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QuestionÌý Do children who resolve dyslipidemic non–high-density lipoprotein cholesterol (non–HDL-C) levels by adulthood have attenuated risk of developing cardiovascular disease (CVD) events?

FindingsÌý Among 5121 children pooled from 6 prospective cohort studies in the US and Finland (mean follow-up, 8.9 years after age 40 years), individuals who had dyslipidemic non–HDL-C in childhood that resolved during adulthood did not have a significantly increased risk of fatal or nonfatal CVD events (hazard ratio, 1.13) than those whose non–HDL-C levels were persistently within the guideline-recommended range in childhood and adulthood.

MeaningÌý Children in whom dyslipidemic non–HDL-C resolves by adulthood have similar risk of CVD to those who never had dyslipidemia.

ImportanceÌý Elevated non–high-density lipoprotein cholesterol (non–HDL-C; a recommended measure of lipid-related cardiovascular risk) is common in children and increases risk of adult cardiovascular disease (CVD). Whether resolution of elevated childhood non–HDL-C levels by adulthood is associated with reduced risk of clinical CVD events is unknown.

ObjectiveÌý To examine the associations of non–HDL-C status between childhood and adulthood with incident CVD events.

Design, Setting, and ParticipantsÌý Individual participant data from 6 prospective cohorts of children (mean age at baseline, 10.7 years) in the US and Finland. Recruitment took place between 1970 and 1996, with a final follow-up in 2019.

ExposuresÌý Child (age 3-19 years) and adult (age 20-40 years) non–HDL-C age- and sex-specific z scores and categories according to clinical guideline–recommended cutoffs for dyslipidemia.

Main Outcomes and MeasuresÌý Incident fatal and nonfatal CVD events adjudicated by medical records.

ResultsÌý Over a mean length of follow-up of 8.9 years after age 40 years, 147 CVD events occurred among 5121 participants (60% women; 15% Black). Both childhood and adult non–HDL-C levels were associated with increased risk of CVD events (hazard ratio [HR], 1.42 [95% CI, 1.18-1.70] and HR, 1.50 [95% CI, 1.26-1.78] for a 1-unit increase in z score, respectively), but the association for childhood non–HDL-C was reduced when adjusted for adult levels (HR, 1.12 [95% CI, 0.89-1.41]). A complementary analysis showed that both childhood non–HDL-C levels and the change between childhood and adulthood were independently associated with the outcome, suggesting that from a preventive perspective, both childhood non–HDL-C levels and the change into adulthood are informative. Compared with those whose non-HDL-C levels remained within the guideline-recommended range in childhood and adulthood, participants who had incident non–HDL-C dyslipidemia from childhood to adulthood and those with persistent dyslipidemia had increased risks of CVD events (HR, 2.17 [95% CI, 1.00-4.69] and HR, 5.17 [95% CI, 2.80-9.56], respectively). Individuals who had dyslipidemic non–HDL-C in childhood but whose non-HDL-C levels were within the guideline-recommended range in adulthood did not have a significantly increased risk (HR, 1.13 [95% CI, 0.50-2.56]).

Conclusions and RelevanceÌý Individuals with persistent non–HDL-C dyslipidemia from childhood to adulthood had an increased risk of CVD events, but those in whom dyslipidemic non–HDL-C levels resolve by adulthood have similar risk to individuals who were never dyslipidemic. These findings suggest that interventions to prevent and reduce elevated childhood non–HDL-C levels may help prevent premature CVD.