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Coronary Heart Disease and Stroke in Adults Born Preterm - The Helsinki Birth Cohort Study
Eero Kajantie1,2,3, Clive Osmond4, Johan G Eriksson1,5,6,7,8
1Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland.
Insights
This study found no increased risk of coronary heart disease (CHD) or stroke in adults born preterm. However, women born early preterm showed a higher CHD rate, highlighting a discrepancy in cardiovascular disease risk.
Area of Science:
- Cardiovascular epidemiology
- Perinatal health outcomes
- Longitudinal cohort studies
Background:
- Adults born preterm exhibit elevated risk factors for cardiovascular disease.
- Previous research indicates a potential link between preterm birth and later-life cardiovascular complications.
- Understanding the long-term cardiovascular health of preterm-born individuals is crucial for public health.
Purpose of the Study:
- To investigate the cumulative incidence of manifest coronary heart disease (CHD) and stroke in adults born preterm.
- To determine if preterm birth is associated with an increased risk of developing CHD or stroke in later life.
- To explore potential sex-specific differences in cardiovascular disease risk among preterm-born individuals.
Main Methods:
- A cohort of 19,015 individuals born in Helsinki, Finland, between 1924-1944 was studied.
- Participants were categorized into early preterm (<34 weeks) and late preterm (34 to <37 weeks) groups.
- Coronary heart disease (CHD) and stroke incidence were ascertained from national hospital discharge and death registers, with hazard ratios estimated using Cox regression.
Main Results:
- No significantly increased risk for CHD or stroke was observed in the overall preterm-born population up to old age.
- Hazard ratios for CHD were 1.17 (early preterm) and 0.99 (late preterm); for stroke, they were 0.84 (early preterm) and 0.86 (late preterm).
- Women born early preterm demonstrated a significantly higher risk of CHD (HR 1.98).
Conclusions:
- Overall, preterm birth did not lead to an increased risk of CHD or stroke in old age.
- A notable exception was observed in women born early preterm, who had a higher rate of CHD.
- The discrepancy between increased risk factors and manifest disease in preterm-born individuals warrants further investigation for cardiovascular disease prevention insights.
Background:
Adults born preterm have increased risk factors for cardiovascular disease. We studied the cumulative incidence of manifest coronary heart disease (CHD) and stroke in adults born preterm.
Methods:
We studied 19 015 people born in Helsinki, Finland, during 1924-44. Of them, 137 (0.7%) were born early (<34 weeks) and 1006 (5.3%) late preterm (34 to <37 weeks). We ascertained CHD and stroke from the National Hospital Discharge and Death Registers and estimated hazard ratios (HRs) by Cox regression.
Results:
A total of 3027 subjects (15.9%) had CHD and 1805 (9.5%) stroke. HRs for CHD were 1.17 (95% confidence interval 0.83, 1.65) for early and 0.99 (0.85, 1.14) for late preterm. For stroke, they were 0.84 (0.50, 1.39) and 0.86 (0.71, 1.06). HRs were little changed when adjusted for childhood and adult socio-economic position and birthweight for gestation standard deviation score. They were similar for first-ever events before or after 65 years, for haemorrhagic and thrombotic stroke, and for men and women, except that the HR for CHD for women born early preterm was 1.98 (1.18, 3.30).
Conclusions:
We found no increased risk of CHD or stroke up to old age in people born preterm, although women born early preterm had a higher rate of CHD. There is a discrepancy between increased risk factors in younger generations born preterm and little or no increase in manifest disease in older age. Uncovering reasons underlying this discrepancy may give important insights into the prevention of cardiovascular disease.