Determinants of intima-media thickness in the young: the ALSPAC Study

Chiesa, S. T. et al. (2021) Determinants of intima-media thickness in the young: the ALSPAC Study. JACC: Cardiovascular Imaging, 14(2), pp. 468-478. (doi: 10.1016/j.jcmg.2019.08.026) (PMID:31607674) (PMCID:PMC7851110)

Abstract

Objectives: This study characterized the determinants of carotid intima-media thickness (cIMT) in a large (n > 4,000) longitudinal cohort of healthy young people age 9 to 21 years. Background: Greater cIMT is commonly used in the young as a marker of subclinical atherosclerosis, but its evolution at this age is still poorly understood. Methods: Associations between cardiovascular risk factors and cIMT were investigated in both longitudinal (ages 9 to 17 years) and cross-sectional (ages 17 and 21 years) analyses, with the latter also related to other measures of carotid structure and stress. Additional use of ultra-high frequency ultrasound in the radial artery at age 21 years allowed investigation of the distinct layers (i.e., intima or media) that may underlie observed differences. Results: Fat-free mass (FFM) and systolic blood pressure were the only modifiable risk factors positively associated with cIMT (e.g., mean difference in cIMT per 1-SD increase in FFM at age 17: 0.007 mm: 95% confidence interval [CI]: 0.004 to 0.010; p < 0.001), whereas fat mass was negatively associated with cIMT (difference: −0.0032; 95% CI: 0.004 to −0.001; p = 0.001). Similar results were obtained when investigating cumulative exposure to these factors throughout adolescence. An increase in cIMT maintained circumferential wall stress in the face of increased mean arterial pressure when increases in body mass were attributable to increased FFM, but not fat mass. Risk factor−associated differences in the radial artery occurred in the media alone, and there was little evidence of a relationship between intimal thickness and any risk factor. Conclusions: Subtle changes in cIMT in the young may predominantly involve the media and represent physiological adaptations as opposed to subclinical atherosclerosis. Other vascular measures might be more appropriate for the identification of arterial disease before adulthood.

• Item Type: Articles
• Additional Information: This research was funded through grants from the British Heart Foundation (RG/10/004/28240, PG/06/145, and CS/15/6/31468), University of Bristol, and UK Medical Research Council and Wellcome Trust (102215/2/13/2, MC_UU_12013/1–9, 096989/Z11/Z, and 086676/7/08/Z). Dr. Deanfield was supported by the British Heart Fund. Dr. Timpson was supported by the University of Bristol NIHR Biomedical Research Centre (BRC-1215-20011) and the MRC Integrative Epidemiology Unit (MC_UU_12013/3). Drs. Davey Smith and Lawlor work in the Medical Research Council Integrative Epidemiology Unit at the University of Bristol, which is supported by the Medical Research Council (MC_UU_00011/1 and MC_UU_00011/6). Dr. Lawlor has received support from Medtronic and Roche Diagnostics.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Sattar, Professor Naveed
• Authors: Chiesa, S. T., Charakida, M., Georgiopoulos, G., Dangardt, F., Wade, K. H., Rapala, A., Bhowruth, D. J., Nguyen, H. C., Muthurangu, V., Shroff, R., Davey Smith, G., Lawlor, D. A., Sattar, N., Timpson, N. J., Hughes, A. D., and Deanfield, J. E.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: JACC: Cardiovascular Imaging
• Publisher: Elsevier
• ISSN: 1936-878X
• ISSN (Online): 1876-7591
• Published Online: 11 October 2019
• Copyright Holders: Copyright © 2019 The Authors
• First Published: First published in JACC: Cardiovascular Imaging 14(2): 468-478
• Publisher Policy: Reproduced under a Creative Commons license