Ideal cardiovascular health in adolescence is associated with reduced risks of hypertension, metabolic syndrome and high cholesterol in adulthood
- 1Department of Nursing, UMass Boston College of Nursing & Health Sciences, Boston, Massachusetts, USA
- 2Department of Exercise and Health Sciences, UMass Boston College of Nursing & Health Sciences, Boston, Massachusetts, USA
- Correspondence to: Laura L Hayman
Department of Nursing, College of Nursing and Health Sciences, UMass Boston, 100 Morrissey Blvd, Boston, MA 02125-3393, USA;
Commentary on: Laitinen TT, Pahkala K, Magnussen CG, et al. Ideal cardiovascular health in childhood and cardiometabolic outcomes in adulthood: the Cardiovascular Risk in Young Finns Study. Circulation 2012;125:1971–8.
Implications for practice and research
Ideal cardiovascular health in childhood is important to prevent adverse cardiometabolic outcomes in adulthood.
Clinical-based and population-based lifestyle approaches are needed to promote ideal cardiovascular health across the life course.
Longitudinal studies of diverse populations are needed to test the utility and generalisability of the American Heart Association (AHA) metrics for ideal cardiovascular health and to guide and inform optimal approaches to achieving ideal cardiovascular health.
Atherosclerotic processes begin early in life and are influenced over time by potentially modifiable behaviours, risk factors and environmental exposures. Primary prevention of cardiovascular disease (CVD) has long been emphasised.1 ,2 Recent attention has focused on primordial prevention, prevention of the development of the risk factor in the first place3 with emphasis on maintaining ideal cardiovascular health across the lifecourse. Operationalising this emphasis, the AHA4 identified seven metrics that include four health behaviours (smoking, weight, physical activity and diet) and three health factors (total cholesterol, blood pressure and blood glucose). For each of the metrics, three levels of cardiovascular health were defined: poor, intermediate and ideal. Laitinen and colleagues examined the utility of these metrics in children and youth. Specifically, data from the Cardiovascular Risk in Young Finns Study, an ongoing population-based prospective study, were used to examine whether the construct of ideal cardiovascular health in childhood is associated with hypertension, dyslipidaemia, metabolic syndrome (MetS), type 2 diabetes mellitus and carotid-intima media thickness (IMT) 21 years later in adulthood.
The sample included 856 participants (42% male) who were 12–18 years of age at baseline (mean age=15 years), had complete risk factor data available from baseline (1986) and measurements during the 2007 survey enabling the assessment of cardiometabolic outcomes in adulthood. Health factors were measured using standard protocols with trained observers; MetS in childhood was characterised using a definition5 previously shown to predict adult outcomes. In childhood, dietary habits were assessed with a non-quantitative food frequency questionnaire (FFQ); in adulthood, a more detailed FFQ was used. Smoking behaviour and intensity, frequency and hours per week of moderate or vigorous physical activity were assessed by self-report. In creating the childhood composite index of cardiovascular health, the AHA's definitions were used with minor modification: a value of zero was assigned to poor or intermediate cardiovascular health and one to ideal health for each metric. Values were summed and ranged from 0 (worst) to 7 (best).
The number of ideal cardiovascular health metrics present in childhood was associated with reduced adult risk of hypertension (OR (95% CI) 0.66 (0.52 to 0.85), p<0.001; MetS (0.66 (0.52 to 0.77), p<0.001; high low-density lipoprotein cholesterol (0.66 (0.52 to 0.85), p=0.001 and high-risk IMT (0.75 (0.60 to 0.94), p=0.01)). The collective results indicate that the number of ideal cardiovascular health metrics present in childhood predicts subsequent cardiometabolic health in adulthood. A finding of concern was that no child met all seven metrics for ideal cardiovascular health.
This observational study underscores the importance of establishing and maintaining ideal cardiovascular health in childhood. The strengths include the longitudinal design and duration of follow-up of the participants who were very well phenotyped in childhood and adulthood. The limitations include the use of surrogate measures for cardiovascular endpoints and non-standardised self-report measurements of diet and physical activity that excluded use of AHA metrics for these variables. Taken together, and with a goal of evaluating the generalisability of the AHA metrics, results point to the need for additional longitudinal research with different population-based samples using cardiovascular outcomes as endpoints. Most importantly and placed in the context of accumulated data, the results underscore the need for primordial and primary prevention beginning early in life.