AUTHOR=Xiong Zhenyu , Li Jiaying , Lin Yifen , Ye Xiaomin , Xie Peihan , Zhang Shaozhao , Liu Menghui , Huang Yiquan , Liao Xinxue , Zhuang Xiaodong 

TITLE=Intensity of hypertensive exposure in young adulthood and subclinical atherosclerosis in middle age: Evidence from the CARDIA study

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.959146

DOI=10.3389/fcvm.2022.959146

ISSN=2297-055X

ABSTRACT=Background: High blood pressure (BP) is a known risk factor for cardiovascular diseases. We measured the association and prognostic significance of intensity of hypertensive exposure in young adults for subclinical atherosclerosis in middle age.
Methods: The Coronary Artery Risk Development in Young Adults (CARDIA) study enrolled 5,115 healthy black and white American aged 18-30 years at baseline (1985-1986). Intensity of hypertensive exposure was calculated as the area under the curve (mmHg × years) from baseline to year 15. Coronary artery calcium (CAC) was identified at years 15, 20, and 25 and intima-media thickness (IMT) was identified at year 20. 
Results: At baseline, mean (standard deviation) age was 40.1 (3.6) years, 55.1% were women and 46.5% were black. After adjustment, cumulative systolic BP (SBP) was associated with CAC (HR = 1.23 [1.14, 1.32]) and IMT (β = 0.022 [0.017, 0.028]). For CAC, the C-statistic for cumulative SBP was 0.643 (0.619, 0.667) and compared to baseline SBP, the net reclassification index (NRI) of cumulative SBP was 0.180 (0.115, 0.256) and the integrated discrimination improvement (IDI) was 0.023 (0.012, 0.036). For IMT, the C-statistic for cumulative SBP was 0.674 (0.643, 0.705), NRI was 0.220 (0.138, 0.305) and IDI was 0.008 (0.004, 0.0012).
Conclusions: In early adulthood, higher intensity of hypertensive exposure is associated with subclinical atherosclerosis in middle age and provides better prognostic value for early cardiovascular risk. 
Keywords: blood pressure, coronary artery calcium, intima-media thickness, prognostic value, young adults