Young Adults

Elevated lipid levels may be tied to cardiac damage in adolescents, young adults

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Key takeaways:

  • Increased lipid levels from age 17 to 24 years were tied to worsening cardiac structure and function.
  • Addressing elevated lipid levels early may improve outcomes and save costs in the long term.

Elevated lipid levels were associated with worsening structural and functional cardiac damage in adolescents and young adults, though in the case of LDL, the relationship was partially mediated by elevated BP and fat mass, data show.

“Evidence on the effect of increasing cholesterol levels on the heart of adolescents and young adults was lacking,” Andrew O. Agbaje, MD, MPH, physician and clinical epidemiologist with the Institute of Public Health and Clinical Nutrition at the University of Eastern Finland, told Healio. “Several studies have associated elevated cholesterol levels in adolescence with premature mortality, stroke and heart attacks in the mid-40s and 50s. This evidence informs the current guidelines on the current age for regular cholesterol checks, which is at age 40 years. Unfortunately, we now see that the damage to the heart in relation to increasing cholesterol levels might have begun 2 decades earlier, and therefore we miss a good chance to prevent adverse events. Checking cholesterol levels at age 40 years is too late and a tragic loss of preventive opportunity.”

Graphical depiction of source quote presented in the article

Agbaje analyzed data from 1,595 adolescents aged 17 years at baseline (60% female) from the Avon Longitudinal Study of Parents and Children who had fasting plasma total cholesterol, triglycerides, HDL, LDL and non-HDL measured at age 17 and 24 years. The findings were published in Atherosclerosis.

The outcomes of interest were left ventricular hypertrophy, defined as LV mass indexed for height2.7 of 51 g/m2.7 or more, and LV dysfunction, defined as LV diastolic function from mitral E/A ratio less than 1.5.

Lipids, LV hypertrophy and LV dysfunction

Agbaje found that the prevalence of LV hypertrophy increased from 3.6% at age 17 years to 11.6% in males and from 1.6% at age 17 years to 4% at age 24 years in females, and that the prevalence of LV dysfunction increased from 7.8% at age 17 years to 16.6% in males and from 10.3% at age 17 years to 15.4% at age 24 years in females.

At 7 years, the following lipid parameters were associated with higher odds of worsening LV hypertrophy: total cholesterol (OR per 1 mmol increase = 1.18; 95% CI, 1.09-1.27), triglycerides (OR per 1 mmol increase = 2.89; 95% CI, 1.54-5.43), LDL (OR per 1 mmol increase = 1.19; 95% CI, 1.08-1.32) and non-HDL (OR per 1 mmol increase = 1.21; 95% CI, 1.11-1.33).

Triglycerides were associated with higher odds of worsening LV dysfunction at 7 years (OR per 1 mmol increase = 1.98; 95% CI, 1.06-3.71), Agbaje wrote.

There was no relationship between HDL levels and worsening cardiac structure and function.

The relationship between LDL and worsening LV hypertrophy was partially mediated by systolic BP (12%) and fat mass (25%), Agbaje found.

“The results are similar in both males and females, and it unfortunately affects adolescents with normal weight and normal blood pressure alike,” Agbaje told Healio. “A $60-per-person cholesterol check in adolescence may prevent $200,000 worth of medical intervention by age 50 years. It is rather sad that universal pediatric lipid screening is still an ongoing debate, while we lose several brilliant minds to the potential pangs of heart diseases and premature death. We have proposed an ‘adolescent cholesterol passport’ in the form of a vaccination card that enables teenagers to check and record their cholesterol level once every 10 years at the health center. This will save at least one in five cases of future heart diseases, and enable early detection and prevention.”

‘A devil’s triad’

The findings dovetail with a prior study showing that sedentary behavior in childhood contributes greatly to increases in cholesterol between mid-adolescence and young adulthood, Agbaje told Healio.

“These new studies present a devil’s triad of sedentariness-hypercholesterolemia-heart damage by mid-20s, leading to a pathologic vicious cycle that stops the heartbeat,” he said. “Nonetheless, there is good news, one of the solutions we have identified is that light physical activity of 3 to 4 hours per day from childhood significantly lowers cholesterol levels, and children, adolescents and young adults should be encouraged to accumulate this amount of light exercise every day.”

Cirrhosis a ‘silent Epidemic’ in Young Adults, Women

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Rates of cirrhosis are increasing, particularly among young adults and women, and an epidemic of non-alcoholic fatty liver disease (NAFLD) is one possible reason, say researchers from Canada.

Traditionally, cirrhosis has been considered a disease of older men, but the face of cirrhosis is changing, Dr. Jennifer Flemming from Queen’s University, in Kingston, Canada, told Reuters Health by phone.

“This is likely either related to alcohol or non-alcohol-related fatty liver disease,” she explained. Non-alcoholic fatty liver disease has been on the rise over the past two decades.

“Alcohol use patterns in young individuals and women have also changed over the past several decades such that women are drinking pretty much the same amount as men and women are predisposed to alcohol-related liver disease at much lower levels of alcohol than are men. My thought is that women are kind of catching up to the same risk factors that men have had, in addition to now having this epidemic of non-alcohol-related fatty liver disease,” said Dr. Flemming.

She and her colleagues did a retrospective population-based study looking at cirrhosis incidence by age group. They identified nearly 166,000 people in Ontario with cirrhosis from 1997 to 2016.

New cases of cirrhosis nearly doubled in the province during the study period, from 6,318 new cases diagnosed in 1997 (3,979 males/2,339 females) to 12,047 in 2016 (7,061 males/4,986 females).

The risk of cirrhosis is 116% higher for millennials who were born in 1990 than for baby boomers born in 1951, the researchers report in The Lancet Gastroenterology & Hepatology, online December 17. For women, the risk is even higher. A woman born in 1990 was 160% more likely to be diagnosed with cirrhosis than a woman born in 1951.

Strategies to increase awareness of this “silent epidemic in young adults and women are needed,” the researchers note in their paper.

“Future studies able to define the cause and natural history of cirrhosis in these groups are essential to develop strategies that could reverse these trends for future generations,” they conclude.

Funding for the study was provided by the Southeastern Ontario Academic Medical Association and the American Association for the Study of Liver Disease (AASLD). Dr. Flemming has received grants from both organizations.

Marijuana use in early adulthood may increase prediabetes risk in middle age

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Young adults who self-reported smoking marijuana had a greater risk for developing prediabetes by middle adulthood when compared with adults who reported never smoking marijuana, according to research in Diabetologia.

In cross-sectional and prospective studies analyzing the metabolic health of adults who self-reported the frequency and quantity of cannabis use, researchers were unable to associate smoking marijuana with an increased risk for developing type 2 diabetes.

“Marijuana use, by status or lifetime frequency, was not associated with incidence or presence of diabetes after adjustment for potential confounding factors,” the researchers said in a press release. “However, marijuana use was associated with the development and prevalence of prediabetes after adjustment. Specifically, occurrence of prediabetes in middle adulthood was significantly elevated for individuals who reported using marijuana in excess of 100 times by young adulthood.”

Michael P. Bancks, a PhD student at the University of Minnesota School of Public Health, and colleagues analyzed data from 3,034 adults who self-reported marijuana use for the ongoing CARDIA study at year 25 (2010-2011), as well as data from 3,151 adults who self-reported marijuana use and did not have prediabetes or diabetes at study year 7 (1992-1993) and who returned for at least one of the four subsequent follow-up examinations over 18 years. Participants completed a self-administered questionnaire on previous and current illegal drug use at each follow-up examination; participants who reported using an illegal drug also reported the number of days of use in the previous 30 days and reported lifetime use (1-2 times, 3-9 times, 10-99 times or more than 100 times).

Adults at study year 25 who reported current marijuana use had higher odds of developing prediabetes, with the risk persisting after adjustment for age, sex and race (OR = 1.65; 95% CI, 1.15-2.38). The risk was slightly lower for adults who reported a lifetime marijuana use of 100 times or more (OR = 1.49; 95% CI, 1.06-2.11) when compared with adults who reported never using marijuana. Researchers found no link between marijuana use and type 2 diabetes.

“In unadjusted analysis, a decreased risk of diabetes was found for those who reported marijuana use compared with never-users, but this did not attain statistical significance,” the researchers wrote. “The associations were attenuated after adjustment for basic demographic and lifestyle characteristics; further adjustment for dietary pattern and [blood pressure] resulted in the greatest attenuation of estimates.”

During 18 years of follow-up, researchers also found a greater risk for prediabetes for participants who reported using marijuana 100 or more times in their lifetime compared with those who reported never using marijuana (HR = 1.39; 95% CI, 1.13-1.71). BMI and waist circumference did not affect the association, according to researchers.

“These results contrast with those previously reported on marijuana use and metabolic health,” the researchers wrote. “Future studies should look to objectively measure mode and quantity of marijuana use in relation to prospective metabolic health.” – by Regina Schaffer

Brain Images Of Depressed Adults Reveal Too Many Network Connections Related To Rumination

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While “the unexamined life is not worth living,” too much self-reflection may be a big-time negative, or so say psychologists who believe rumination — when you think about a problem over and over without coming to a solution — is a risk factor for depression and for reoccurrence of depression. Now, a new study from the University of Illinois at Chicago plainly reveals the startling effects of rumination on the brain. Brain scans of previously depressed young adults showed hyperconnected emotional and cognitive networks, especially in the regions related to rumination, the researchers found. “Rumination is not a very healthy way of processing emotion,” said Dr. Scott Langenecker, associate professor of psychiatry and psychology at UIC.

depression

Previous Studies of Depression

Two relatively recent studies of depression may provide insight to those who are frequently down in the dumps. A 2011 survey of more than 30,000 people found that, as expected, negative life events in childhood or early adulthood were the strongest factors when predicting whether or not you might be prone to depression and anxiety. But the study carried an important caveat; how much you ruminate and blame yourself for these past events determined, to a very large extent, how depressed or anxious you might become. In other words, you could possibly gain some control over depression by zealously regulating your thoughts.

A separate study published just last year found that depressed people have more abstract goals than their healthier counterparts, who tended to be more precise in their aims. While a depressed person, for instance, aims “to be happy,” a non-depressed person might aim to “add two more workouts to my schedule each week.” The researchers believe less specific goals are more ambiguous and harder to visualize, thus they may offer less motivation. In essence, the fuzzy goal may be harder to achieve and so contributes to depression.

For the current study, a team of UIC researchers used functional magnetic resonance imaging (fMRI) to examine network connections in the brains of young adults between the ages of 18 and 23 while they were in a resting state. Among the participants, 30 had previously experienced depression though they were currently unmedicated, while 23 were healthy controls who had never experienced depression. “We wanted to see if the individuals who have had depression during their adolescence were different from their healthy peers,” said Dr. Rachel Jacobs, research assistant professor in psychiatry and lead author of the study.

Upon examination, the team found many regions that are hyperconnected, “or talking to each other a little too much,” among the participants who had a history of depression, Jacobs explained, and these hyperconnected networks were related to rumination. The researchers also looked at cognitive control or the ability to engage and disengage in thought processes or behaviors; this is a predictor of response to treatment and also a forecaster of relapse. “As rumination goes up, cognitive control goes down,” Langenecker noted.

The researchers plan to follow these young adults to see whether or not hyperconnectivities predict who will or won’t have a recurrence of depression. “If we can help youth learn how to shift out of maladaptive strategies such as rumination, this may protect them from developing chronic depression and help them stay well as adults,” Jacobs said.

Source: Jacobs R, Jenkins LM, Langenecker S, et al. Increased Coupling of Intrinsic Networks in Remitted Depressed Youth Predicts Rumination and Cognitive Control. PLOS ONE. 2014.

Insomnia Increases Stroke Risk.

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People with insomnia may be more likely to experience a stroke compared with people who sleep well, a risk that is especially pronounced among young adults, suggests a retrospective cohort study. The study is based on a review of claims data from 21 438 people with insomnia and 64 314 age- and sex-matched controls in Taiwan (Wu M-P et al. Stroke. 2014;45[5]:1349-1354.

 People with insomnia have a higher risk of stroke compared with persons who sleep well, especially among young adults, a new study has found.

http://jama.jamanetwork.com/article.aspx?articleid=1874506&utm_campaign=social_052814&utm_medium=facebook&utm_source=jama_fb

 

Association Between Duration of Overall and Abdominal Obesity Beginning in Young Adulthood and Coronary Artery Calcification in Middle Age.

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Importance  Younger individuals are experiencing a greater cumulative exposure to excess adiposity over their lifetime. However, few studies have determined the consequences of long-term obesity.

Objective  To examine whether the duration of overall and abdominal obesity was associated with the presence and 10-year progression of coronary artery calcification (CAC), a subclinical predictor of coronary heart disease.

Design, Setting, and Participants  Prospective study of 3275 white and black adults aged 18 to 30 years at baseline in 1985-1986 who did not initially have overall obesity (body mass index [BMI] ≥30) or abdominal obesity (men: waist circumference [WC] >102 cm; women: >88 cm) in the multicenter, community-based Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants completed computed tomography scanning for the presence of CAC during the 15-, 20-, or 25-year follow-up examinations. Duration of overall and abdominal obesity was calculated using repeat measurements of BMI and WC, respectively, performed 2, 5, 7, 10, 15, 20, and 25 years after baseline.

Main Outcomes and Measures  Presence of CAC was measured by computed tomography at the year 15 (2000-2001), year 20 (2005-2006), or year 25 (2010-2011) follow-up examinations. Ten-year progression of CAC (2000-2001 to 2010-2011) was defined as incident CAC in 2010-2011 or an increase in CAC score of 20 Agatston units or greater.

Results  During follow-up, 40.4% and 41.0% developed overall and abdominal obesity, respectively. Rates of CAC per 1000 person-years were higher for those who experienced more than 20 years vs 0 years of overall obesity (16.0 vs 11.0, respectively) and abdominal obesity (16.7 vs 11.0). Approximately 25.2% and 27.7% of those with more than 20 years of overall and abdominal obesity, respectively, experienced progression of CAC vs 20.2% and 19.5% of those with 0 years. After adjustment for BMI or WC and potential confounders, the hazard ratios for CAC for each additional year of overall or abdominal obesity were 1.02 (95% CI, 1.01-1.03) and 1.03 (95% CI, 1.02-1.05), respectively. The adjusted odds ratios for CAC progression were 1.04 (95% CI, 1.01-1.06) and 1.04 (95% CI, 1.01-1.07), respectively. Associations were attenuated but largely persisted following additional adjustment for potential intermediate metabolic factors during follow-up.

Conclusions and Relevance  Longer duration of overall and abdominal obesity was associated with subclinical coronary heart disease and its progression through midlife independent of the degree of adiposity. Preventing or at least delaying the onset of obesity in young adulthood may lower the risk of developing atherosclerosis through middle age.

Source: JAMA