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Accumulation of metabolic cardiovascular risk factors in black and white young adults over 20 years
University of Massachusetts Medical School Faculty Publications
  • Nina P. Paynter, Harvard Medical School
  • Catarina I. Kiefe, University of Massachusetts Medical School
  • Cora E. Lewis, University of Alabama - Birmingham
  • Catherine M. Loria, National Heart, Lung, and Blood Institute
  • David C. Goff, Colorado School of Public Health
  • Donald Lloyd-Jones, Northwestern University
UMMS Affiliation
Department of Quantitative Health Sciences
Publication Date
Document Type

BACKGROUND: Cross-sectional clustering of metabolic risk factors for cardiovascular disease in middle-aged adults is well described, but less is known regarding the order in which risk factors develop through young adulthood and their relation to subclinical atherosclerosis.

METHOD AND RESULTS: A total of 3178 black and white women and men in the Coronary Artery Risk Development in Young Adults study were assessed to identify the order in which cardiovascular disease risk factors including diabetes, hypertension, dyslipidemia (low high-density lipoprotein cholesterol or high triglyceride levels), hypercholesterolemia (high total or low-density lipoprotein cholesterol), and obesity develop. Observed patterns of risk factor development were compared with those expected if risk factors accumulated randomly, given their overall distribution in the population. Over the 20 years of follow-up, 80% of participants developed at least 1 risk factor. The first factor to occur was dyslipidemia in 39% of participants, obesity in 20%, hypercholesterolemia in 11%, hypertension in 7%, and diabetes in 1%. Dyslipidemia was the only risk factor both to occur first and to be followed by additional risk factors more often than expected (P < 0.001 for both). Order of risk factor accrual did not affect subclinical atherosclerosis at year 20. Results were similar by sex, race, and smoking status.

CONCLUSIONS: Multiple patterns of cardiovascular risk factor development were observed from young adulthood to middle age. Dyslipidemia, a potentially modifiable condition, often preceded the development of other risk factors and may be a useful target for intervention and monitoring.

  • atherosclerosis,
  • epidemiology,
  • lipids,
  • obesity,
  • primary prevention,
  • risk factors,
  • type 2 diabetes
Rights and Permissions
Copyright © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
DOI of Published Version
J Am Heart Assoc. 2015 Apr 24;4(4). pii: e001548. doi: 10.1161/JAHA.114.001548. Link to article on publisher's site
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Link to Article in PubMed
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Creative Commons License
Creative Commons Attribution-Noncommercial 4.0
Citation Information
Nina P. Paynter, Catarina I. Kiefe, Cora E. Lewis, Catherine M. Loria, et al.. "Accumulation of metabolic cardiovascular risk factors in black and white young adults over 20 years" Vol. 4 Iss. 4 (2015) ISSN: 2047-9980 (Linking)
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