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Cardiovascular Risk Factors from Early Life Predict Future Adult Cardiac Structural and Functional Abnormalities: A
Arjun K Ghosh1, Darrel P Francis2, Nishi Chaturvedi2
1International Centre for Circulatory Health, Imperial College London; Medical Research Council Unit for Lifelong Health and Ageing, London, UK.
Insights
Lifetime cardiovascular risk factors like blood pressure and BMI impact heart structure and function years later. Understanding this history is key for better clinical practice and prevention strategies.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- Current cardiovascular risk assessment relies on present factor levels, neglecting life-course history.
- Risk factors are linked to cardiac structure and function, but their long-term impact is understudied.
- Previous risk factor exposure's effect on future echocardiographic changes remains largely unexamined.
Purpose of the Study:
- To systematically review the literature on the impact of life-course risk factor history on cardiac structure and function.
- To determine if earlier blood pressure, body mass index, and glycaemic control predict future cardiac abnormalities.
Main Methods:
- A systematic literature review was conducted.
- 24 studies were analyzed, examining the relationship between earlier risk factors (BP, BMI, glycaemic control) and subsequent cardiac outcomes.
- Studies focused on changes in cardiac structure and function over time.
Main Results:
- Elevated blood pressure and BMI, and greater cumulative burden, were linked to poorer cardiac structure up to 24 years later.
- Poorer glycaemic control in young adulthood predicted increased future left ventricular mass.
- All examined risk factors were associated with worse future diastolic function.
Conclusions:
- Childhood, adolescent, and early adulthood risk factor levels and trajectories predict future cardiac structure and function abnormalities.
- Incorporating lifetime risk factor history into clinical practice is recommended.
- Further research is needed to identify sensitive life-course periods for effective prevention.
Background:
Clinical practice evaluates cardiovascular risk based on current risk factor (RF) levels [Blood pressure (BP), body mass index (BMI) and glycaemic control] largely disregarding previous risk-factor history over the totality of the life course. RFs are related to contemporaneous echocardiographic measures of cardiac structure and function which in turn are independently related to cardiovascular morbidity and mortality in cross-sectional studies. However, the effect of lifetime or earlier RF history on future echocardiographic changes has never been systematically examined.
Methods:
A systematic review of the published literature identified 24 studies relating either earlier BP, BMI, glycaemic control or a combination to future cardiac structure and/or function.
Results:
The majority of studies showed that elevated BP and BMI in earlier life and greater cumulative burden of these factors resulted in worse cardiac structure up to 24 years later. Studies examining glycaemic control as RF were few, but poorer glycaemic control in young adults was associated with increased future left ventricular mass. While only 5 papers related RFs to future cardiac function, all RFs were positively associated with worse future diastolic function.
Conclusions:
BP, BMI and glycaemic control measures in childhood, adolescence and early adulthood and subsequent longitudinal trajectories of BP and BMI are predictive of future abnormalities in cardiac structure and function. Lifetime RF history should be used to inform clinical practice. Further research is required to enable the identification of any sensitive periods in the life course to enable prevention when it is most likely to be effective.
