Effects of nonlipid risk factors on atherosclerosis in youth with a favorable lipoprotein profile

Background-The strong association between coronary heart disease and dyslip oproteinemia has often overshadowed the effects of the nonlipid risk factor s-smoking, hypertension, obesity, and diabetes and impaired glucose toleran ce-and even led to questioning the importance of these risk factors in the presence of a favorable lipoprotein profile. Methods and Results-A cooperative multicenter study, the Pathobiological De terminants of Atherosclerosis in Youth (PDAY), examined the relation of the nonlipid risk factors to atherosclerosis in 629 men and 227 women 15 to 34 years of age who died of external causes and who had a favorable lipoprote in profile (non-HDL cholesterol <4.14 mmol/L [< 160 mg/dL] and HDL choleste rol greater than or equal to0.91 mmol/L [greater than or equal to 35 mg/dL] ). In the abdominal aorta, smokers had more extensive fatty streaks and rai sed lesions than nonsmokers, and hypertensive blacks had more raised lesion s than normotensive blacks, In the right coronary artery, hypertensive blac ks had more raised lesions than normotensive blacks, obese men (body mass i ndex greater than or equal to 30 kg/m(2)) had more extensive fatty streaks and raised lesions than nonobese men, and individuals with impaired glucose intolerance had more extensive fatty streaks. Obese men had more severe le sions (American Heart Association grade 2 through 5) of the left anterior d escending coronary artery. Conclusions-These substantial effects of the nonlipid risk factors on the e xtent and severity of coronary and aortic atherosclerosis, even in the pres ence of a favorable lipoprotein profile, support the need to control all ca rdiovascular risk factors.