ESPEYB19 14. Science and Medicine Risk and Outcome (5 abstracts)
14.10. Childhood cardiovascular risk factors and adult cardiovascular events
Jacobs DR Jr , Woo JG , Sinaiko AR , Daniels SR , Ikonen J , Juonala M , Kartiosuo N , Lehtimäki T , Magnussen CG , Viikari JSA , Zhang N , Bazzano LA , Burns TL , Prineas RJ , Steinberger J , Urbina EM , Venn AJ , Raitakari OT & Dwyer T
N Engl J Med. 2022 May 19;386(20):1877–1888. doi: 10.1056/NEJMoa2109191.
Brief summary: This prospective cohort study leveraged data from the International Childhood Cardiovascular Cohorts (i3C) Consortium, including 42 324 participants at baseline and followed-up over a mean of 35 years, in order to investigate associations between cardiovascular risk factors (CVRF, including body-mass index, systolic blood pressure, total cholesterol levels, triglycerides, and smoking) in childhood (mean age 11.8 years) with fatal and non-fatal cardiovascular events in adulthood (mean age 47 years). They showed that increases in each individual CVRF in childhood, and a combined-CVRF risk score, were associated with higher risks of fatal and non-fatal cardiovascular disease events in adults, robust to adjustment for adult CVRF levels.
According to post-mortem pathology studies among youths the process of atherosclerosis starts in very early life and that its severity is associated with both, the presence, and the severity of CVRF. However, direct evidence that CVRF in childhood are linked to hard cardiovascular disease endpoints in adulthood has remained elusive.
The study results showed that hazard ratios for a fatal and non-fatal cardiovascular event in adulthood increased per standard deviation (SD) increase of each individual CVRF, and even more per an increase of a combined-risk z-score, irrespective of race or sex. Adjustment for CVRF measurements in adulthood attenuated the hazard ratio of the childhood combined-CVRF risk score, but the latter remained significant, which highlights the likely direct adverse effects of childhood CVRF on later disease risks. Also, changes in CVRF profiles were associated with fatal and non-fatal cardiovascular disease endpoints.
The results illustrate that both CVRF in childhood and the path to risk in adulthood are important to predict adult cardiovascular disease events. These findings provide robust evidence that reduction in CVRF levels in childhood have the potential to prevent adult incidence of premature cardiovascular events.
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ESPE Yearbook of Paediatric Endocrinology
ISSN 1662-4009 (Online)
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