Longitudinal impact of lipid levels on subclinical atherosclerosis in adolescents: insights from the LOOK study

Abstract

Background Carotid intima-media thickness (CIMT) is a validated, non-invasive marker of subclinical atherosclerosis. While oxidised low-density lipoprotein cholesterol (LDL-C) and very-low-density lipoprotein cholesterol (VLDL-C) have traditionally been considered the primary drivers of atherosclerosis, recent evidence highlights the contributory role of triglycerides and the triglyceride-to-high-density lipoprotein cholesterol (TG:HDL) ratio. Despite the well-established link between dyslipidaemia and cardiovascular disease, few longitudinal studies have assessed the cumulative impact of lipid levels during childhood on subclinical atherosclerosis. Given that lipid abnormalities in youth often persist into adulthood and contribute to cardiovascular risk, understanding how long-term lipid exposure influences CIMT is crucial.

Purpose This study aimed to investigate the long-term impact of lipid load on CIMT in adolescents from the Lifestyle of Our Kids (LOOK) cohort, to better characterise early contributors to subclinical atherosclerosis.

Methods In this prospective cohort study, 85 participants aged 16 years had CIMT measured in 2013 using ultrasound. Fasting lipids were assessed at four time points over an 8-year period (ages 8–16). Lipid load was calculated as the time-weighted average of total cholesterol, HDL-C, LDL-C, and TG. Associations between lipid load and CIMT were evaluated using multivariable linear regression models adjusted for sex and height.

Results Boys exhibited significantly higher CIMT than girls (0.438 mm versus 0.422 mm, p < 0.01), and height was positively correlated with CIMT (r = 0.31, p < 0.001). In multivariable analysis adjusting for sex and height, the load of both triglycerides and the TG:HDL ratio was positively associated with CIMT (β = 30.1 and β = 27.5, respectively; p < 0.05). In contrast, the loads of total cholesterol, LDL-C, and HDL-C were not significantly associated with CIMT (p > 0.25 for all).

Conclusions Higher cumulative triglyceride levels and TG:HDL ratio from childhood to adolescence are associated with increased CIMT, suggesting that triglycerides may contribute to the early development of atherosclerosis and serve as an important cardiovascular risk factor in children. Show more