Adolescent risk factors can predict risk for future cardiovascular events
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Key takeaways:
- Nonlaboratory risk factors in adolescents can predict CV outcomes with or without lipid measurements.
- Adolescent obesity nearly tripled participants’ risk for CV events as adults.
Childhood BMI, blood pressure and smoking status performed as well as lipid levels in predicting the risk for cardiovascular events in adulthood, according to study findings published in Pediatrics.
Adding lipid levels on top of nonlaboratory risk factors did not provide additional predictive value for cardiovascular disease (CVD), the researchers found.
“Strong evidence suggests that CVD has its origins in childhood,” Joe Nuotio, MD, PhD, from the research center of applied and preventive cardiovascular medicine at University of Turku in Turku, Finland, and colleagues wrote. “Prevention strategies conducted in children have provided evidence of the benefits of lifestyle counseling on risk markers and remain the cornerstones for promoting cardiovascular health in children at the population level.”
The researchers tracked CV outcomes for a cohort of 11,550 participants (55.1% women; mean age, 50 years ± 7.7 years) from the United States, Australia and Finland. They used baseline health data from when the participants were aged 12 to 19 years to identify risk factors for later CV outcomes. The primary endpoint was a fatal or nonfatal CV event, including myocardial infarction, stroke and heart failure, among others.
Overall, 513 participants (4.4%) experienced CV events. In a multivariable analysis, overweight and obesity in adolescence was strongly associated with CV events in adulthood (HR = 1.96; 95% CI, 1.59-2.42, and HR = 2.73; 95% CI, 2.04-3.65, respectively), according to the researchers. Elevated blood pressure (HR = 1.45; 95% CI, 1.2-1.75) and smoking (HR = 1.67; 95% CI, 1.4-1.99) were also associated with increased risk for CV outcomes, the study found.
“When lipids (total cholesterol and triglycerides) were introduced into the model, the significant associations for overweight, obesity, elevated blood pressure and smoking remained,” Nuotio and colleagues wrote.
Total cholesterol levels of 5.18 mmol/L and higher doubled participants’ risk for CV outcomes in adulthood, the researchers reported. Triglycerides of 1.46 mmol/L and higher (HR = 1.82; 95% CI, 1.39-2.61), LDL cholesterol of 3.37 mmol/L and above (HR = 1.93; 95% CI, 1.39-2.68) were also associated with increased risk for CV events, according to the researchers. Borderline low HDL cholesterol between 1.15-1.03 mmol/L, as well as low HDL cholesterol below 1.03 increased participants’ risk for CV events (HR = 1.53; 95% CI, 1.05-2.24, and HR = 1.74; 95% CI, 1.23-2.44, respectively).
Nuotio and colleagues wrote that the results were similar when only counting fatal CV outcomes.
“The results from the present study suggest that a risk prediction method based on BMI, blood pressure and smoking status that does not require any laboratory tests could be noninferior to one requiring laboratory information,” the researchers wrote.
In a related commentary, Samuel S. Gidding, MD, from the department of genomic health at Geisinger Health in Danville, Pennsylvania, wrote that “the authors were able to show that the incremental value in knowing lipid values does not substantially improve risk prediction for adult heart disease.”
“As demonstrated in the report by Nuotio and colleagues, the case for measuring lipids to identify mild-to-moderate dyslipidemias, those that would typically be treated by diet and weight management, has grown considerably weaker,” Gidding wrote.
References:
- Gidding SS, et al. Pediatrics. 2024;doi:10.1542/peds.2024-068548.
- Nuotio J, et al. Pediatrics. 2024;doi:10.1542/peds.2024-066736.
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