Original Research
Determinants of Intima-Media Thickness in the Young: The ALSPAC Study

https://doi.org/10.1016/j.jcmg.2019.08.026Get rights and content
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Abstract

Objectives

This study characterized the determinants of carotid intima-media thickness (cIMT) in a large (n > 4,000) longitudinal cohort of healthy young people age 9 to 21 years.

Background

Greater cIMT is commonly used in the young as a marker of subclinical atherosclerosis, but its evolution at this age is still poorly understood.

Methods

Associations between cardiovascular risk factors and cIMT were investigated in both longitudinal (ages 9 to 17 years) and cross-sectional (ages 17 and 21 years) analyses, with the latter also related to other measures of carotid structure and stress. Additional use of ultra-high frequency ultrasound in the radial artery at age 21 years allowed investigation of the distinct layers (i.e., intima or media) that may underlie observed differences.

Results

Fat-free mass (FFM) and systolic blood pressure were the only modifiable risk factors positively associated with cIMT (e.g., mean difference in cIMT per 1-SD increase in FFM at age 17: 0.007 mm: 95% confidence interval [CI]: 0.004 to 0.010; p < 0.001), whereas fat mass was negatively associated with cIMT (difference: −0.0032; 95% CI: 0.004 to −0.001; p = 0.001). Similar results were obtained when investigating cumulative exposure to these factors throughout adolescence. An increase in cIMT maintained circumferential wall stress in the face of increased mean arterial pressure when increases in body mass were attributable to increased FFM, but not fat mass. Risk factor−associated differences in the radial artery occurred in the media alone, and there was little evidence of a relationship between intimal thickness and any risk factor.

Conclusions

Subtle changes in cIMT in the young may predominantly involve the media and represent physiological adaptations as opposed to subclinical atherosclerosis. Other vascular measures may be more appropriate for the identification of arterial disease before adulthood.

Key Words

ALSPAC
fat-free mass
intima-media thickness
systolic blood pressure

Abbreviations and Acronyms

BMI
body mass index
BP
blood pressure
CI
confidence intervals
cIMT
common carotid artery intima-media thickness
CVD
cardiovascular disease
CWS
circumferential wall stress
FFM
fat-free mass
FM
fat mass
LCGMM
latent class growth mixture modelling
UGFUS
ultra-high frequency ultrasound technology

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