{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T20:14:45Z","timestamp":1790280885767,"version":"4.1.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100019547","name":"Korean Society of Lipid and Atherosclerosis","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100019547","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Young adults with pre-hypertension, pre-diabetes, and pre-hyperlipidemia are often classified as \u2018low risk\u2019 by conventional 10-year cardiovascular prediction tools, resulting in limited preventive attention. This study evaluated the long-term cardiovascular consequences of concurrently having all three premorbid metabolic conditions in a nationwide cohort of young adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We analysed 1 743 696 Korean adults aged 30\u201339 years who underwent national health screening in 2009. Individuals with established hypertension, diabetes, or dyslipidemia were excluded. Participants were categorized into those with combined pre-hypertension (systolic blood pressure 120\u2013139\u2005mmHg or diastolic blood pressure 80\u201389\u2005mmHg), pre-diabetes (fasting plasma glucose 100\u2013125\u2005mg\/dL), and borderline dyslipidemia (low-density lipoprotein cholesterol 130\u2013159\u2005mg\/dL) vs. those with none of the three conditions. The primary outcome was a composite of myocardial infarction, stroke, and cardiovascular death during long-term follow-up. Risks were estimated using multivariable Cox proportional hazards models. Among 497 316 eligible participants, 44 553 (9.0%) had all three premorbid conditions. During a mean 14.2-year follow-up, the incidence of the composite outcome was nearly twofold higher in the combined pre-disease group. After full adjustment, the combined pre-disease group was significantly associated with higher composite risk (adjusted HR 1.23, 95% CI 1.11\u20131.36), driven primarily by increased risks of myocardial infarction (aHR 1.18) and stroke (aHR 1.35). No significant differences were observed for all-cause mortality. Subgroup findings were consistent across BMI, lifestyle behaviours, and lipid patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The simultaneous presence of pre-hypertension, pre-diabetes, and pre-hyperlipidaemia in young adults confers a measurable and clinically relevant elevation in long-term cardiovascular risk, despite the absence of overt cardiometabolic disease. These findings highlight a metabolic \u2018grey zone\u2019 that is underestimated by current guidelines and underscore the need for earlier identification and preventive attention in young adults with clustered borderline abnormalities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwag233","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T12:49:57Z","timestamp":1776430197000},"source":"Crossref","is-referenced-by-count":3,"title":["Combined pre-hypertension, pre-diabetes, and pre-hyperlipidaemia and long-term cardiovascular risk in young adults: a nationwide cohort study"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8074-8603","authenticated-orcid":false,"given":"Yeon Jung","family":"Lee","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital , 7 Ke unjaebong-gil, Hwaseong-si, Gyeonggi-do 18450 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeen Hwa","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital , 7 Ke unjaebong-gil, Hwaseong-si, Gyeonggi-do 18450 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3180-4565","authenticated-orcid":false,"given":"Mina","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Data Science, Hanmi Pharm. Co., Ltd , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3063-8024","authenticated-orcid":false,"given":"Hoseob","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Data Science, Hanmi Pharm. Co., Ltd , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myung Soo","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital , 7 Ke unjaebong-gil, Hwaseong-si, Gyeonggi-do 18450 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sook Jin","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital , 7 Ke unjaebong-gil, Hwaseong-si, Gyeonggi-do 18450 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seongwoo","family":"Han","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital , 7 Ke unjaebong-gil, Hwaseong-si, Gyeonggi-do 18450 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8474-5744","authenticated-orcid":false,"given":"Minwoo","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hallym University Sacred Heart Hospital , 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do 14068 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6713-4300","authenticated-orcid":false,"given":"Dae young","family":"Cheon","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital , 7 Ke unjaebong-gil, Hwaseong-si, Gyeonggi-do 18450 ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"2026051209123656900_zwag233-B1","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1016\/S0002-9440(10)65647-7","article-title":"Risk factors and progression of atherosclerosis in youth. 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