Changes in Composite Cardiovascular Risk Scores from Childhood to Adulthood and Cardiometabolic Outcomes in...

Cardiovascular risk factors often co-exist, originate early in life, and track over the life course; however, dynamic changes can happen, which can be effectively captured through trajectory analysis. We aimed to systematically synthesise evidence on associations between trajectories of composite cardiovascular risk scores from childhood to adulthood and adult cardiometabolic outcomes.

Following a registered protocol (PROSPERO ID: CRD42023455203), MEDLINE, Embase, and Web of Science databases were searched until 12 April 2025. We included population-based longitudinal studies with composite scores comprising at least two modifiable cardiovascular risk factors in both childhood and adulthood, along with adult cardiometabolic outcomes.

Of 5,677 articles identified, 11 met the inclusion criteria, representing nine cohorts from four countries. Composite scores included three to seven risk factors, most commonly body mass index (n=9), smoking (n=8), glucose (n=7), cholesterol (n=7), blood pressure (n=6), diet (n=5), and physical activity (n=5). Six studies created trajectories using data from at least three visits, and four applied advanced trajectory modelling approaches. An increase in continuous composite scores indicating improving cardiovascular health was associated with lower risk of adverse vascular and cardiac outcomes, type 2 diabetes, and cardiovascular events. Compared with the consistently low-risk trajectory, persistently high-risk and worsening trajectories were associated with higher cardiometabolic risk. The resolution trajectory was associated with outcomes similar to those of the consistently low-risk trajectory, except for type 2 diabetes.

Despite variations in score definitions and trajectory modelling approaches, current evidence suggests that worsening or persistently high-risk trajectories of composite cardiovascular score from childhood to adulthood were associated with increased cardiometabolic risk in adulthood, while resolution may mitigate many of these risks.