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(Circulation. 2008;117:32-42.)
© 2008 American Heart Association, Inc.

Epidemiology

Utility of Currently Recommended Pediatric Dyslipidemia Classifications in Predicting Dyslipidemia in Adulthood

Evidence From the Childhood Determinants of Adult Health (CDAH) Study, Cardiovascular Risk in Young Finns Study, and Bogalusa Heart Study

Costan G. Magnussen, BHM; Olli T. Raitakari, MD, PhD; Russell Thomson, PhD; Markus Juonala, MD, PhD; Dharmendrakumar A. Patel, MD, MPH; Jorma S.A. Viikari, MD, PhD; Jukka Marniemi, PhD; Sathanur R. Srinivasan, PhD; Gerald S. Berenson, MD; Terence Dwyer, MD, MPH; Alison Venn, PhD

From Menzies Research Institute, University of Tasmania, Hobart, Australia (C.G.M., R.T., A.V.); Research Center of Applied and Preventive Cardiovascular Medicine (M.J.) and Departments of Clinical Physiology (O.T.R.) and Medicine (J.S.A.V.), University of Turku, Turku, Finland; Department of Epidemiology, Tulane Center for Cardiovascular Health, Tulane University School of Public Health and Tropical Medicine, New Orleans, La (D.A.P., S.R.S., G.S.B.); National Public Health Institute, Department of Health and Functional Capacity, Turku, Finland (J.M.); and Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Melbourne, Australia (T.D.).

Correspondence to Costan Magnussen, Menzies Research Institute, Private Bag 23, Hobart, Tasmania 7001, Australia. E-mail cmagnuss{at}utas.edu.au

Received June 1, 2007; accepted September 28, 2007.

Background— New age- and sex-specific lipoprotein cut points developed from National Health and Nutrition Examination Survey (NHANES) data are considered to be a more accurate classification of a high-risk lipoprotein level in adolescents compared with existing cut points established by the National Cholesterol Education Program (NCEP). The aim of this study was to determine which of the NHANES or NCEP adolescent lipoprotein classifications was most effective for predicting abnormal levels in adulthood.

Methods and Results— Adolescent and adult measures of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides were collected in 365 Australian, 1185 Finnish, and 273 US subjects participating in 3 population-based prospective cohort studies. Lipoprotein variables in adolescence were classified according to NCEP and NHANES cut points and compared for their ability to predict abnormal levels in adulthood. With the use of diagnostic performance statistics (sensitivity, specificity, positive predictive value, negative predictive value, area under receiver operating characteristic curve) in pooled and cohort-stratified data, the NHANES cut points (compared with NCEP cut points) were more strongly predictive of low high-density lipoprotein cholesterol in adults but less predictive of high total cholesterol, high low-density lipoprotein cholesterol, and high triglyceride levels in adults. We identified heterogeneity in the relative usefulness of each classification between cohorts.

Conclusions— The separate use of NHANES cut points for high-density lipoprotein cholesterol and NCEP cut points for total cholesterol, low-density lipoprotein cholesterol, and triglycerides yielded the most accurate classification of adolescents who developed dyslipidemia in adulthood.

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CLINICAL PERSPECTIVE

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