▎ WuXi AppTec content team editor
Cardiovascular risk factors in childhood can predict subclinical cardiovascular disease in adulthood, but the association of cardiovascular risk factors in childhood with cardiovascular events in adulthood is unclear due to the lack of comprehensive long-term data.
Recently, the New England Journal of Medicine published a blockbuster study from it. Through half a century of tracking, the International Alliance of Pediatric Cardiovascular Cohorts (i3Cs) identified five childhood risk factors that can predict events such as stroke and myocardial infarction in adulthood, including body mass index (BMI), abnormalities in blood pressure, cholesterol, triglycerides, and smoking in adolescence, which are associated with cardiovascular events that begin at about age 40.
According to the research team's press release, this is the "largest international prospective cardiovascular disease study" in the field.
截图来源：The New England Journal of Medicine
Study senior author Professor Terence Dwyer of the Murdoch Children's Research Institute emphasizes: "While medical advances have improved the treatment of heart disease, the effectiveness of cardiovascular disease prevention depends more on effective prevention strategies. This study confirms that prevention should begin in childhood. ”
"Studying the effects of early life on disease has always been considered too difficult. But the i3C researchers accepted the challenge because we know that the ultimate potential benefits for human health could be enormous. ”
Image credit: 123RF
The study analyzed a sample of 40,648 participants from Australia, Finland and the United States to assess the effect of their risk factors on cardiovascular events after an average of 35 years (most often up to 50 years) between the ages of 3 and 19 years.
The team used a standardized index to reflect BMI, blood pressure, cholesterol, triglycerides, and the risk of smoking in adolescence —age and sex-specific z-scores and comprehensive risk z-scores derived from i3C (an unashamed average of 5 risk z-scores), and combined an algebraically comparable adult comprehensive risk z-score (before cardiovascular events occur) with childhood risk factors.
The results showed that more than half of the study participants were associated with the above risks during childhood, and some of them were 9 times more likely to be at low risk than low-risk children!
The average age of study participants at the time of cardiovascular events was 47.0 ±8.0 years. Participants who had cardiovascular events were older, more men, and had relatively lower levels of parental and personal education.
In adulthood, there were 319 fatal cardiovascular events.
For each unit increase in total cholesterol level, systolic blood pressure, BMI, and triglyceride z-score, the risk of fatal cardiovascular events in adulthood increased by 30%, 34%, 44%, and 50%, respectively;
Adolescent smokers had a 61% increased risk of fatal cardiovascular events in adulthood compared with non-smoking.
For each additional unit of the combined risk z-score, the risk of fatal cardiovascular events increased by 171%.
Combined with lethal or non-fatal cardiovascular events in adulthood, the associations were similar.
For each unit increase in total cholesterol level, systolic blood pressure, BMI, and triglyceride z-score, the risk of all cardiovascular events in adulthood increased by 31%, 33%, 45%, and 45%, respectively;
Adolescent smokers have a 70% increased risk of all cardiovascular events in adulthood compared to non-smoking.
For every unit increase in the composite risk z-score, the risk of all cardiovascular events increases by 175%.
In this subgroup analysis, 13,401 participants with data on adult risk factors (age at age 31.0 ±5.6 years at the time of adult assessment) and a total of 115 fatal cardiovascular events occurred:
For each unit increase in the combined risk z-score in childhood, the risk of fatal cardiovascular events in adulthood increases by 254%;
For each additional unit of the change in the composite risk z-score from childhood to adulthood, the risk of fatal cardiovascular events in adulthood increases by 188%.
In a comprehensive analysis of 524 lethal or nonfatal cardiovascular events, the results were similar.
Image credit: 123RF
Combined, childhood risk factors and changes in risk from childhood to adulthood are associated with the development of cardiovascular events in midlife.
Professor Dwyer noted: "Although there was no previous evidence of this, the findings are not entirely surprising as it has long been known that children as young as 5 years old can show early signs of fat deposition in the arteries. This new evidence justifies greater emphasis on preventing risk factors in children. ”
"While interventions in adulthood, such as improving diet, smoking cessation, multiactivity, and, if necessary, taking medications to reduce risk factors, can help improve cardiovascular health, there is more we can do in childhood and adolescence to reduce the lifetime risk of cardiovascular disease."