CV risk factors in childhood can translate to CV events in midlife
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WASHINGTON — Childhood risk factors and the change in combined-risk z score between childhood and adulthood were associated with CV events in midlife, researchers reported.
The findings were presented as a poster at the American College of Cardiology Scientific Session and simultaneously published in The New England Journal of Medicine.
The researchers followed 38,589 participants (mean age at baseline, 11.8 years; 49.7% male; 15% Black) from the International Childhood Cardiovascular Cohorts Consortium for 35 years to see if risk factors in childhood — including youth smoking, BMI, systolic BP, total cholesterol level and triglyceride level — were associated with CV events in adulthood.
Jessica G. Woo, PhD, MHSA, FAHA, professor of pediatrics in the division of biostatistics and epidemiology at Cincinnati Children’s Hospital, and colleagues calculated an age- and sex-specific z score for each childhood risk factor in each participant, and produced a combined-risk z score for each participant that was the unweighted mean of the individual z scores. They then calculated an adult combined-risk z score for each participant before the occurrence of any CV event.
The HRs for a fatal CV event in adulthood ranged from 1.3 (95% CI, 1.14-1.47) per unit increase in z score for total cholesterol level to 1.61 (95% CI, 1.21-2.13) per unit increase in z score for youth smoking, according to the researchers.
The HR for a fatal CV event per unit increase in combined-risk z score was 2.71 (95% CI, 2.23-3.29), Woo and colleagues found.
Among the 13,401 participants who had data on adult risk factors (mean age at adult measurement, 31 years), the adjusted HR for a fatal CV event per unit increase in combined-risk z score was 3.54 (95% CI, 2.57-4.87) and the adjusted HR for a fatal CV event per unit increase in change in combined-risk z score from childhood to adulthood was 2.88 (95% CI, 2.06-4.05).
For all analyses, the HRs were similar when calculated for combined fatal and nonfatal CV events.
“The current study ... showed comprehensive associations between the levels of childhood risk factors, individually and in combination, and the development of incident adult cardiovascular events beginning as early as 40 years of age,” Woo and colleagues wrote in NEJM. “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.”
Reference:
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Woo JG, et al. Poster Presentations. Presented at: American College of Cardiology Scientific Session; April 2-4, 2022; Washington, D.C. (hybrid meeting).
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