Trajectories of Lipid Profile During Adolescence and Risk of Subclinical Atherosclerosis in Early Adulthood: A Two-Decade Population-Based Study.

Background And Aims: To examine the impact of early-life lipid profile trajectories in adolescence on subclinical atherosclerosis, evidenced by carotid intima-media thickness (cIMT) in adulthood.

Methods And Results: In this trajectory analysis of 1,006 TLGS participants (472 male, mean age = 14.72 ± 3.23 years) with ≥ 3 lipid measurements and 3-year follow-ups, latent class growth modeling was used to analyze heterogeneity in longitudinal lipid alterations (total cholesterol [TC], triglycerides [TG], high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], and non-HDL-C). The association between lipid trajectories and cIMT values, both as continuous and categorical variable, were evaluated using multivariate regression analysis adjusted for age, sex, body mass index, and systolic blood pressure at the baseline, as well as antihypertensive and lipid-lowering drug use, smoking, physical activity, and desired lipid parameter at the nearest survey to cIMT measurement. During a median follow-up of 17.6 years (1999-2018), the "Rising" trajectories of TC, TG, LDL-C, and non-HDL-C were linked to elevated cIMT values. "Rapid-Rising" trajectories of TG, LDL-C, and non-HDL-C notably amplified the risk (odds ratios (OR) = 2.05 [1.46-2.75], 1.99 [1.35-2.92], and 2.02 [1.45-2.77], respectively). Conversely, the "Decreasing" trajectories of TC, LDL-C, and TG were associated with lower cIMT measures (beta-coefficient = -0.09 [-0.16,-0.03], -0.11 [-0.17,-0.01], and -0.08 [-0.14,-0.02], respectively); also "Decreasing" trajectories of the two former lowered the risk by at least 30 %. While HDL-C "Rapid-Decreasing" trajectory doubled the risk of elevated cIMT (OR = 1.98 [1.47-2.68]).

Conclusions: The findings showed unfavorable trajectory alterations in all lipid parameters were significantly associated with higher cIMT values, underscoring the need for sustained efforts to monitor lipid levels from early adolescence.