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Implications for Prevention From the Pathobiological Determinants of Atherosclerosis in Youth Study

Jack P. Strong, MD; Gray T. Malcom, PhD; C. Alex McMahan, PhD; Richard E. Tracy, MD, PhD; William P. Newman III, MD; Edward E. Herderick; J. Fredrick Cornhill, DPhil; for the Pathobiological Determinants of Atherosclerosis in Youth Research Group

JAMA. 1999;281:727-735.

Context  Atherosclerosis, the underlying cause of coronary heart disease, has been shown to be present even in young adults.

Objective  To document the extent and severity of atherosclerosis in adolescents and young adults in the United States.

Design and Setting  The Pathobiological Determinants of Atherosclerosis in Youth Study, a multi-institutional autopsy study conducted in US medical centers.

Subjects  A total of 2876 study subjects, between 15 and 34 years old, black and white, men and women, who died of external causes and underwent autopsy between June 1, 1987, and August 31, 1994.

Main Outcome Measures  Extent, prevalence, and topography of atherosclerotic lesions.

Results  Intimal lesions appeared in all the aortas and more than half of the right coronary arteries of the youngest age group (15-19 years) and increased in prevalence and extent with age through the oldest age group (30-34 years). Fatty streaks were more extensive in black subjects than in white subjects, but raised lesions did not differ between blacks and whites. Raised lesions in the aortas of women and men were similar, but raised lesions in the right coronary arteries of women were less than those of men. The prevalence of total lesions was lower in the right coronary artery than in the aorta, but the proportion of raised lesions among total lesions was higher in the right coronary artery than in the aorta.

Conclusions  Atherosclerosis begins in youth. Fatty streaks and clinically significant raised lesions increase rapidly in prevalence and extent during the 15- to 34-year age span. Primary prevention of atherosclerosis, as contrasted with primary prevention of clinically manifest atherosclerotic disease, must begin in childhood or adolescence.

Author Affiliations: Department of Pathology, Louisiana State University Medical Center, New Orleans (Drs Strong, Malcom, Tracy, and Newman); Department of Pathology, University of Texas Health Science Center, San Antonio (Dr McMahan); Biomedical Engineering Center, Ohio State University, Columbus (Mr Herderick); and Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, Ohio (Dr Cornhill). A list of the PDAY Investigators appears at the end of this article.

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