Elevated Non–HDL Cholesterol During Adolescence Increases Risk of Coronary Atherosclerosis in Mid-Adulthood

Close up of a mother and daughter having an appointment with the pediatrician
Autopsy studies have shown that aortic and coronary artery atherosclerotic lesions are present in toddlers and progresses into adulthood. This study explores the development of coronary atherosclerosis due to non–HDL-C over three stages of life.

Elevated non–high-density lipoprotein cholesterol (non–HDL-C), particularly during adolescence, is strongly associated with the presence of coronary atherosclerosis in mid-adulthood, a study in JAMA Cardiology suggests.

Heart disease develops long before the symptoms manifest. Previous autopsy studies have shown that aortic and coronary artery atherosclerotic lesions are present in children as young as 2 years old. “The prevalence and severity of which rapidly increase during adolescence,” wrote Matthew K. Armstrong, PhD, et al. The authors sought to determine the association between non–HDL-C levels at different life stages and the development of coronary artery calcification in mid-adulthood.

The study included 3,589 participants from the population-based Cardiovascular Risk in Young Finns Study which began in 1980 and included a follow up over 28 years.

Using data from 1980 to 2008, the investigators assessed non–HDL-C levels measured at 3 stages of life, including adolescence (12-18 years of age), young adulthood (21-30 years of age), and mid-adulthood (33-45 years of age).

The primary outcome measure was the association between coronary artery calcification (CAC) in mid-adulthood. Researchers conducted an analysis of this association using a model adjusted for birth year, sex, body mass index, systolic blood pressure, blood glucose, smoking status, use of lipid-lowering and antihypertensive medications, and family history of heart disease.

In the adjusted model, cumulative non–HDL-C exposure across all stages of life was associated with coronary artery calcification (odds ratio [OR], 1.50; 95% CrI, 1.14-1.92). Non–HDL-C was also associated with coronary artery calcification at each life stage, with adolescents featuring the strongest association between coronary artery calcification at mid-adulthood (OR, 1.16; 95% CrI, 1.01-1.46) compared with young adulthood (OR, 1.14; 95% CrI, 1.01-1.43) and mid-adulthood (OR, 1.12; 95% CrI, 1.01-1.34).

“These data suggest elevated non–HDL-C levels at all life stages are associated with coronary atherosclerosis in mid-adulthood. However, adolescent non–HDL-C levels showed the strongest association with the presence of CAC in mid-adulthood,” the authors wrote.

A limitation of this study included the wide and often overlapping credible intervals, with the investigators suggesting their “estimates need to be confirmed and extended to other cardiovascular outcomes of interest.”


Armstrong MK, Fraser BJ, Hartiala O, et al. Association of non-high-density lipoprotein cholesterol measured in adolescence, young adulthood, and mid-ddulthood with coronary artery calcification measured in mid-adulthood. Published online January 27, 2021. JAMA Cardiol. doi:10.1001/jamacardio.2020.7238