University of Oulu

Juhani S. Koskinen, Ville Kytö, Markus Juonala, Jorma S.A. Viikari, Jaakko Nevalainen, Mika Kähönen, Terho Lehtimäki, Nina Hutri-Kähönen, Tomi Laitinen, Päivi Tossavainen, Eero Jokinen, Costan G. Magnussen, Olli T. Raitakari, Childhood risk factors and carotid atherosclerotic plaque in adulthood: The Cardiovascular Risk in Young Finns Study, Atherosclerosis, Volume 293, 2020, Pages 18-25, ISSN 0021-9150,

Childhood risk factors and carotid atherosclerotic plaque in adulthood : the cardiovascular risk in Young Finns Study

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Author: Koskinen, Juhani S.1,2,3; Kytö, Ville1,4; Juonala, Markus1,2,5;
Organizations: 1Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland
2Division of Medicine, Turku University Hospital, Kiinamyllynkatu 4-8, 20521, Turku, Finland
3Department of Medicine, Satakunta Central Hospital, Sairaalantie 3, 28500, Pori, Finland
4Heart Centre, Turku University Hospital, Hämeentie 11, 20521, Turku, Finland
5Department of Medicine, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland
6Faculty of Social Sciences, University of Tampere, Kalevantie 5, 33100, Tampere, Finland
7Department of Clinical Physiology, University of Tampere, Arvo Ylpön katu 34, 33520, Tampere, Finland
8Faculty of Medicine and Health Technology, University of Tampere, Arvo Ylpön katu 34, 33520, Tampere, Finland
9Finnish Cardiovascular Research Center Tampere, University of Tampere, Kalevantie 4, 33100, Tampere, Finland
10Department of Clinical Chemistry, University of Tampere, Arvo Ylpön katu 34, 33520, Tampere, Finland
11Fimlab Laboratories, Arvo Ylpön katu 4, 33520, Tampere, Finland
12Department of Pediatrics, Tampere University Hospital, Teiskontie 35, 33520, Tampere, Finland
13Department of Clinical Physiology, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland
14Department of Pediatrics, Oulu University Hospital, Kajaanintie 50, 90220, Oulu, Finland
15PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Aapistie 5 A, 90220, Oulu, Finland
16Department of Pediatrics, University of Helsinki, Stenbäckinkatu 11, 00290, Helsinki, Finland
17Hospital for Children and Adolescents, Helsinki University Hospital, Stenbäckinkatu 9, 00290, Helsinki, Finland
18Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia
19Department of Clinical Physiology and Nuclear Medicine, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland
20Centre for Population Health Research, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 1.2 MB)
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Language: English
Published: Elsevier, 2020
Publish Date: 2020-04-03


Background and aims: Carotid plaque is a specific sign of atherosclerosis and adults with carotid plaque are at increased risk for cardiovascular outcomes. Atherosclerosis has roots in childhood and pediatric guidelines provide cut-off values for cardiovascular risk factors. However, it is unknown whether these cut-offs predict adulthood advanced atherosclerosis.

Methods: The Cardiovascular Risk in Young Finns Study is a follow-up of children that begun in 1980 when 2653 participants with data for the present analyses were aged 3—18 years. In 2001 and 2007 follow-ups, in addition to adulthood cardiovascular risk factors, carotid ultrasound data was collected. Long-term burden, as the area under the curve, was evaluated for childhood (6—18 years) risk factors. To study the associations of guideline-based cut-offs with carotid plaque, both childhood and adult risk factors were classified according to clinical practice guidelines.

Results: Carotid plaque, defined as a focal structure of the arterial wall protruding into lumen <50% compared to adjacent intima-media thickness, was present in 88 (3.3%) participants. Relative risk for carotid plaque, when adjusted for age and sex, was 3.03 (95% CI, 1.76—5.21) for childhood dyslipidemia, 1.51 (95% CI, 0.99—2.32) for childhood elevated systolic blood pressure, and 1.93 (95% CI, 1.26—2.94) for childhood smoking. Childhood dyslipidemia and smoking remained independent predictors of carotid plaque in models additionally adjusted for adult risk factors and family history of coronary heart disease. Carotid plaque was present in less than 1% of adults with no childhood risk factors.

Conclusions: Findings reinforce childhood prevention efforts and demonstrate the utility of guideline-based cut-offs in identifying children at increased risk for adulthood atherosclerosis.

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Series: Atherosclerosis
ISSN: 0021-9150
ISSN-E: 1879-1484
ISSN-L: 0021-9150
Volume: 293
Pages: 18 - 25
DOI: 10.1016/j.atherosclerosis.2019.11.029
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
3123 Gynaecology and paediatrics
Funding: The Cardiovascular Risk in Young Finns Study has been financially supported by the Academy of Finland: grants 286284, 134309 (Eye), 126925, 121584, 124282, 129378 (Salve), 117787 (Gendi), and 41071 (Skidi), the Social Insurance Institution of Finland, Competitive State Research Financing of the Expert Responsibility area of Kuopio, Tampere and Turku University Hospitals (grant X51001), the Turku University Foundation, Tampere University Hospital Supporting Foundation, the Juho Vainio Foundation, Paavo Nurmi Foundation, the Finnish Foundation of Cardiovascular Research, Orion-Farmos Research Foundation, Sigrid Juselius Foundation, Emil Aaltonen Foundation, Yrjö Jahnsson Foundation, Signe and Ane Gyllenberg Foundation, Diabetes Research Foundation of Finnish Diabetes Association, Tampere Tuberculosis Foundation, the Finnish Cultural Foundation, EU Horizon 2020 (grant 755320 for TAXINOMISIS), European Research Council (grant 742927 for MULTIEPIGEN project), JSK is supported by Maud Kuistila Memorial Foundation, and Päivikki and Sakari Sohlberg Foundation, CGM is supported by a National Heart Foundation of Australia Future Leader Fellowship (100849).
Copyright information: © 2019 Elsevier B.V. All rights reserved. This manuscript version is made available under the CC-BY-NC-ND 4.0 license