A 23 year follow-up study of serum lipids change and tracking from adolescence to adulthood : the Kangwha study

Abstract

INTRODUCTION: Many risk factors of cardiovascular disease (CVD) show tracking pattern from childhood. So, early detection of such risk factors is important for prevention of cardiovascular disease. Serum lipid profile is well-known CVD risk factor. Several studies have examined tracking pattern of lipid profile level during long follow-up periods in Western countries, but these studies are still rare in East Asia. The objectives of this study are to evaluate tracking pattern of serum lipid profile level from adolescence to adulthood in Korea and to evaluate the association between lipid profile level at adolescence and the incidence of adult dyslipidemia. METHODS: A total of 400 adolescents (186 male and 214 female) was enrolled in this study. Total cholesterol, triglyceride, and high density lipoprotein (HDL) cholesterol level of study participants were measured at least once during 1992-1996, and were repeatedly measured at least once during 2005-2015. Body mass index (BMI), waist circumstance, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured, and family history of CVD, smoking history, and presence of adult dyslipidemia was checked. The tracking coefficients of lipid profiles were calculated by Generalized Estimating Equation. The association and predictability between serum lipid profile levels at adolescence and adult dyslipidemia was assessed by multiple logistic regression and area under curve (AUC) value. Additional analyses were performed to find out whether repeated lipid profile measurements during adolescence can enhance the predictability of adult dyslipidemia or not. RESULTS: The presence of adult dyslipidemia was 26.3%. When adjusted for age, BMI, waist circumstance, SBP and DBP, tracking coefficient of total cholesterol was 0.64, that of triglyceride was 0.54, and that of HDL cholesterol was 0.58. When adjusted for age, BMI, SBP, family history of CVD, and smoking history, increased total cholesterol level at adolescence was associated with adult dyslipidemia (odds ratio [OR], 1.47; 95% CI, 1.05-2.05, per 1 SD unit increase). Meanwhile, decreased HDL cholesterol level at adolescence was associated with adult dyslipidemia (OR, 0.54; 95% CI, 0.37-0.77, per 1 SD unit decrease). The addition of serum lipid profile level into the model significantly enhanced the AUC value (p=0.02 for total participants, p=0.03 for male, and p=0.01 for female). But the use of the average lipid profile levels of repeated measurements dose not enhanced AUC value (p≥0.26 for total participants, p≥0.42 for male, and p≥0.23 for female). CONCLUSION: Moderate tracking patterns of serum lipid profile level were shown in this study. Serum lipid profile measurements at adolescence could help adult dyslipidemia prediction. Increased total cholesterol and decreased HDL cholesterol at adolescence was associated with adult dyslipidemia. The results of this study supported the importance of lipid profile screening at adolescence for CVD prevention.