High prevalence of coronary atherosclerosis in asymptomatic teenagers and young adults : Evidence from intravascular ultrasound

• Published in: Circulation (New York, N.Y.) Vol. 103; no. 22; pp. 2705 - 2710
• Main Authors: TUZCU, E. Murat, KAPADIA, Samir R, TUTAR, Eralp, ZIADA, Khaled M, HOBBS, Robert E, MCCARTHY, Patrick M, YOUNG, James B, NISSEN, Steven E
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 05.06.2001; American Heart Association, Inc
• Subjects: Adolescent; Adult; Biological and medical sciences; Cardiology. Vascular system; Cohort Studies; Coronary Angiography; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - epidemiology; Coronary Artery Disease - pathology; Coronary heart disease; Female; Heart; Heart Transplantation; Humans; Male; Medical sciences; Middle Aged; Prevalence; Tissue Donors; Tunica Intima - pathology; Ultrasonography, Interventional; United States - epidemiology; Sonography; Human; Vascular disease; Echocardiography; Prevalence; Adolescent; Young adult; Atherosclerosis; Cardiovascular disease; Asymptomatic; Esophageal route; Coronary heart disease
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.CIR.103.22.2705

Most of our knowledge about atherosclerosis at young ages is derived from necropsy studies, which have inherent limitations. Detailed, in vivo data on atherosclerosis in young individuals are limited. Intravascular ultrasonography provides a unique opportunity for in vivo characterization of early atherosclerosis in a clinically relevant context. Intravascular ultrasound was performed in 262 heart transplant recipients 30.9+/-13.2 days after transplantation to investigate coronary arteries in young asymptomatic subjects. The donor population consisted of 146 men and 116 women (mean age of 33.4+/-13.2 years). Extensive imaging of all possible (including distal) coronary segments was performed. Sites with the greatest and least intimal thickness in each CASS segment were measured in multiple coronary arteries. Sites with intimal thickness >/=0.5 mm were defined as atherosclerotic. A total of 2014 sites within 1477 segments in 574 coronary arteries (2.2 arteries per person) were analyzed. An atherosclerotic lesion was present in 136 patients, or 51.9%. The prevalence of atherosclerosis varied from 17% in individuals <20 years old to 85% in subjects >/=50 years old. In subjects with atherosclerosis, intimal thickness and area stenosis averaged 1.08+/-0.48 mm and 32.7+/-15.9%, respectively. For all age groups, the average intimal thickness was greater in men than women, although the prevalence of atherosclerosis was similar (52% in men and 51.7% in women). This study demonstrates that coronary atherosclerosis begins at a young age and that lesions are present in 1 of 6 teenagers. These findings suggest the need for intensive efforts at coronary disease prevention in young adults.