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Preterm, early birth may raise risk for ischemic heart disease in adulthood
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Adults born preterm or early term have an increased risk for ischemic heart disease, according to findings published in JAMA Pediatrics.
Early evaluation and preventive actions were also recommended to reduce ischemic heart disease risk.
Casey Crump, MD, PhD, and colleagues investigated whether preterm birth is associated with an increased risk for ischemic heart disease in adulthood in a large population-based cohort.
“Preterm birth has been linked with increased risk of cardiometabolic disorders in adulthood, including hypertension, diabetes and metabolic syndrome, which are major risk factors for ischemic heart disease,” Crump, a professor of family medicine and community health at the Icahn School of Medicine at Mount Sinai, the departments of family medicine and community health and of population health science and policy, and colleagues wrote. “However, most studies have failed to show an association between preterm birth and the risk of ischemic heart disease.”
The researchers analyzed data from a national, population-based cohort of 2,141,709 participants born as singleton live births between 1973 and 1994 in Sweden. Age of gestation at birth was obtained from nationwide records in the Swedish Birth Registry.
The primary outcome was ischemic heart disease reported from nationwide inpatient and outpatient diagnosis through 2015 (maximum age, 43 years), Crump and colleagues wrote. The researchers examined gestational age at birth in association with ischemic heart disease in adulthood while adjusting for other perinatal and maternal factors.
Of the participants, 48.6% were women and 0.09% received a diagnosis of ischemic heart disease in 30.9 million person-years of follow-up. Gestational age at birth was inversely associated with risk for ischemic heart disease in adulthood, the researchers wrote.
From age 30 to 43 years, compared with full-term birth, preterm birth (adjusted HR = 1.53; 95% CI, 1.2-1.94) and early-term birth (aHR = 1.19; 95% CI, 1.01-1.4) were associated with elevated ischemic heart disease risk, Crump and colleagues wrote.
Women born preterm had lower ischemic heart disease incidence compared with men born preterm (15.16 vs. 22 per 100,000 person-years) but had a higher adjusted HR (women, 1.93; 95% CI, 1.28-2.9; men, 1.37; 95% CI, 1.01-1.84), the researchers wrote.
“These associations did not appear to be explained by shared genetic or environmental factors in families,” Crump and colleagues wrote.
In a related editorial, Adrien Flahault, MD, PhD, Thuy Mai Luu, MD, MSc, and Anne-Monique Nuyt, MD, from the department of pediatrics at Centre Hospitalier Universitaire Sainte-Justine Research Center in Montreal, wrote: “Given that the pathophysiological pathways may differ in individuals born preterm, interventional clinical trials targeting this population are needed to determine optimal preventive and therapeutic strategies. Moreover, whether screening policies will translate into cardiovascular risk reduction over the long term in individuals born preterm should also be formally assessed. In the meantime, physicians caring for adults should routinely inquire about birth history to identify this at-risk population.” – by Earl Holland Jr.
Disclosures: The authors and editorial writers report no relevant financial disclosures.
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