Childhood risk factors associated with CV events in adulthood
Childhood Cardiovascular Risk Factors and Adult Cardiovascular EventsLiterature - Jacobs, Jr. DE, Woo JG, Sinaiko AR et al. - N Engl J Med. 2022 Apr 4. doi: 10.1056/NEJMoa2109191
Introduction and methods
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.
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.
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:
- 1.30 (95% CI 1.14-1.47) per unit increase in the childhood z score for total cholesterol level
- 1.34 (95% CI 1.19-1.50) per unit increase in the childhood z score for SBP
- 1.44 (95% CI 1.33-1.57) per unit increase in the childhood z score for BMI
- 1.50 (95% CI 1.33-1.70) per unit increase in the childhood z score for ln(triglycerides)
- 1.61 (95% CI 1.21-2.13) for youth smoking (yes vs. no)
Association between the combined-risk childhood z score and CV events in adulthood
- The HR for a fatal CV event in adulthood with respect to the combined-risk childhood z score was 2.71 (95% CI 2.23-3.29) per unit increase. The corresponding HR for a fatal or nonfatal CV event was 2.75 (95% CI 2.48-3.06) per unit increase.
Subgroup analyses with risk factors evaluated in adulthood
- In a subgroup of 13,401 participants who had data on adult risk factors, the adjusted HR for a fatal CV event in adulthood with respect to the childhood combined-risk z score was 3.54 (95% CI 2.57-4.87) per unit increase.
- The adjusted HR for a fatal CV event with respect to the change in the combined-risk z score from childhood to adulthood was 2.88 (95% CI 2.06-4.05) per unit increase.
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.'