From Adolescence to Adulthood: Predictors of Cardiovascular Events

Non-laboratory risk factors in adolescents such as age, sex, blood pressure, body mass index (BMI), and smoking can effectively predict cardiovascular outcomes as adults, regardless of the inclusion of lipid levels in risk assessment, according to a study published in the journal Pediatrics.1 Adolescent obesity increased the risk of cardiovascular events in adulthood by nearly threefold. 

This prospective study compared the predictive ability of a risk model that used only non-laboratory risk factors (age, sex, blood pressure, BMI, and smoking) in adolescence in predicting cardiovascular events in adulthood against a model that also included lipid levels (triglycerides and total cholesterol). Data from 11,550 participants, mean age mean age 50.0 years, from seven long-term cohort studies conducted in Australia, Finland and the United States was analyzed; 55% of the participants were female. The risk factors including overweight/obesity, elevated blood pressure, smoking, and high borderline/high total cholesterol and triglycerides were measured during adolescence and were tracked into adulthood. The primary outcome was the first occurrence of a fatal or nonfatal CVD event after the age of 25 years.  

Results showed that confirmed cardiovascular events, the main outcomes of the study, occurred in 513 (4.4%) of the 11,550 participants.

In a multivariable analysis, the major independent predictors of cardiovascular events in adulthood included raised blood pressure (hazard ratio 1.25), overweight (1.76), obesity (2.19), smoking (1.63), and high total cholesterol (1.79). All these associations were statistically significant (P < .05). Adding lipids to the nonlaboratory risk model did not enhance its ability to predict cardiovascular events.  The C-statistics for both the lipid-model and the non-laboratory model were identical at 0.75.

The findings of this study indicate that non-laboratory risk factors in adolescence such as overweight, obesity, hypertension, and smoking can predict cardiovascular events in adulthood. Although lipids were also linked to future CV events, their inclusion did not enhance the predictive accuracy of the risk model. This suggests that a risk model that does not require any laboratory tests was non-inferior to the model that required laboratory tests. Drawing blood samples can be quite a distressing experience for many children or at times may not be possible; hence, a nonlaboratory approach may be a more practical and acceptable alternative as a simple preliminary screening to identify adolescents at risk. It is also a more cost-effective approach. 

Reference

1.   Joel Nuotio, et al. Predictors in youth of adult cardiovascular events. Pediatrics. 2024 Nov 1;154(5):e2024066736. doi: 10.1542/peds.2024-066736.