Gerald S. Berenson; Sathanur R. Srinivasan
Acknowledgment: The authors thank the children and families who made the Bogalusa Heart Study possible.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-1343.
Requests for Single Reprints: Gerald S. Berenson, MD, 1440 Canal Street, New Orleans, LA 70112; e-mail, email@example.com.
Current Author Addresses: Drs. Berenson and Srinivasan: 1440 Canal Street, New Orleans, LA 70112.
Berenson GS, Srinivasan SR. Cardiovascular Risk in Young Persons: Secondary or Primordial Prevention?. Ann Intern Med. 2010;153:202-203. doi: 10.7326/0003-4819-153-3-201008030-00012
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Published: Ann Intern Med. 2010;153(3):202-203.
In this issue, Pletcher and colleagues (1) study the risk factor burden of serum low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides associated with coronary artery calcification detected by electron-beam computed tomography. They use valuable observations collected over 20 years from the CARDIA (Coronary Artery Risk Development in Young Adults) study.
The risk factor burden of LDL cholesterol, HDL cholesterol, and triglycerides was estimated as a cumulative exposure by time average of nonoptimal levels, as defined by the National Cholesterol Educational Program (NCEP) (2). The NCEP recommendations serve as targets for the general population in the United States. The levels have been progressively revised over time; for example, LDL cholesterol has been reduced from 4.14 mmol/L (160 mg/dL) to 3.37 mmol/L (130 mg/dL) to 2.59 mmol/L (100 mg/dL), and practicing cardiologists now recommend a target level of 1.81 mmol/L (70 mg/dL). As background, childhood studies indicate that the average serum total cholesterol level is 4.27 mmol/L (165 mg/dL), which increases by adulthood to about 5.31 mmol/L (205 mg/dL), whereas the average LDL cholesterol level in childhood is 2.46 mmol/L (95 mg/dL) and increases to 3.11 mmol/L (120 mg/dL) in young adults. As mean levels, these values reflect the high prevalence of abnormal levels even among young persons in our society. Pletcher and colleagues aptly selected suboptimal levels that occurred in most (87%) of the CARDIA cohort. Such values are expected, because mortality from coronary heart disease remains high and the disease is a leading cause of death in the United States. The NCEP guidelines are derived from the high-risk population of our study.
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Cardiology, Coronary Risk Factors, Prevention/Screening.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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