European Primary Care Cardiovascular Society

Risk factors in childhood associated with cardiovascular events in adulthood

Childhood Cardiovascular Risk Factors and Adult Cardiovascular Events

Literature - Jacobs, Jr. DE, Woo JG, Sinaiko AR et al. - N Engl J Med. 2022 Apr 4. doi: 10.1056/NEJMoa2109191

Introduction and methods

Background

The International Childhood Cardiovascular Cohorts (i3C) Consortium includes seven cohorts in the United States, Australia and Finland [1,2]. Since the 1970s the cohorts have collected data on CV risk factors in childhood and have followed participants into midlife. This consortium represents a opportunity to explore the association of childhood risk factors with adult cardiovascular events.

Aim of the study

This study investigated whether traditional cardiovascular risk factors (BMI, SBP, total cholesterol level, triglyceride level, and smoking) in childhood are associated with CV events during adulthood.

Methods

The i3C Consortium cohorts enrolled participants 3 to 19 years of age from the 1970s through the 1990s. A total of 38,589 participants (49.7% male, 15.0% Black) from the i3C Consortium were included in this analysis. Individual childhood risk factors of BMI, SBP, triglyceride level and total cholesterol level were analyzed with the use of z scores. Youth smoking was analyzed as a dichotomous variable (yes/no). In addition, a combined-risk z score was calculated using the unweighted mean of the z scores plus youths smoking (a value of 2 for smoking [a high-risk value] or 0 for nonsmoking [average risk]). Mean follow-up was 35 years. Study outcomes were fatal CV events and fatal or nonfatal CV events.

Main results

Association between individual childhood risk factors and adult CV events

HRs for a fatal CV event in adulthood according to individual childhood risk factors were:

Association between the combined-risk childhood z score and CV events in adulthood

Subgroup analyses with risk factors evaluated in adulthood

Conclusion

This study demonstrated that traditional cardiovascular risk factors (BMI, SBP, total cholesterol level, triglyceride level, and smoking) in childhood are associated with CV events during adulthood.

The authors of the article stated: ‘From the perspective of prevention, both childhood risk factor levels and the path to risk in adulthood appear to be informative. Thus, we posit that assessment of cardiovascular risk should begin in childhood, and a reduction in risk-factor levels between childhood and adulthood may have the potential to lower the incidence of premature cardiovascular disease.'

References

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Find this article online at N Engl J Med.

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