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A Clinical Tool to Relate Youth Risk Factors to Adult Cardiovascular Events and Type 2 Diabetes: The International
Jessica Haley1, Jessica G Woo2, David R Jacobs3
1Rady Children's Hospital, Pediatric Cardiology, San Diego, CA; Department of Pediatrics, University of California, San Diego, CA.
Insights
Childhood cardiovascular risk factors, including body mass index and blood pressure, predict adult disease. Early risk identification in children is crucial, as elevated levels below current thresholds indicate future cardiovascular events and type 2 diabetes mellitus.
Area of Science:
- Pediatric cardiology and public health research.
- Longitudinal cohort studies in cardiovascular epidemiology.
Background:
- Childhood cardiovascular risk factors are linked to adult cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM).
- Translating these associations into clinically actionable risk levels is essential for early intervention.
Purpose of the Study:
- To establish clinically actionable values for childhood cardiovascular risk factors and their association with adult CVD and T2DM.
- To quantify the risk of adult CVD and T2DM based on childhood measurements of key risk factors.
Main Methods:
- Prospective observational study of 38,589 children followed for over 30 years.
- Analysis of five childhood CV risk factors (smoking, BMI, systolic blood pressure, triglycerides, total cholesterol) and their relation to adult CV events.
- Calculation of age- and sex-specific z scores for risk factors, combined risk scores, and back-transformation to natural units for clinical interpretation.
Main Results:
- Elevated risk for CV events was detected at levels below current clinical thresholds for most factors, except total cholesterol.
- A doubling of risk was observed at high-normal levels just below established abnormality cut points.
- Risk for adult T2DM was evident at BMI and glucose levels currently considered normal.
Conclusions:
- Childhood cardiovascular risk begins at levels below those currently deemed normal.
- These findings underscore the importance of early identification and management of cardiovascular risk factors in children.
- The study provides a framework for translating childhood risk factor data into clinically relevant risk assessments for adult disease prevention.
Objective:
To translate data relating childhood cardiovascular (CV) risk factors and adult CV disease and type 2 diabetes mellitus (T2DM) to clinically actionable values.
Study Design:
This was a prospective observational study (n = 38 589) in the International Childhood Cardiovascular Cohort Consortium. Children at age 3 through 19 years were enrolled in the 1970s and 1980s and followed for more than 30 years. Five childhood CV risk factors (smoking, body mass index [BMI], systolic blood pressure, triglycerides, and total cholesterol) were related to adult CV events. Secondary analyses in a subset included low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, glucose, and insulin level. Age- and sex-specific z scores were calculated for each risk factor, and a combined-risk z score was calculated by averaging z scores for the 5 key CV risk factors. Risk factor z scores were back-transformed to natural units for clinical interpretation, with hazard ratios for adult CV events presented in color-coded tables (green: no increased risk; orange: 1.4 to <2.0-fold increased risk; red: at least doubling of risk). Risk levels for development of adult T2DM on the basis of BMI, glucose, and insulin were similarly calculated and presented.
Results:
Increased risk for CV events was observed at levels lower than currently defined abnormal clinical thresholds except for TC. Doubling of risk was observed at high normal levels just below the clinical cut point for abnormality. Risk for adult T2DM began at levels of BMI and glucose currently considered normal.
Conclusions:
On the basis of data showing significant relationships between childhood CV risk factors and adult CV events and T2DM, this study shows that risk in childhood begins below levels currently considered normal.
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