Longitudinal associations of cumulative dyslipidaemia from mid-adolescence through young adulthood with arterial stiffness progression: the ALSPAC study

Abstract

Abstract Background Arterial stiffness assessed with carotid-femoral pulse wave velocity (cfPWV) strongly predicts the risk of cardiovascular morbidity and mortality. Recent temporal causal evidence suggests that cfPWV progression may precede the development of cardiometabolic diseases in adolescence, young adults, and middle-aged adults. However, the longitudinal relationship between cfPWV progression and dyslipidaemia in the young population is unclear. Purpose To investigate the longitudinal associations of total cholesterol (TC), non–high-density lipoprotein cholesterol (non–HDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride, and low-density lipoprotein cholesterol (LDL-C) with cfPWV progression in adolescents. Methods We studied 1779 British 15-year-olds (50% females) followed up for 9 years. TC, triglyceride, and HDL-C were measured in line with standard protocols at ages 15, 17, and 24 years, respectively. LDL-C and non-HDL-C were estimated. Lipid phenotypes were categorized based on the 2011 National Heart, Lung, and Blood Institute classification into normal (reference), and elevated/dyslipidaemia. At age 17 and 24 years, cfPWV was computed from pressure waveforms obtained using the Vicorder device. We conducted linear mixed-effect model analyses and adjusted for sex, age, high sensitivity C-reactive protein, glucose, insulin, total fat mass, lean mass, heart rate, systolic blood pressure, diastolic blood pressure, sedentary time, light physical activity, moderate to vigorous physical activity, family history of cardiometabolic disease, socioeconomic status, pubertal attainment, and smoking status, in addition to lipid covariates such as HDL-C, LDL-C, or triglyceride depending on the predictor. However, TC and non-HDL-C analyses were not adjusted for lipids. Results Participants' mean (SD) age in years at different time points were 15.43 (0.29), 17.69 (0.31), and 24.53 (0.72). Persistently elevated/dyslipidaemia TC: effect estimate 0.006 m/s [95% CI −0.023 to 0.035; p=0.683], non–HDL-C: 0.004 m/s [−0.025 to 0.033; p=0.771], LDL-C: 0.017 m/s [−0.019 to 0.052; p=0.351], and Triglyceride: −0.009 m/s [−0.036 to 0.018; p=0.532] from 15 through 24 years were not cumulatively associated with the 7-year cfPWV progression. Persistent borderline-low/very-low HDL-C: 0.007 m/s [−0.017 to 0.031; p=0.556] was not associated with cfPWV progression. Conclusion These findings suggest that elevated lipids and dyslipidaemia from mid-adolescence through young adulthood were not associated with arterial stiffness progression, a marker of preclinical arteriosclerosis. Thus, lipid-lowering interventions targeted at preventing or reversing arterial stiffness progression in the young may be ineffective, particularly in a healthy young population. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Finnish Cultural Foundation