This is a repository copy of Complete revascularization with multivessel PCI for myocardial infarction.

Objectives This study characterized the determinants of carotid intima-media thickness (cIMT) in a large (n > 4,000) longitudinal cohort of healthy young people age 9 to 21 years. Background Greater cIMT is commonly used in the young as a marker of subclinical atherosclerosis, but its evolution at this age is still poorly understood. Methods Associations between cardiovascular risk factors and cIMT were investigated in both longitudinal (ages 9 to 17 years) and cross-sectional (ages 17 and 21 years) analyses, with the latter also related to other measures of carotid structure and stress. Additional use of ultra-high frequency ultrasound in the radial artery at age 21 years allowed investigation of the distinct layers (i.e., intima or media) that may underlie observed differences. Results Fat-free mass (FFM) and systolic blood pressure were the only modifiable risk factors positively associated with cIMT (e.g., mean difference in cIMT per 1-SD increase in FFM at age 17: 0.007 mm: 95% confidence interval [CI]: 0.004 to 0.010; p < 0.001), whereas fat mass was negatively associated with cIMT (difference: −0.0032; 95% CI: 0.004 to −0.001; p = 0.001). Similar results were obtained when investigating cumulative exposure to these factors throughout adolescence. An increase in cIMT maintained circumferential wall stress in the face of increased mean arterial pressure when increases in body mass were attributable to increased FFM, but not fat mass. Risk factor−associated differences in the radial artery occurred in the media alone, and there was little evidence of a relationship between intimal thickness and any risk factor. Conclusions Subtle changes in cIMT in the young may predominantly involve the media and represent physiological adaptations as opposed to subclinical atherosclerosis. Other vascular measures may be more appropriate for the identification of arterial disease before adulthood.

is an officer and both he and J. R. Axt are consultants of Project Implicit, Inc., a nonprofit organization with the mission to "develop and deliver methods for investigating and applying phenomena of implicit social cognition, including especially phenomena of implicit bias based on age, race, gender, or other factors." The authors declared that they had no other potential conflicts of interest with respect to their authorship or the publication of this article. Author Contributions: All authors developed the concept of studies 1a and 2a. J. R. Axt and H. N. Nguyen programmed studies 1a and 2a and analyzed the data. For all other studies, J. R. Axt and B.A. Nosek developed the concept, with J.R. Axt programming them and analyzing the data. J. R. Axt drafted the manuscript, and B. A. Nosek and H.N. Nguyen edited it. All authors approved the final version of the manuscript for submission.