Identifying Childhood Predictors of Adult Cardiovascular Morbidity and Mortality

Risk factors for atherosclerotic cardiovascular disease (ASCVD) in adolescence such as hypertension, obesity, smoking, and hypercholesterolemia were independently linked to fatal and nonfatal ASCVD events in adulthood, according to a study tracking over 11,000 participants from adolescence to an average age of 50 years, published in the journal Pediatrics.1 

Researchers examined the predictive utility of a risk model based only on nonlaboratory risk factors in adolescence, which included age, sex, blood pressure, BMI, and smoking and compared it to a model that also incorporated lipid measurements (total cholesterol and triglycerides) to predict cardiovascular events in adulthood. Data of 11,550 participants, mean age 50.0 years, from seven longitudinal cohort studies conducted in the United States, Australia, and Finland were included in this evaluation. More than half (55.1%) were female. 

The risk factors during adolescence included overweight or obesity, raised blood pressure, smoking, and borderline high or high total cholesterol and triglycerides. The primary outcomes were medically adjudicated fatal or nonfatal cardiovascular disease events occurring after age 25. 

Out of the 11,550 study participants, 513 (4.4%) experienced confirmed cardiovascular events. 

In a multivariable model, significant predictors of cardiovascular events were found to be elevated blood pressure (hazard ratio [HR] 1.25), overweight (HR 1.76), obesity (HR 2.19), smoking (HR 1.63), and high total cholesterol (HR 1.79). However, adding lipid measurements (total cholesterol and triglycerides) to the nonlaboratory model did not improve predictive discrimination for cardiovascular events (C-statistics: lipid model 0.75 [SD 0.07] vs. nonlaboratory model 0.75 [SD 0.07], P = .82). 

These findings suggest that nonlaboratory-based risk factors such as BMI, blood pressure, and smoking measured in adolescence may adequately predict cardiovascular events in adulthood, without the need for lipid testing. 

Urgent action is needed to curb the rising prevalence of non-communicable diseases (NCDs) like heart disease, hypertension and diabetes. Childhood is a critical window of opportunity for shaping lifelong habits that influence health as habits learnt at this time tend to be carried into adulthood. Children should be educated about how adopting and maintaining healthy lifestyle behaviors can impact their long-term health, including cardiovascular health. 

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.