Pathobiological Studies of Americans in the PDAY Study

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Association of CHD risk factors with the intermediate lesion of atherosclerosis in youth (PDAY Study)

Reproduced from McGill et al. [2000], with permission from Lippincott Williams & Wilkins.

Abdominal aorta

Right coronary artery

]] Low-risk subjects ]] High-risk subjects

Age (years)

Subjects (n = 2,876) aged 15-34 years who died of external causes (accidents, homicides or suicides) within 72 h of injury were autopsied within 48 h of death. High-risk groups were characterized by non-HDL cholesterol of >160 mg/dl, HDL cholesterol of <35 mg/dl, smoking, hypertensive (6110 mm Hg), and BMI of >30.

Conclusion: Association of risk factors with raised fatty streaks became evident in subjects in their late teens, whereas associations of risk factors with raised lesions became evident in subjects aged >25 years. These results are consistent with the putative transitional role of raised fatty streaks and show that CHD risk factors accelerate atherogenesis in the second decade of life. Thus, long-range prevention of atherosclerosis should begin in childhood or adolescence.

Our comments: This study clearly indicates that prevention of atherosclerosis should begin at younger ages. However, relative contributions of risk factors to raised lesions and their causal relationship need to be evaluated carefully. For example, hypertension analyzed by intimal thickness and an algorithm to estimate mean arterial pressure was characterized to be a risk factor in this study, but it may be the effect of atherosclerosis. Other studies revealed unfavorable results of antihypertensive drugs during interventions for CHD, e.g. MRFIT Study (fig. 9), J-LIT Area-Matched Control Study (fig. 11), and ALLHAT Study [The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group, 2002]. Another factor to be estimated is the proportion of FH; high LDL/HDL group in these young generations may include more than the average proportion of FH.

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