Usefulness of childhood low-density lipoprotein cholesterol level in predicting adult dyslipidemia and other cardiovascular risks - The Bogalusa Heart Study

Objective: To examine the usefulness of childhood low-density lipoprotein cholesterol (LDL-C) measurement for predicting future dyslipidemia and other cardiovascular risk in adulthood. Methods: A longitudinal cohort over 15 years was identified from a community study of the natural course of arteriosclerosis: 1169 individuals (34% black), aged 5 to 14 years, were included at initial study. Results: Levels of lipoprotein variables in childhood were associated with levels in adulthood, more strongly for total cholesterol (r=.4-.6) and LDL-C (r=.4-.6) than for high-density lipoprotein cholesterol (r=.2-.4) and triglycerides (r=.1-.4). In a stepwise multiple regression, the childhood level was most predictive of the adulthood level, followed by change in body mass index (weight in kilograms/height in meters squared) from childhood to adulthood, with explained variability (R(2)) of .29, .30, .27, and .19 for total cholesterol, LDL-C, high-density lipoprotein cholesterol, and triglycerides, respectively. Adulthood dyslipidemia, as defined by the National Cholesterol Education Program criterion, was best predicted by childhood LDL-C level among other lipoprotein variables. Compared with subjects with acceptable childhood risk (LDL-C level, <2.84 mmol/L [<110 mg/dL]), those (6%) with high childhood risk (LDL-C level, greater than or equal to 3.36 mmol/L [greater than or equal to 130 mg/dL]) not only had a higher prevalence of dyslipidemic total cholesterol level (24%, 8.3-fold), LDL-C level (28%, 5.4-fold), triglyceride level (7%, sevenfold) and lower HDL-C level (14%, 2.1-fold), but also had a significantly higher (P<.05) prevalence of obesity (43%, 1.6-fold) and hypertension (19%, 2.4-fold). In addition, if the childhood LDL-C elevation (>90th percentile) was persistent, the prevalence of adult dyslipidemia would be markedly increased (P<.001). Conclusions: Adverse levels of LDL-C in childhood persist over time, progress to adult dyslipidemia, and relate to obesity and hypertension as well. National Cholesterol Education Program guidelines to classify cardiovascular risk on the basis of LDL-C level are helpful in targeting individuals at risk early in life.