A new study conducted by a multinational team of researchers suggests that late adolescence is a critical period to prevent dyslipidemia-related preclinical atherosclerosis.

The study results might have important clinical implications for managing adolescent patients with lysosomal acid lipase deficiency (LAL-D) who are at risk of accelerated atherosclerosis and consequently cardiovascular and cerebrovascular accidents.

“We observed that all lipid indices except triglyceride were cumulatively associated with [carotid intima-media thickness (cIMT)] progression but not carotid-femoral pulse wave velocity progression. Our results buttress existing evidence on the importance of early-life cardiovascular risk factors and provide novel information regarding the early development of dyslipidemia-related preclinical atherosclerosis,” the researchers said.

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They found that mean lipid levels and proportions in the elevated lipids and dyslipidemia groups increased from ages 15 to 24 years. Further analysis showed that persistently elevated total cholesterol levels and elevated non-high-density lipoprotein cholesterol (non-HDL-C) and low-density lipoprotein cholesterol levels were cumulatively associated with cIMT progression across all life stages. In addition, persistent borderline-low HDL-C levels and very low HDL-C levels were also associated with cIMT progression.

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These associations would be attenuated if lipid levels at 17 years of age were normal, as demonstrated by using temporal inverse allocation in linear mixed-effect modelling. This method simulates the effects of treating dyslipidemia at specific life stages.

The study enrolled 1779 participants aged 15 years from the Avon Longitudinal Study of Parents and Children UK birth cohort. Participants were followed up for 9 years, and their lipid panel was determined at 15, 17, and 24 years of age. The results were age-categorized as normal, elevated, or dyslipidemia according to guidelines from the National Heart, Lung, and Blood Institute.


Agbaje AO, Lloyd-Jones DM, Magnussen CG, Tuomainen TP. Cumulative dyslipidemia with arterial stiffness and carotid IMT progression in asymptomatic adolescents: a simulated intervention longitudinal study using temporal inverse allocation model. Atherosclerosis. Published online November 12, 2022. doi:10.1016/j.atherosclerosis.2022.11.011