(Circulation. 2001;103:2705.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
High Prevalence of Coronary Atherosclerosis in Asymptomatic Teenagers and Young Adults
Evidence From Intravascular Ultrasound
From the Departments of Cardiology (E.M.T., S.R.K., E.T., K.M.Z., R.E.H., J.B.Y., S.E.N.) and Cardiothoracic Surgery (P.M.M.), The Cleveland Clinic Foundation, Cleveland, Ohio.
Correspondence to E. Murat Tuzcu, MD, Cleveland Clinic Foundation, F25 9500, Euclid Ave, Cleveland, OH 44195. E-mail tuzcue{at}ccf.org
Background—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.
Methods and
Results—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).
Conclusions—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.
Key Words: atherosclerosis • ultrasonics • plaque • coronary disease
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|
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|
|
|
|
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|
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|
|
|
|
|
|
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|
|
|
|
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|
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|
|
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|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
 K. O. Akosah, R. M. Cerniglia, P. Havlik, and A. Schaper Myocardial Infarction in Young Adults With Low-Density Lipoprotein Cholesterol Levels <= 100 mg/dL : Clinical Profile and 1-Year Outcomes Chest, December 1, 2001; 120(6): 1953 - 1958. [Abstract] [Full Text] [PDF]
|
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|
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