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Lower birth weight is linked to poorer cardiovascular health in middle-aged population-based adults
Zahra Raisi-Estabragh1,2, Jackie Cooper2, Mae S Bethell3
1Barts Heart Centre, Saint Bartholomew's Hospital, Barts Health NHS Trust, London, UK zahraraisi@doctors.org.uk.
Insights
Lower birth weight increases myocardial infarction (MI) risk, mediated by factors like hypertension and inflammation. This highlights birth weight as a key indicator for cardiovascular disease prevention strategies.
Area of Science:
- Cardiovascular Health
- Reproductive Health
- Epidemiology
Background:
- Birth weight is a crucial indicator of early-life development.
- Associations between birth weight and later-life cardiovascular health require further investigation.
- Understanding mechanistic pathways is vital for effective prevention strategies.
Purpose of the Study:
- To investigate the relationship between birth weight and cardiovascular health indicators.
- To explore the mediating roles of various factors in the birth weight-cardiovascular disease link.
- To assess birth weight associations with cardiac structure and function.
Main Methods:
- Utilized UK Biobank data from 258,787 participants.
- Employed competing risk regression for incident myocardial infarction (MI) and mortality.
- Used mediation analysis and linear regression for mechanistic and imaging assessments (cardiac MRI).
Main Results:
- A non-linear association between birth weight and MI risk was observed, with lower birth weight (<3.2kg) linked to increased risk.
- Key mediators included hypertension, glycated hemoglobin, C-reactive protein, HDL, and cholesterol.
- Lower birth weight correlated with adverse left ventricular (LV) remodeling and poorer cardiac function.
Conclusions:
- Lower birth weight is associated with elevated MI risk and adverse cardiac phenotypes.
- Cardiometabolic diseases and systemic inflammation partially mediate these effects.
- Birth weight should be considered in cardiovascular risk prediction and prevention efforts.
Objective:
To examine associations of birth weight with clinical and imaging indicators of cardiovascular health and evaluate mechanistic pathways in the UK Biobank.
Methods:
Competing risk regression was used to estimate associations of birth weight with incident myocardial infarction (MI) and mortality (all-cause, cardiovascular disease, ischaemic heart disease, MI), over 7-12 years of longitudinal follow-up, adjusting for age, sex, deprivation, maternal smoking/hypertension and maternal/paternal diabetes. Mediation analysis was used to evaluate the role of childhood growth, adulthood obesity, cardiometabolic diseases and blood biomarkers in mediating the birth weight-MI relationship. Linear regression was used to estimate associations of birth weight with left ventricular (LV) mass-to-volume ratio, LV stroke volume, global longitudinal strain, LV global function index and left atrial ejection fraction.
Results:
258 787 participants from white ethnicities (61% women, median age 56 (49, 62) years) were studied. Birth weight had a non-linear relationship with incident MI, with a significant inverse association below an optimal threshold of 3.2 kg (subdistribution HR: 1.15 (1.08 to 1.22), p=6.0×10-5) and attenuation to the null above this threshold. The birth weight-MI effect was mediated through hypertension (8.4%), glycated haemoglobin (7.0%), C reactive protein (6.4%), high-density lipoprotein (5.2%) and high cholesterol (4.1%). Birth weight-mortality associations were statistically non-significant after Bonferroni correction. In participants with cardiovascular magnetic resonance (n=19 314), lower birth weight was associated with adverse LV remodelling (greater concentricity, poorer function).
Conclusions:
Lower birth weight was associated with greater risk of incident MI and unhealthy LV phenotypes; effects were partially mediated through cardiometabolic disease and systemic inflammation. These findings support consideration of birth weight in risk prediction and highlight actionable areas for disease prevention.
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