Published: Sep 30, 2013 | Updated: Oct 1, 2013

By Todd Neale

Full Story:  http://www.medpagetoday.com/Cardiology/Prevention/41956

Action Points

• Note that this analysis of three cohort studies demonstrated that risk factors present in childhood are associated with cardiovascular disease in adulthood.
• Be aware that there was a substantial number of participants who were lost to follow-up; these individuals may differ from those that could be evaluated up to two decades after the initial assessment.

Family socioeconomic status, body mass index, and either personal or parental smoking during childhood predicted the likelihood of achieving ideal cardiovascular health as an adult, researchers found.

Better socioeconomic status and lower BMI were significantly associated with having ideal cardiovascular health 2 to 3 decades later in three cohort studies conducted in Finland, Australia, and the U.S. (P<0.01 for both variables), according to Tomi Laitinen, BM, of the University of Turku in Finland, and colleagues.

In addition, personal smoking was a predictor of ideal cardiovascular health in the Australian cohort and parental smoking was a predictor in the Finnish cohort (P≤0.001 for both), the researchers reported online in the International Journal of Cardiology.

“As atherosclerotic cardiovascular diseases are rooted in childhood, our findings suggest that special attention could be paid to children who are from low socioeconomic status families, and who smoke or whose parents smoke, to prevent cardiovascular disease morbidity and mortality,” they wrote.

In 2010, the American Heart Association defined ideal cardiovascular health as part of its 2020 impact goals using optimal states of seven variables:

• Smoking
• BMI
• Physical activity
• Dietary quality
• Total cholesterol level
• Blood pressure
• Fasting plasma glucose level

A study published 2 years later showed that 2% of Americans or fewer achieved ideal status on all seven factors from 1988 to 2010, and that 59% of all deaths, 64% of cardiovascular deaths, and 63% of ischemic heart disease deaths could have been prevented during that time if people had attained ideal cardiovascular health.

A previous study by Laitinen and colleagues further showed that the number of ideal factors present in childhood was associated with adult risks of hypertension, metabolic syndrome, high LDL cholesterol, and high-risk carotid intima-media thickness.

In the current study, the researchers set out to identify factors in children and teens that predicted the presence of ideal cardiovascular health in adults using data from three studies — the Cardiovascular Risk in Young Finns Study from Finland, the Childhood Determinants of Adult Health Study from Australia, and the Princeton Follow-up Study from the U.S.

The analysis included a total of 4,409 participants ages 3 to 19 at baseline (average ages 10.8 to 12.5). Follow-up was conducted when participants were ages 30 to 48.

In adulthood, the average number of ideal health characteristics achieved by the participants was 3.5 in the Finnish study, 3.9 in the Australian study, and 3.8 in the U.S. study.

Higher family socioeconomic status defined by parental education or income and lower BMI were associated with ideal cardiovascular health in adulthood in all three cohorts after multivariate adjustment. Additional predictors included systolic blood pressure, LDL cholesterol, and parental smoking in the Finnish study and personal smoking in the Australian study.

Laitinen and colleagues further explored the relationships with family socioeconomic status and parental smoking, and found that socioeconomic status was directly associated with ideal smoking status and BMI in all three cohorts.

They calculated that children who came from families with low socioeconomic status or whose parents smoked might have a 15% to 25% elevated risk of cardiovascular disease as adults compared with other kids.

Even after adjustment for each participant’s own socioeconomic status as an adult, the correlation between family socioeconomic status during childhood and ideal cardiovascular health in adulthood remained significant in the Finnish and U.S. cohorts.

“These data … support the recent AHA Scientific Statement, which encourages to implement community-wide interventions that are socially and culturally appropriate to reduce disparities and inequities in the cardiovascular health of socioeconomically disadvantaged subgroups,” the authors wrote.

They acknowledged some limitations of their analysis, including the assessment of smoke exposure using self-report and not biochemical testing and the possibility that individuals who continued in the studies differed from those who were lost to follow-up.

From the American Heart Association:

• AHA Heart Disease and Stroke Statistics 2013 Update
• Implementing AHA Pediatric and Adult Nutrition Guidelines
• Approaches to the Prevention and Management of Childhood Obesity
• Promoting Physical Activity in Children and Youth
• Primary Prevention of Cardiovascular Disease in Nursing Practice: Focus on Children and Youth

Primary source: International Journal of Cardiology