Migration within Great Britain and cardiovascular disease: early life and adult environmental factors

Area of Science:

• Epidemiology
• Cardiovascular Health
• Public Health

Background:

• Cardiovascular disease (CVD) remains a leading cause of mortality globally.
• Understanding the interplay of early life versus adult life factors is crucial for effective CVD prevention strategies.
• Internal migration within Great Britain (GB) offers a unique model to study these influences.

Purpose of the Study:

• To investigate the relative impact of early life (zone of birth) and adult life (zone of examination) on cardiovascular disease risk.
• To assess how migration patterns within GB affect cardiovascular outcomes in middle-aged men.
• To identify key determinants of cardiovascular risk in a middle-aged male population.

Main Methods:

• A prospective study involving 7,735 middle-aged men (40-59 years) from 24 British towns.
• Categorization of participants based on zone of birth and zone of examination (South of England vs. rest of GB).
• Long-term follow-up (mean 21.8 years) to record coronary heart disease (CHD) events and cardiovascular deaths.

Main Results:

• Men examined in the South of England exhibited lower risk of CHD events and CVD mortality, irrespective of their birth zone.
• The zone of examination was a stronger predictor of cardiovascular risk than the zone of birth.
• Men born and examined in the rest of GB had the highest adjusted risk, while those migrating to the South had risks similar to men born and examined in the South.

Conclusions:

• Adult life circumstances, particularly the place of residence, appear to be the dominant factor in determining cardiovascular risk in middle and older age.
• While adult factors are dominant, the potential influence of early life factors on cardiovascular risk cannot be entirely excluded.
• These findings highlight the importance of environmental and lifestyle factors during adulthood for cardiovascular health.