Body mass index and low-density lipoprotein cholesterol levels in childhood may have a direct effect on the risk of developing cardiovascular disease in middle-aged patients, independent of adulthood risk factors.
In the cohort study, published in JAMA Network Open, investigators evaluated the influence of early life factors such as LDL cholesterol, total cholesterol, triglycerides, systolic blood pressure, smoking status, and BMI on adult cardiovascular disease outcomes among 10,634 patients.
They noted that 42.4% (n = 4,506) of the patients were male, 9.7% (n = 1,036) were Black, and 90.3% (n = 9,598) of them were from other racial groups. The average age of the patients at childhood visit was 13.3 years (standard deviation [SD] = 3.0), and the average age at adulthood visit was 32.3 years (SD = 6.0). The cohort comprised diverse populations from the United States, Finland, and Australia, with follow-up data collected until 2019.
The investigators found that childhood BMI and LDL cholesterol showed both direct and indirect effects on adult cardiovascular disease risk. Specifically, the direct effect incidence rate ratio for childhood BMI was 1.18 (95% confidence interval [CI] = 1.05–1.34), whereas for LDL cholesterol, it was 1.16 (95% CI =1.01–1.34). Indirect effects, mediated through adulthood risk factors, were higher for total cholesterol 1.14 (95% CI = 1.08–1.19), triglycerides 1.17 (95% CI = 1.12–1.21), and systolic blood pressure 1.15 (95% CI = 1.10–1.19).
Additionally, childhood smoking affected the cardiovascular disease risk only through its influence on adulthood smoking. Life-course models showed that childhood BMI had a nearly equal role in cardiovascular disease risk as adulthood BMI, whereas adulthood was a more important period for other risk factors and the combined risk score.
The average age at cardiovascular event or censoring was 49.2 years (SD = 7.0). The median follow-up time was 23.6 years (interquartile range = 18.7–30.2).
Full disclosures can be found in the original study.