PDAY risk score predicts advanced coronary artery atherosclerosis in middle-aged persons as well as youth
Introduction
Atherosclerosis begins in childhood and progresses during adolescence and young adulthood [1] to result in lesions that cause clinically manifest coronary heart disease (CHD) in middle-aged and older individuals [2], [3]. The risk factors for CHD are associated with atherosclerosis during adolescence and the young adult years [4], [5], [6], [7], [8], decades before the occurrence of CHD, and with lesions in older adults [9].
The Community Pathology Study (CPS) showed that the major established risk factors for adult CHD were associated with coronary atherosclerosis as well as death from CHD among young (25–44 years) men autopsied in Orleans Parish, LA between 1969 and 1978 [10]. A second phase of CPS found similar associations in males and females 10–54 years of age who died in Orleans Parish between 1984 and 1986 [11]. The data from this second phase of CPS enabled us to investigate a coronary artery risk score derived from another population of autopsied young persons.
Between 1987 and 1994, immediately following CPS, the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study collected arteries, blood, tissue, and data from individuals 15–34 years of age who died of external causes (accidents, homicides, or suicides) and were autopsied in seven cooperating forensic laboratories in different metropolitan areas of the United States. Using the CHD risk factors (non-HDL cholesterol, HDL cholesterol, smoking, hypertension, obesity, and hyperglycemia) and measurements of arterial lesions, we developed a risk score [12] to estimate the probability of significant lesions in the coronary arteries of young individuals 15–34 years of age. The risk score provides an inexpensive and convenient tool that clinicians may use to identify persons who have high probability of advanced coronary atherosclerosis and who should take action to reduce their long-term risk of clinically manifest CHD.
In this report, we show that the PDAY risk score derived from cases 15–34 years of age predicts atherosclerotic lesions in CPS cases of the same age range and also in CPS cases 35–54 years of age. The results validate the ability of the PDAY risk score to predict atherosclerotic lesions in youth, and extend the applicability of the risk score to middle-aged persons. The results from combined PDAY and CPS data suggest a seamless progression of the effects of the modifiable risk factors on atherosclerosis from 15 to 54 years of age.
Section snippets
Community Pathology Study
Investigators from the Louisiana State University Health Sciences Center (LSUHSC) in New Orleans adopted standardized methods to collect specimens and data from autopsied individuals. Methods are described in previous publications [10], [11].
CPS subjects were persons 10–54 years of age who died in Orleans Parish, LA between 1 January 1984 and 31 December 1986. Approximately 34% of all deaths were autopsied. Only cases age 15–54 are included in this report. Age and race were obtained from the
Risk scores by sex, age, and cause of death
The fraction of CPS cases in each cause of death category is given in Table 2. The mean of the PDAY coronary artery risk score computed from the modifiable risk factors is given in Table 3 for each sex and cause of death category. Because there were only two CHD cases among women, we examined the CHD category only in men. In men, both Related and CHD groups had significantly higher average risk scores than the basal group. The risk score for the related group was slightly, but not
Summary
The PDAY coronary artery risk score that used traditional CHD risk factors to estimate the probability of advanced atherosclerotic lesions in the coronary arteries of 15–34-year-old persons successfully predicted extent of raised lesions in a different group of autopsied subjects of the same age. This result validates the PDAY risk score. The PDAY risk score was related to the extent of raised lesions in the LCF and this result extends the application of the PDAY risk score to that coronary
Acknowledgments
The PDAY study was supported by multiple grants from the National Heart, Lung, and Blood Institute to the following cooperating institutions: University of Alabama, Birmingham, AL; Albany Medical College, Albany, NY; Baylor College of Medicine, Houston, TX; University of Chicago, Chicago, IL; The University of Illinois, Chicago, IL; Louisiana State University Health Sciences Center, New Orleans, LA; University of Maryland, Baltimore, MD; Medical College of Georgia, Augusta, GA; University of
References (30)
- et al.
Coronary heart disease in young black and white males in New Orleans: Community Pathology Study
Am Heart J
(1984) - et al.
Tracking of cardiovascular disease risk factor variables in school-age children
J Chron Dis
(1983) Prevalence and extent of atherosclerosis in adolescents and young adults: implications for prevention from the Pathobiological Determinants of Atherosclerosis in Youth Study
JAMA
(1999)- et al.
The natural history of coronary atherosclerosis
Am J Pathol
(1962) - et al.
Natural history of human atherosclerotic lesions
- et al.
Relation of glycohemoglobin and adiposity to atherosclerosis in youth
Arterioscler Thromb Vasc Biol
(1995) - et al.
Effects of serum lipoproteins and smoking on atherosclerosis in young men and women
Arterioscler Thromb Vasc Biol
(1997) Relation of a postmortem renal index of hypertension to atherosclerosis and coronary artery size in young men and women
Arterioscler Thromb Vasc Biol
(1998)Association of coronary heart disease risk factors with microscopic qualities of coronary atherosclerosis in youth
Circulation
(2000)- et al.
Obesity accelerates the progression of coronary atherosclerosis in young men
Circulation
(2002)
Risk factors and atherosclerotic lesions: a review of autopsy studies
Arteriosclerosis
Nephrosclerosis, glycohemoglobin, cholesterol, and smoking in subjects dying of coronary heart disease
Modern Pathol
Risk scores predict atherosclerotic lesions in young people
Arch Intern Med
Community pathology of atherosclerosis and coronary heart disease: postmortem serum cholesterol and extent of coronary atherosclerosis
Am J Epidemiol
Blood pressure, nephrosclerosis and age: autopsy findings from the Honolulu Heart Program
Modern Pathol
Cited by (54)
Associations of telomere length at birth with predicted atherosclerotic lesions and cardiovascular disease risk factors in midlife: A 40-year longitudinal study
2021, AtherosclerosisCitation Excerpt :In the present study, we aim to examine the association of birth TL with CVD risk factors in midlife by leveraging data from a 40-year follow-up study of offspring from the Collaborative Perinatal Project (CPP) birth cohort. The primary outcome was the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) score [18,19], an established prediction of subclinical atherosclerotic lesions among young to midlife populations in previous studies [20,21]. CVD risk factors including hypertension, hyperlipidemia, diabetes, and metabolic syndrome were examined as secondary outcomes.
Elevated Systemic Inflammatory Burden and Cardiovascular Risk in Young Adults with Endodontic Apical Lesions
2019, Journal of EndodonticsCuring atherosclerosis should be the next major cardiovascular prevention goal
2014, Journal of the American College of CardiologyThe use of lipid-lowering drugs in children
2010, Journal of Clinical LipidologyThe 2018 AHA/ACC/Multi-Society Cholesterol guidelines: Looking at past, present and future
2019, Progress in Cardiovascular DiseasesCitation Excerpt :Thus inclusion of a section on children and adolescents was an important feature of the 2018 AHA/ACC/MS Guidelines. The landmark Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study showed that early measurement of ASCVD risk factors predicts atherosclerosis assessed noninvasively up to 15 years later, and that subsequent change in risk score during the 15-year interval also predicts subclinical atherosclerosis.26 The section on children and adolescents noted that testing for lipid disorders can identify both severe hypercholesterolemia and multifactorial lifestyle-related dyslipidemia, nonfasting lipid testing is effective for initial screening purposes and that non–HDL-C (total cholesterol- HDLC) is a reasonable screening test as well.