Study Questions:

Is the presence of cardiovascular (CV) risk factors in childhood associated with CV clinical events in adulthood?

Methods:

Data from the International Childhood  Cardiovascular Cohorts (i3C) Consortium, a prospective cohort study that  includes six cohorts from Australia, Finland, and the United States,  were used for the present analysis. These cohorts collected data on CV  risk factors from early childhood through adolescence and collected  adjudicated CV events in adulthood. A total of 42,324 participants 3-19  years of age were enrolled from the 1970s through the 1990s for a mean  follow-up of 35 years. Body mass index (BMI), 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 CV event) was analyzed jointly with  the childhood risk factors. Study outcomes were fatal CV events and  fatal or nonfatal CV events, and analyses were performed after multiple  imputation with the use of proportional-hazards regression.

Results:

A total of 38,589 participants were included,  of which 49.7% were male and 15.0% were Black. Mean age of the  participants during childhood was 11.8 ± 3.1 years. During follow-up,  319 fatal CV events were identified. The mean age of the participants at  the time of their CV event was 47.0 ± 8.0 years. Participants with CV  events were older, more likely to be male, and had a lower parental and  personal education level than those without CV events. The hazard ratios  for a fatal CV event in adulthood ranged from 1.30 (95% confidence  interval [CI], 1.14-1.47) per unit increase in the z score for total  cholesterol level to 1.61 (95% CI, 1.21-2.13) for youth smoking (yes vs.  no). The hazard ratio for a fatal CV event with respect to the  combined-risk z score (smoking, BMI, systolic blood pressure,  triglycerides, and total cholesterol) was 2.71 (95% CI, 2.23-3.29) per  unit increase. 

Conclusions:

The investigators concluded that in this  prospective cohort study, childhood risk factors and the change in the  combined-risk z score between childhood and adulthood were associated  with CV events in midlife.

Perspective:

These data provide strong longitudinal  evidence that CV health in childhood is important for CV health in  adulthood. Preventing weight gain and smoking in particular are  important CV risk factors to focus on during childhood.