Introduction
Childhood declines in cardiovascular health have been linked to the development of
subclinical atherosclerosis; however, less is known about the timing and sequence
of the decline of the specific cardiovascular health components. The study objective
is to identify the patterns of decline and associations with adulthood subclinical
atherosclerosis.
Methods
Data were pooled from 5 cardiovascular cohorts. Clinical components of cardiovascular
health (BMI, blood pressure, cholesterol, and blood glucose) were categorized as ideal
or nonideal using American Heart Association definitions. Multitrajectory models simultaneously
fitted the probability ideal for each factor. Adjusted associations between trajectory
groups and carotid intima-media thickness were modeled. Data were pooled from December
1, 2015 to June 1, 2019; statistical analysis occurred between June 1, 2019 and June
1, 2020.
Results
This study included 9,388 individuals (55% female, 66% White). A total of 5 distinct
trajectory groups were created: 1 maintained the ideal levels of all the 4 health
factors, 2 had risk onset of a single factor in childhood, 1 had risk onset of multiple
factors in childhood, and 1 had risk onset in adulthood. Those with childhood multiple
risk onset had 8.1% higher carotid intima-media thickness (95% CI=0.067, 0.095) than
those in the ideal group, childhood cholesterol risk onset had 5.9% higher carotid
intima-media thickness (95% CI=0.045, 0.072), childhood BMI risk onset had 5.5% higher
carotid intima-media thickness (95% CI=0.041, 0.069), and early adulthood multiple
risk onset had 2.7% higher carotid intima-media thickness (95% CI=0.013, 0.041).
Conclusions
Those who lost the ideal status of cardiovascular health in childhood and early adulthood
had more subclinical atherosclerosis than those who retained the ideal cardiovascular
health across the life course, underscoring the importance of preserving the ideal
cardiovascular health beginning in childhood and continued into adulthood.
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REFERENCES
- Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic impact goal through 2020 and beyond.Circulation. 2010; 121: 586-613https://doi.org/10.1161/CIRCULATIONAHA.109.192703
- Status of cardiovascular health in U.S. adolescents: prevalence estimates from the National Health and Nutrition Examination Surveys (NHANES) 2005−2010.Circulation. 2013; 127: 1369-1376https://doi.org/10.1161/CIRCULATIONAHA.113.001559
- Status of cardiovascular health in U.S. children up to 11 years of age: the National Health and Nutrition Examination Surveys 2003-2010.Circ Cardiovasc Qual Outcomes. 2015; 8: 164-171https://doi.org/10.1161/CIRCOUTCOMES.114.001274
- Carotid intimal-medial thickness is related to cardiovascular risk factors measured from childhood through middle age: the Muscatine Study.Circulation. 2001; 104: 2815-2819https://doi.org/10.1161/hc4601.099486
- Influence of age on associations between childhood risk factors and carotid intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study, the Childhood Determinants of Adult Health Study, the Bogalusa Heart Study, and the Muscatine Study for the International Childhood Cardiovascular Cohort (i3C) Consortium.Circulation. 2010; 122: 2514-2520https://doi.org/10.1161/CIRCULATIONAHA. 110.966465
- Impact of lipid measurements in youth in addition to conventional clinic-based risk factors on predicting preclinical atherosclerosis in adulthood:International Childhood Cardiovascular Cohort Consortium.Circulation. 2018; 137: 1246-1255https://doi.org/10.1161/CIRCULATIONAHA.117.029726
- Childhood cardiovascular risk factors and carotid vascular changes in adulthood: the Bogalusa Heart Study [published correction appears in JAMA. 2003;290(22):2943].JAMA. 2003; 290: 2271-2276https://doi.org/10.1001/jama.290.17.2271
- Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study.JAMA. 2003; 290: 2277-2283https://doi.org/10.1001/jama.290.17.2277
- Hypertension in late adolescence and cardiovascular mortality in midlife: a cohort study of 2.3 million 16- to 19-year-old examinees.Pediatr Nephrol. 2016; 31: 485-492https://doi.org/10.1007/s00467-015-3240-1
- Risk factors for cardiovascular disease and type 2 diabetes retained from childhood to adulthood predict adult outcomes: the Princeton LRC Follow-up Study.Int J Pediatr Endocrinol. 2012; 2012: 6https://doi.org/10.1186/1687-9856-2012-6
- Does obesity modify the effect of blood pressure on the risk of cardiovascular disease? A population-based cohort study of more than one million Swedish men.Circulation. 2008; 118: 1637-1642https://doi.org/10.1161/CIRCULATIONAHA.108.772707
- Body-mass index in 2.3 million adolescents and cardiovascular death in adulthood.N Engl J Med. 2016; 374: 2430-2440https://doi.org/10.1056/NEJMoa1503840
- Ideal cardiovascular health in childhood and cardiometabolic outcomes in adulthood: the Cardiovascular Risk in Young Finns Study.Circulation. 2012; 125: 1971-1978https://doi.org/10.1161/CIRCULATIONAHA.111.073585
- Lifetime measures of ideal cardiovascular health and their association with subclinical atherosclerosis: the Cardiovascular Risk in Young Finns Study.Int J Cardiol. 2015; 185: 186-191https://doi.org/10.1016/j.ijcard.2015.03.051
- Life-time risk factors and progression of carotid atherosclerosis in young adults: the Cardiovascular Risk in Young Finns study.Eur Heart J. 2010; 31: 1745-1751https://doi.org/10.1093/eurheartj/ehq141
- Change in weight status and development of hypertension.Pediatrics. 2016; 137e20151662https://doi.org/10.1542/peds.2015-1662
- Cardiovascular risk factors from birth to 7 years of age: the Bogalusa Heart Study. Design and participation.Pediatrics. 1987; 80 (https://pediatrics.aappublications.org/content/80/5/767. Accessed June 28, 2021): 767-778
- CARDIA: study design, recruitment, and some characteristics of the examined subjects.J Clin Epidemiol. 1988; 41: 1105-1116https://doi.org/10.1016/0895-4356(88)90080-7
- Cohort profile: the cardiovascular risk in Young Finns Study.Int J Epidemiol. 2008; 37: 1220-1226https://doi.org/10.1093/ije/dym225
- Project HeartBeat! Concept, development, and design.Am J Prev Med. 2009; 37: S9-S16https://doi.org/10.1016/j.amepre.2009.04.016
- Cohort profile: the STRIP study (Special Turku Coronary Risk Factor Intervention Project), an infancy-onset dietary and life-style intervention trial.Int J Epidemiol. 2009; 38: 650-655https://doi.org/10.1093/ije/dyn072
- Cardiovascular health trajectories from childhood through middle age and their association with subclinical atherosclerosis.JAMA Cardiol. 2020; 5: 557-566https://doi.org/10.1001/jamacardio.2020.0140
- Growth chart training: a SAS program for the 2000 CDC growth charts (ages 0 to <20 years).Centers for Disease Control and Prevention, 2019http://www.cdc.gov/nccdphp/dnpao/growthcharts/resources/sas.htm(Updated February 26,)Date accessed: April 27, 2021
- National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents.Pediatrics. 2004; 114: 555-576https://doi.org/10.1542/peds.114.2.S2.555
- The association of pediatric low- and high-density lipoprotein cholesterol dyslipidemia classifications and change in dyslipidemia status with carotid intima−media thickness in adulthood evidence from the cardiovascular risk in Young Finns study, the Bogalusa Heart study, and the CDAH (Childhood Determinants of Adult Health) study.J Am Coll Cardiol. 2009; 53: 860-869https://doi.org/10.1016/j.jacc.2008.09.061
- Group-based multi-trajectory modeling.Stat Methods Med Res. 2018; 27: 2015-2023https://doi.org/10.1177/0962280216673085
- Group-based trajectory modeling in clinical research.Annu Rev Clin Psychol. 2010; 6: 109-138https://doi.org/10.1146/annurev.clinpsy.121208.131413
- Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study.Circulation. 1997; 96: 1432-1437https://doi.org/10.1161/01.cir.96.5.1432
- Predictive value for cardiovascular events of common carotid intima media thickness and its rate of change in individuals at high cardiovascular risk - results from the PROG-IMT collaboration [published correction appears in PLoS One. 2018;13(9):e0204633].PLoS One. 2018; 13e0191172https://doi.org/10.1371/journal.pone.0191172
- The value of carotid intima-media thickness for predicting cardiovascular risk.Arterioscler Thromb Vasc Biol. 2010; 30: 182-185https://doi.org/10.1161/ATVBAHA.109.196980
- Metabolically healthy obesity from childhood to adulthood - does weight status alone matter?.Metabolism. 2014; 63: 1084-1092https://doi.org/10.1016/j.metabol.2014.06.009
- Metabolically healthy and metabolically unhealthy obese children both have increased carotid intima-media thickness: a case control study.BMC Cardiovasc Disord. 2018; 18: 140https://doi.org/10.1186/s12872-018-0874-5
- Metabolically healthy obesity and high carotid intima-media thickness in children and adolescents: international childhood vascular structure evaluation consortium.Diabetes Care. 2019; 42: 119-125https://doi.org/10.2337/dc18-1536
- Poor performance of body mass index as a marker for hypercholesterolemia in children and adolescents.Arch Pediatr Adolesc Med. 2009; 163: 716-723https://doi.org/10.1001/archpediatrics.2009.109
- Insulin resistance of puberty.Curr Diab Rep. 2016; 16: 64https://doi.org/10.1007/s11892-016-0751-5
- Child−parent familial hypercholesterolemia screening in primary care.N Engl J Med. 2016; 375: 1628-1637https://doi.org/10.1056/NEJMoa1602777
- Familial hypercholesterolaemia in children and adolescents: gaining decades of life by optimizing detection and treatment.Eur Heart J. 2015; 36: 2425-2437https://doi.org/10.1093/eurheartj/ehv157
- Optimal lifestyle components in young adulthood are associated with maintaining the ideal cardiovascular health profile into middle age.J Am Heart Assoc. 2015; 4e002048https://doi.org/10.1161/JAHA.115.002048
- Measuring physical activity in children and adolescents for dietary surveys: practicalities, problems and pitfalls.Proc Nutr Soc. 2014; 73: 218-225https://doi.org/10.1017/S0029665113003820
- Validity and reliability of dietary assessment in school-age children.in: Berdanier CD Dwyer J Beldman EB Handbook of Nutrition and Food. 3rd ed. CRC PressTaylor & Francis Group, Boca Raton, FL2013
- Cardiovascular health promotion in children: challenges and opportunities for 2020 and beyond: a scientific statement from the American Heart Association.Circulation. 2016; 134: e236-e255https://doi.org/10.1161/CIR.0000000000000441
- Measurement issues related to studies of childhood obesity: assessment of body composition, body fat distribution, physical activity, and food intake.Pediatrics. 1998; 101 (https://pediatrics.aappublications.org/content/101/Supplement_2/505. Accessed June 28, 2021): 505-518
Article Info
Publication History
Published online: July 05, 2021
Identification
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© 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
