. Nonetheless, the first signs of atherosclerosis have been identified in up to 78% of healthy young adults at autopsy, indicating that the needed conditions for disease development are present long before the appearance of traditional risk factors. We sought to determine whether and to what degree atherosclerosis is present in apparently healthy young adults devoid of traditional cardiovascular risk factors and obesity, and we investigated the associations of cardiometabolic risk markers with early atherosclerosis burden in this population. Young Caucasian adults (18-36 years) devoid of traditional cardiovascular risk factors and obesity, and no history of chronic medication use or disease were assessed for cardiometabolic risk markers. Subcutaneous abdominal adipose tissue (SAT), ectopic fat depots (visceral abdominal adipose tissue [VAT], epicardial adipose tissue [EAT], and hepatic fat fraction [HFF]), as well as carotid artery wall volumes (CAWV) were measured by magnetic resonance imaging. According to cardiometabolic profile, the 240 participants (25.8 ± 4.5 years; 48% women) had a low-risk for atherosclerosis. However, premature atherosclerosis was present in 68.8% of the population with no difference between prevalence in both sexes although the burden was significantly greater in men vs. women (CAWV: 1817 ± 330 vs. 1579 ± 228 mm3/48mm, p<0.0001). Men possessed lesser SAT volume than women, while they presented higher EAT and VAT volumes compared to women. HFF was similar between men and women. CAWV increased progressively with the accumulation of VAT and EAT. Early atherosclerosis was associated with apolipoprotein B/apolipoprotein A-1 ratio, fasting blood glucose, waist circumference and EAT volume, but waist circumference was the strongest marker independently associated with atherosclerosis burden. In addition, “high-normal” levels of risk factors commonly used (≥50th percentile), especially when clustering, are associated with greater atherosclerosis burden in this population. Subclinical atherosclerosis is present in more than half of all apparently healthy young adults despite the absence of traditional cardiovascular risk factors and obesity. Waist circumference is the strongest predictor of atherosclerosis burden in both males and females of our cohort. Our findings suggest routine waist circumference measurement may help identify risk of premature atherosclerosis in apparently healthy young men and women in the absence of traditional risk factors.