Section II: Lipid management A. Epidemiology update High prevalence of coronary atherosclerosis in teens and young adults Content Points: Intravascular ultrasonography (IVUS) provides a unique opportunity for in vivo characterization of early atherosclerosis. In this study, Tuzcu and colleagues performed IVUS in 262 heart transplant recipients approximately 1 month after transplantation to investigate coronary arteries in young asymptomatic subjects.1 The donor population consisted of 146 men and 116 women, ranging from 23 to 45 years old. A total of 2014 sites within 1477 segments in 574 coronary arteries (2.2 arteries per person) were analyzed. The prevalence of atherosclerosis varied from 17% in individuals <20 years old to 85% in donors aged >50 years old. This study demonstrates that coronary atherosclerosis begins at a young age. Lesions were present in 1 of 6 teenagers. The findings suggest the need for intensive efforts at coronary disease prevention in young adults.

Long-term risk of CHD death in young men according to baseline cholesterol level Content points: The Chicago Heart Association Detection Project in Industry study examined the impact of coronary heart disease risk factors in young men on long-term outcome.2 The study enrolled 11 017 men aged 18 through 39 years in 1967-1973 and they were followed-up for 25 years. A study of mortality risks and estimated life expectancy in relation to baseline serum cholesterol levels demonstrated a continuous, graded relationship of serum cholesterol level to long-term risk of CHD. Age-adjusted mortality increases from 5.5 deaths per 1000 men with a baseline serum cholesterol of <160 mg/dL to 84 deaths per 1000 men with a baseline cholesterol level of >280 mg/dL. Findings were similar for the impact of elevated cholesterol levels on cardiovascular disease and all-cause mortality. Clinical implications: This demonstration of the relationship between serum cholesterol levels in young men and long-term risk of CHD suggests the value of detecting and treating hypercholesterolemia in younger adults

Impact of weight on 10-year risk of developing heart disease Content points: A 10-year follow-up (1986-1996) of middle-aged women in the Nurses’ Health Study (n = 77 690 women aged 30 to 55 years) and of men in the Health Professionals Follow-up Study (n = 46 060 men aged 40 to 75 years) showed that in both cohorts, the risk of developing heart disease increased with severity of overweight.3 Adults who were overweight but not obese (ie body mass index [BMI] between 25.0 and 29.9) were more likely to develop heart disease than their leaner peers. The risk of heart disease was 1.4 times greater in women and 1.5 times greater in men after adjusting for age, smoking status, and race. The risk of heart disease was 2.0 times greater in men with a BMI of 30 to 34.9 and 2.2 times greater with a BMI of >35.