Abstract
Importance: Cross-sectional measures of cardiovascular health (CVH) have been associated with cardiovascular disease in older age, but little is known about longitudinal trajectories in CVH and their association with subclinical atherosclerosis in middle age. Objectives: To model long-term patterns in CVH starting in childhood and to assess their association with subclinical atherosclerosis in middle age. Design, Setting, and Participants: This cohort study used data from 5 prospective cardiovascular cohort studies from the United States and Finland from 1973 to 2015. A total of 9388 participants aged 8 to 55 years had at least 3 examinations and were eligible for this study. Statistical analysis was performed from December 1, 2015, to June 1, 2019. Exposures: Clinical CVH factors (body mass index, total cholesterol level, blood pressure, and glucose level) were classified as ideal, intermediate, or poor, and were summed as a clinical CVH score. Group-based latent class modeling identified trajectories in this score over time. Main Outcomes and Measures: Carotid intima-media thickness (cIMT) was measured for participants in 3 cohorts, and high cIMT was defined as a value at or above the 90th percentile. The association between CVH trajectory and cIMT was modeled using both linear and logistic regression adjusted for demographics, baseline health behaviors, and baseline (or proximal) CVH score. Results: Among 9388 participants (5146 [55%] female; 6228 [66%] white; baseline mean [SD] age, 17.5 [7.5] years), 5 distinct trajectory groups were identified: High-late decline (1518 participants [16%]), high-moderate decline (2403 [26%]), high-early decline (3066 [32%]), intermediate-late decline (1475 [16%]), and intermediate-early decline (926 [10%]). The high-late decline group had significantly lower adjusted cIMT vs other trajectory groups (high-late decline: 0.64 mm [95% CI, 0.63-0.65 mm] vs intermediate-early decline: 0.72 mm [95% CI, 0.69-0.75 mm] when adjusted for demographics and baseline smoking, diet, and physical activity; P <.01). The intermediate-early declining group had higher odds of high cIMT (odds ratio, 2.4; 95% CI, 1.3-4.5) compared with the high-late decline group, even after adjustment for baseline or proximal CVH score. Conclusions and Relevance: In this study, CVH declined from childhood into adulthood. Promoting and preserving ideal CVH from early life onward may be associated with reduced CVD risk later in life.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 557-566 |
| Number of pages | 10 |
| Journal | JAMA cardiology |
| Volume | 5 |
| Issue number | 5 |
| DOIs | |
| State | Published - May 2020 |
Funding
Funding/Support: This work was supported by an American Heart Association Strategically Funded Prevention Research Network Center Grant (14SFRN20780002) to Northwestern University, Chicago, Illinois. The Young Finns Study has been financially supported by grants 286284, 134309 (Eye), 126925, 121584, 124282, 129378 (Salve), 117787 (Gendi), and 41071 (Skidi) from the Academy of Finland; the Social Insurance Institution of Finland; by grant X51001 from the Competitive State Research Financing of the Expert Responsibility area of Kuopio, Tampere, and Turku University Hospitals; the Juho Vainio Foundation; the Paavo Nurmi Foundation; the Finnish Foundation for Cardiovascular Research; the Finnish Cultural Foundation; the Tampere Tuberculosis Foundation; the Emil Aaltonen Foundation; the Yrjö Jahnsson Foundation; the Signe and Ane Gyllenberg Foundation; the Diabetes Research Foundation of Finnish Diabetes Association, and by grant 755320 for TAXINOMISIS from the EU Horizon 2020. The Bogalusa Heart Study was supported by grant R01HL121230 from the National Heart, Lung and Blood Institute (NHLBI), grant ES021724 from the National Institute of Environmental Health Sciences, grant R01AG016592 from the National Institute of Aging, and grant P20GM109036 from the National Institute of General Medical Sciences of the National Institutes of Health. The Coronary Artery Risk Development in Young Adults Study (CARDIA) is conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with grant HHSN268201800005I and HHSN268201800007I from the University of Alabama at Birmingham, Birmingham, grant HHSN268201800003I from Northwestern University, Chicago, Illinois, grant HHSN268201800006I from the University of Minnesota, Minneapolis, and grant HHSN268201800004I from the Kaiser Foundation Research Institute. The Special Turku Coronary Risk Factor Intervention Project has been supported by grants 206374, 294834, 251360, and 275595 from the Academy of Finland; the Juho Vainio Foundation; the Finnish Cultural Foundation; the Finnish Foundation for Cardiovascular Research; the Sigrid Jusélius Foundation; the Yrjö Jahnsson Foundation; the Finnish Diabetes Research Foundation; the Novo Nordisk Foundation; the Finnish Ministry of Education and Culture; the Special Governmental Grants for Health Sciences Research, the Turku University Hospital; and the University of Turku Foundation. Project HeartBeat! has been supported by research awards UO1 HL41166, 1 RO3 HL57101, and 1 RO3 HL59223 (cardiac development) from the National Institutes of Health and the Centers for Disease Control and Prevention (CDC); contract PO# 0009966385 from the CDC, 00IPA24501 from the Intergovernmental Personnel Agreement, and Cooperative Agreement U48/CCU609653. Additional support included the Compaq Computer Corporation and the University of Texas Health Science Center at Houston, School of Public Health. receiving grants from the American Heart Association during the conduct of the study. Dr Greenland reported receiving grants from the American Heart Association and the National Institutes of Health during the conduct of the study. Dr Lloyd-Jones reported receiving grants from the National Institutes of Health during the conduct of the study. No other disclosures were reported.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
