SAT-260 - Opportunistic Cardiometabolic Risk Detection in Young Blood Donors

Background/Synopsis:
Cardiometabolic risk factors often develop silently in adolescence, and nearly 50% of adolescents with risk factors are undiagnosed, representing a missed opportunity for prevention. Blood donation centers provide a pragmatic venue for opportunistic screening in adolescents.

Objectives/Purposes
Interim analysis of an ongoing study that will screen 10,000 adolescent blood donors, aged 17-19, to evaluate feasibility as well as prevalence of cardiometabolic risk factors.

Methods
Between November 2025 and January 2026, Carter BloodCare (Dallas, Texas) measured Lipoprotein (a) [Lp(a)], hemoglobin A1c, HDL-C, triglycerides, and total cholesterol in parallel with routine infectious disease testing. These data were utilized to calculate two indices validated in adolescents to predict subclinical atherosclerosis and longitudinal risk: TG/HDL ratio (≥3.0 indicating elevated risk) and Atherogenic Index of Plasma (AIP = log₁₀[TG/HDL], with >0.21 considered high risk). We estimated Wilson 95% CIs to convey precision of prevalence estimates, and fit multivariable logistic regressions (high AIP, high TG/HDL, Lp(a)>50 mg/dL) adjusting for sex, BMI, and age. All donors provided informed consent to Carter BloodCare for cardiovascular and diabetes screening.

Results
Among 1055 blood donors (42% male, median age 17 years; median BMI 24.4 kg/m2), median A1c was 5.3% (IQR 5.1-5.4%) with 7.1% (95% CI 5.7–8.8) meeting criteria for prediabetes and 1.4% (95% CI 0.86–2.33) meeting criteria for diabetes. Median triglycerides were 81 mg/dL (IQR 58-116), HDL-C 52 mg/dL (IQR 45-59), total cholesterol 150 mg/dL (IQR 132-267), and Lp(a) 12 mg/dL (IQR 5-29). Lp(a) was elevated (>50 mg/dL) in 22.4%. A few donors had extreme values: two had A1c > 9%, two had triglycerides ≥500 mg/dL, three had total cholesterol ≥300 mg/dL, and one donor had Lp(a) > 180 mg/dL. 494 donors (47%; 95% CI 44-50) had a high-risk AIP, and 185 (18%; 95% CI 15-20) donors had high TG/HDL ratio. In adjusted models, male sex (OR 1.90, 95% CI 1.46–2.47) and BMI (OR 1.11 per kg/m², 1.09–1.14) were associated with high AIP; similar for high TG/HDL (male OR 2.65, 1.88–3.76; BMI OR 1.12, 1.09–1.15). Lp(a)>50 mg/dL showed no independent association with sex, BMI, or age.

Conclusion
Opportunistic screening in adolescent donors is feasible and high‑yield, uncovering substantial hidden risk (nearly 1 in 2 with high AIP; ~1 in 6 with high TG/HDL; ~1 in 4 with elevated Lp(a)) and identifying rare but severe outliers (e.g., TG ≥500 mg/dL) who merit urgent follow‑up. Donor center screening can help close the gap of undetected adolescent cardiometabolic risk.

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