High prevalence of coronary atherosclerosis in asymptomatic teenagers and young adults - Evidence from intravascular ultrasound

Background-Most of our knowledge about atherosclerosis at young ages is der ived from necropsy studies, which have inherent limitations. Detailed, in v ivo data on aterosclerosis in young individuals are limited. Intravascular ultrasonography provides a unique opportunity for in vivo characterization of early atherosclerosis in a clinically relevant context. Methods and Results-Intravascular ultrasound was performed in 262 heart tra nsplant recipients 30.9 +/- 13.2 days after transplantation to investigate coronary arteries in young asymptomatic subjects. The donor population cons isted of 146 men and 116 women (mean age of 33.4 +/- 13.2 years). Extensive imaging of all possible (including distal) coronary segments was performed . Sites with the greatest;md least intimal thickness in each CASS segment w ere measured in multiple coronary arteries. Sites with intimal thickness gr eater than or equal to0.5 mm were defined as atherosclerotic. A total of 20 14 sites within 1477 segments in 574 coronary arteries (2.2 arteries per pe rson) were analyzed. An atherosclerotic lesion was present in 136 patients, or 51.9%. The prevalence: of atherosclerosis varied from 17% in individual s < 20 years old to 85% in subjects greater than or equal to 50 years old. In subjects with atherosclerosis, intimal thickness and area stenosis avera ged 1.08 +/-0.48 mm and 32.7 +/- 15.9%, respectively. For all age groups, t he average intimal thickness was greater in men than women, although the pr evalence of atherosclerosis was similar (52% in men and 51.7% in women). Conclusions-This study demonstrates that coronary atherosclerosis begins at a young age and that lesions are present in 1 of 6 teenagers. These findin gs suggest the need for intensive efforts at coronary disease prevention in young adults.