CV risk factors in childhood linked to hard CV disease outcomes in adulthood: NEJM

The possibility of extending the findings to include associations with adult cardiovascular events has been hampered by a lack of cohorts with available comprehensive childhood data on anthropometric measures, blood pressure, and laboratory values and with follow-ups conducted up to ages at which cardiovascular events become prevalent. Therefore, Dr David R. Jacobs and his team evaluated whether childhood risk factors (at the ages of 3 to 19 years) were associated with cardiovascular events in adulthood after a mean follow-up of 35 years.

In a prospective cohort study involving 38,589 participants in the International Childhood Cardiovascular Cohorts (i3C) Consortium, the researchers analyzed body-mass index, systolic blood pressure, total cholesterol level, triglyceride level and youth smoking with the use of i3C-derived age- and sex-specific z scores and with a combined-risk z score that was calculated as the unweighted mean of the five risk z scores. They further analyzed an algebraically comparable adult combined-risk z score (before any cardiovascular event) was analyzed jointly with the childhood risk factors. The major outcome assessed was fatal cardiovascular events and fatal or nonfatal cardiovascular events. They also performed analysis after multiple imputations with the use of proportional-hazards regression.

Key findings of the study:

• Upon analysis, the researchers found that the hazard ratios for a fatal cardiovascular event in adulthood ranged from a 1.30 per unit increase in the z score for total cholesterol level to 1.61 for youth smoking.
• They noted that the hazard ratio for a fatal cardiovascular event with respect to the combined-risk z score was 2.71 per unit increase.
• In a subgroup analysis of 13,401 participants who had data on adult risk factors, they found that the adjusted hazard ratio with respect to the childhood combined-risk z score was 3.54 per unit increase, and the mutually adjusted hazard ratio with respect to the change in the combined-risk z score from childhood to adulthood was 2.88 per unit increase.
• They noted that the results were similar in the analysis of 524 fatal or nonfatal cardiovascular events.

The authors concluded, "This prospective cohort study showed that the cardiovascular risk factors of body-mass index, systolic blood pressure, total cholesterol level, triglyceride level, and youth smoking, particularly in combination beginning in early childhood, were associated with adult cardiovascular events and death from cardiovascular causes before the age of 60 years."

They further wrote, "Childhood risk factors and the change in the combined-risk z score between childhood and adulthood were associated with cardiovascular events in midlife."

For further information:

DOI: 10.1056/NEJMoa2109191

https://www.nejm.org/doi/full/10.1056/NEJMoa2109191