Childhood Risk Factors Associated with Cardiovascular Events in Midlife

Jessica Woo, MHSA, PhD

According to findings from a recent prospective cohort study, childhood cardiovascular risk factors were associated with adult cardiovascular events and death from cardiovascular causes before the age of 60 years.

The change in combined risk z-score between childhood and adulthood measured in the study was associated with cardiovascular events in midlife.

“From the perspective of prevention, both childhood risk-factor levels and the path to risk in adulthood appear to be informative,” wrote study author Jessica Woo, MHSA, PhD, Cincinnati Children’s Hospital Medical Center. “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.”

The study used data from the International Childhood Cardiovascular Cohort Consortium to examine the development of cardiovascular disease over the life course. Investigators aimed to test their hypothesis that traditional cardiovascular risk factors in childhood are associated with the subsequent development of adult cardiovascular events.

They included a total of 42,324 participants 3 to 19 years of age from the 1970s through the 1990s. The study focused on 5 risk factors evaluated in childhood and adolescence, including the body-mass index, systolic blood pressure, total cholesterol level, triglyceride level, and youth smoking.

Due to age-related developmental changes, childhood risk factors at each visit were normalized to z scores within the i3c Consortium, calculated with the mean values of the study variables, stratified according to age and sex. Investigators additionally noted an algebraically comparable adult combined-risk z score was analyzed alongside childhood risk factors.

Study outcomes were identified as fatal cardiovascular events and fatal or nonfatal cardiovascular events. Then, analyses were performed after multiple imputation using proportional-hazards regression.

The study included a total of 38,589 participants in the overall sample (49.7% male, 15.0% Black) with a mean age at which the participant was seen during childhood at 11.8 ± 3.1 years. A total of 318 fatal cardiovascular events occurred among this patient population.

Data show hazard ratios for a fatal cardiovascular event in adulthood with respect to the risk factor z-scores 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.

Additionally, the hazard ratio for a fatal cardiovascular event in adulthood regarding the combined-risk z score was 2.71 (95% CI, 2.23 to 3.29) per unit increase, while the hazard ratio for a fatal or nonfatal cardiovascular event in adulthood was 2.75 (95% CI, 2.48 to 3.06) per unit increase.

Further, the analysis of 115 fatal cardiovascular events that occurred in a subgroup of of 13,401 participants (31.0 ± 5.6 years of age at the adult measurement) who included data on adult risk factors showed the adjusted hazard ratio in respect to the childhood combined-risk z score was 3.54 (95% CI, 2.57 to 4.87) per unit increase. Then, 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.

Similar findings were observed in the analysis of 524 fatal or nonfatal cardiovascular events.

The study, “Childhood Cardiovascular Risk Factors and Adult Cardiovascular Events,” was published in The New England Journal of Medicine.