{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:41:01Z","timestamp":1787168461595,"version":"build-2736575974"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2016,10,3]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Despite evidence suggesting that early metabolic dysfunction impacts cardiovascular disease risk, current guidelines focus on risk assessments later in life, missing early transitions in metabolic risk that may represent opportunities for averting the development of cardiovascular disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">In 4420 young adults in the Coronary Artery Risk Development in Young Adults (CARDIA) study, we defined a \u201cmetabolic\u201d risk score based on components of the Third Report of the Adult Treatment Panel's definition of metabolic syndrome. Using latent class trajectory analysis adjusted for sex, race, and time\u2010dependent body mass index, we identified 6 distinct metabolic trajectories over time, specified by initial and final risk: low\u2010stable, low\u2010worsening, high\u2010stable, intermediate\u2010worsening, intermediate\u2010stable, and high\u2010worsening. Overall, individuals gained weight over time in CARDIA with statistically but not clinically different body mass index trend over time. Dysglycemia and dyslipidemia over time were highest in initially high or worsening trajectory groups. Divergence in metabolic trajectories occurred in early adulthood (before age 40), with 2 of 3 individuals experiencing an increase in metabolic risk over time. Membership in a higher\u2010risk trajectory (defined as initially high or worsening over time) was associated with greater prevalence and extent of coronary artery calcification, left ventricular mass, and decreased left ventricular strain at year 25. Importantly, despite similar rise in body mass index across trajectories over 25\u00a0years, coronary artery calcification and left ventricular structure and function more closely tracked risk factor trajectories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Transitions in metabolic risk occur early in life. Obesity\u2010related metabolic dysfunction is related to subclinical cardiovascular phenotypes independent of evolution in body mass index, including coronary artery calcification and myocardial hypertrophy and dysfunction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.116.003934","type":"journal-article","created":{"date-parts":[[2016,10,13]],"date-time":"2016-10-13T21:53:57Z","timestamp":1476395637000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":46,"title":["Transitions in Metabolic Risk and Long\u2010Term Cardiovascular Health: Coronary Artery Risk Development in Young Adults (CARDIA) Study"],"prefix":"10.1161","volume":"5","author":[{"given":"Venkatesh L.","family":"Murthy","sequence":"first","affiliation":[{"name":"Cardiovascular Medicine Division, Department of Medicine, University of Michigan, Ann Arbor, MI"},{"name":"Nuclear Medicine Division, Department of Radiology, University of Michigan, Ann Arbor, MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siddique A.","family":"Abbasi","sequence":"additional","affiliation":[{"name":"Providence VA Medical Center and Cardiovascular Institute, Alpert Medical School of Brown University, Providence, RI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juned","family":"Siddique","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura A.","family":"Colangelo","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jared","family":"Reis","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bharath A.","family":"Venkatesh","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institute, Johns Hopkins University, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Jeffrey","family":"Carr","sequence":"additional","affiliation":[{"name":"Vanderbilt University, Nashville, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James G.","family":"Terry","sequence":"additional","affiliation":[{"name":"Vanderbilt University, Nashville, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah M.","family":"Camhi","sequence":"additional","affiliation":[{"name":"Exercise and Health Sciences Department, College of Nursing and Health Sciences, University of Massachusetts, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Jerosch\u2010Herold","sequence":"additional","affiliation":[{"name":"Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"de Ferranti","sequence":"additional","affiliation":[{"name":"Preventative Cardiology, Boston Children's Hospital, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saumya","family":"Das","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Freedman","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Massachusetts at Worcester, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mercedes R.","family":"Carnethon","sequence":"additional","affiliation":[{"name":"Department of Preventative Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cora E.","family":"Lewis","sequence":"additional","affiliation":[{"name":"Division of Preventative Medicine, University of Alabama at Birmingham, AL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joao A. 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