Adolescent cholesterol metabolism predicts coronary risk factors at middle age: the Cardiovascular Risk in Young Finns Study

Atherosclerosis develops at an early age. We studied whether cholesterol metabolism in adolescence is related to coronary risk factors later during the adult years. A random population sample of 12-year-old (n = 162), 15-year-old (n = 158), and 18-year-old (n = 148) boys who participated in the Cardiovascular Risk in Young Finns Study was studied for major coronary risk factors in 1980 and 2001. These values were related to noncholesterol sterols and their quartiles in 1980 (ie, markers of cholesterol absorption and synthesis). In 1980, serum triglycerides, body mass index (BMI), and systolic blood pressure were lower and high-density lipoprotein (HDL) cholesterol was higher in high absorbers versus low absorbers. This difference, except HDL cholesterol, was maintained after follow-up (eg, in 2001, systolic blood pressure was 123 ± 1 mm Hg in low absorbers vs 119 ± 1 mm Hg in high absorbers, P < 0.01). Cholesterol synthesis (r = up to 0.470, P < 0.001) and absorption (r = down to −0.347, P < 0.001) were related to BMI at baseline and after follow-up. Significant associations were also found between cholesterol metabolism and serum triglycerides, blood pressure, and HDL cholesterol after follow-up. Cholesterol absorption was related to LDL cholesterol only in low absorbers (r = 0.251, P < 0.01). In conclusion, synthesis and absorption of cholesterol measured with serum noncholesterol sterols in adolescence were related to coronary risk factors later in adult life. High synthesis and low absorption of cholesterol are related to risk factors that determine the characteristics of the metabolic syndrome.