Associations of coronary heart disease risk factors with the intermediate lesion of atherosclerosis in youth

The raised fatty streak (fatty plaque) is the gross term for the lesion int ermediate between the juvenile (flat) fatty streak and the raised lesion of atherosclerosis. We measured the percentage of intimal surface involved wi th flat fatty streaks, raised fatty streaks, and raised lesions in the aort as and right coronary arteries of 2876 autopsied persons aged 15 through 34 years who died of external causes. Raised fatty streaks were present in th e abdominal aortas of approximate to 20% of 15- to 19-year-old subjects, an d this percentage increased to approximate to 40% for 30- to 34-year-old su bjects, Raised fatty streaks were present in the right coronary arteries of approximate to 10% of 15- to 19-year-old subjects, and this percentage inc reased to approximate to 30% for 30- to 34-year-old subjects. The percent i ntimal surface involved with raised fatty streaks increased with age in bot h arteries and was associated with high non-high density lipoprotein (HDL) and low HDL cholesterol concentrations in the abdominal aorta and right cor onary artery, with hypertension in the abdominal aorta, with obesity in the right coronary artery of men, and with impaired glucose tolerance in the r ight coronary artery. Associations of risk factors with raised fatty streak s became evident in subjects in their late teens, whereas associations of r isk 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 coronary heart disease risk factors accelerate atherogenesis in the second decade of life. Thus, long-range prevention of atherosclerosis should begin in childhood or adolescence.