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Childhood cardiovascular risk factors and adult cardiovascular events


Jacobs, DR and Woo, JG and Sinaiko, AR and Daniels, SR and Ikonen, J and Juonala, M and Kartiosuo, N and Lehtimaki, T and Magnussen, CG and Viikari, JSA and Zhang, N and Bazzano, LA and Burns, TL and Prineas, RJ and Steinberger, J and Urbina, EM and Venn, AJ and Raitakari, OT and Dwyer, T, Childhood cardiovascular risk factors and adult cardiovascular events, The New England Journal of Medicine, 386, (20) pp. 1877-1888. ISSN 0028-4793 (2022) [Refereed Article]

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Available from 07 October 2022

Copyright Statement

Copyright (2022) Massachusetts Medical Society.

DOI: doi:10.1056/NEJMoa2109191


Background: Childhood cardiovascular risk factors predict subclinical adult cardiovascular disease, but links to clinical events are unclear.

Methods: In a prospective cohort study involving participants in the International Childhood Cardiovascular Cohort (i3C) Consortium, we evaluated whether childhood risk factors (at the ages of 3 to 19 years) were associated with cardiovascular events in adulthood after a mean follow-up of 35 years. Body-mass index, systolic blood pressure, total cholesterol level, triglyceride level, and youth smoking were analyzed with the use of i3C-derived age- and sex-specific z scores and with a combined-risk z score that was calculated as the unweighted mean of the five risk z scores. An algebraically comparable adult combined-risk z score (before any cardiovascular event) was analyzed jointly with the childhood risk factors. Study outcomes were fatal cardiovascular events and fatal or nonfatal cardiovascular events, and analyses were performed after multiple imputation with the use of proportional-hazards regression.

Results: In the analysis of 319 fatal cardiovascular events that occurred among 38,589 participants (49.7% male and 15.0% Black; mean [±SD] age at childhood visits, 11.8±3.1 years), the hazard ratios for a fatal cardiovascular event in adulthood ranged from 1.30 (95% confidence interval [CI], 1.14 to 1.47) per unit increase in the z score for total cholesterol level to 1.61 (95% CI, 1.21 to 2.13) for youth smoking (yes vs. no). The hazard ratio for a fatal cardiovascular event with respect to the combined-risk z score was 2.71 (95% CI, 2.23 to 3.29) per unit increase. The hazard ratios and their 95% confidence intervals in the analyses of fatal cardiovascular events were similar to those in the analyses of 779 fatal or nonfatal cardiovascular events that occurred among 20,656 participants who could be evaluated for this outcome. In the analysis of 115 fatal cardiovascular events that occurred in a subgroup of 13,401 participants (31.0±5.6 years of age at the adult measurement) who had data on adult risk factors, the adjusted hazard ratio with respect to the childhood combined-risk z score was 3.54 (95% CI, 2.57 to 4.87) per unit increase, and the mutually adjusted hazard ratio with respect to the change in the combined-risk z score from childhood to adulthood was 2.88 (95% CI, 2.06 to 4.05) per unit increase. The results were similar in the analysis of 524 fatal or nonfatal cardiovascular events.

Conclusions: In this prospective cohort study, childhood risk factors and the change in the combined-risk z score between childhood and adulthood were associated with cardiovascular events in midlife. (Funded by the National Institutes of Health.).

Item Details

Item Type:Refereed Article
Keywords:cardiovascular risk factors, cardiovascular events
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiovascular medicine and haematology not elsewhere classified
Objective Division:Health
Objective Group:Public health (excl. specific population health)
Objective Field:Nutrition
UTAS Author:Venn, AJ (Professor Alison Venn)
ID Code:150893
Year Published:2022
Web of Science® Times Cited:6
Deposited By:Menzies Institute for Medical Research
Deposited On:2022-07-04
Last Modified:2022-09-08

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