Objective-Intravenous lipid use is associated with an acute hyperlipidemia, but long-term consequences have not been studied. We investigated whether elevated lipids in humans during the critical period of preterm neonatal life have a long-term impact on aortic and myocardial function relevant to adult disease. Methods and Results-We followed up 102 subjects born prematurely and now aged 23 to 28 years. Eighteen received intravenous lipids as neonates and were matched to controls with equivalent perinatal characteristics. Global and regional aortic stiffness and left ventricular function were assessed by cardiovascular magnetic resonance. Those who received intravenous lipids had greater aortic stiffness in early adulthood (Pϭ0.0002), with greater stiffness in the abdominal aorta (Pϭ0.012). The relationship was graded according to the elevation in neonatal cholesterol induced by intravenous lipids (PϽ0.0001) but not other metabolic parameters altered by the infusion. Peak systolic circumferential strain was also reduced in the lipid group (Pϭ0.006), which, again, was proportional to neonatal cholesterol level (PϽ0.01). Key Words: aortic development Ⅲ cholesterol Ⅲ early development Ⅲ myocardial function Ⅲ young adults H yperlipidemia is a key biological driver for atherogenesis. 1-3 Lipid-rich fatty streaks first emerge in the aortic wall during fetal life and peak in prevalence during the first year following birth. 4,5 Newborn offspring of hypercholesterolemic mothers who have been exposed to abnormal lipid profiles have significantly more aortic fatty streaks which persist into adolescence. 6 Whether changes in the cardiovascular system are seen in those without a maternal history of hypercholesterolemia or those who are exposed to hyperlipidemia after birth is unknown but of potential importance because of its clinical relevance to a broader population and postnatal nutrition.
Conclusion-Aortic
See accompanying article on page 1939Therefore, we studied young adults whose mothers were normocholesterolemic but who were born prematurely and, as part of their routine clinical care, had received a brief, artificial, nutritional elevation in lipid levels postnatally in the form of an intravenous lipid infusion. Intralipid is widely used in parenteral nutrition as a source of energy and essential fatty acids. It consists of triglycerides in the form of soybean oil emulsified by egg phospholipid and glycerol. 7 Hypercholesterolemia secondary to Intralipid use is well described, likely driven by endogenous cholesterol synthesis as a result of delayed lipid clearance. [7][8][9] Because fatty streaks first appear in the aorta, 5 and in animal models arterial stiffness is the first pathophysiological change that occurs during this process, 10 we studied global aortic stiffness in early adulthood, measured as pulse wave velocity (PWV), a measure known to be relevant to later cardiovascular outcome in large-scale studies. 11 We used cardiovascular magnetic resonance imaging, 12 which, as it images the aorta directly, also...