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Childhood CV Risk Factors and Midlife Cognitive Performance
Study Questions:
What is the relationship between cardiovascular (CV) risk factors in childhood and adolescence and midlife cognitive performance?
Methods:
The study made use of a cohort from the Young Finns Study, a longitudinal population-based study of CV risk factors from childhood to adulthood. A total of 3,596 children (baseline age 3-18 years) have been followed for 31 years, with regular assessment of CV risk factors including blood pressure (BP), serum lipids, body mass index, and smoking. Cumulative exposure as the area under the curve for each risk factor was determined in childhood (6-12 years), adolescence (12-18 years), and young adulthood (18-24 years). In 2011, cognitive testing was performed in 2,026 participants aged 34-49 years.
Results:
Childhood risk factors of elevated systolic BP, elevated serum total cholesterol, and smoking were independently associated with worse midlife cognitive performance, especially memory and learning. Individuals with all risk factors within recommended levels between ages 6-24 performed 0.29 standard deviations better on the cognitive domain of visual and episodic memory and visuospatial associative learning than those exceeding all risk factor guidelines at least twice (p = 0.006) during serial measurements over the study period. This difference corresponds to the effect of 6 years of aging on this cognitive domain.
Conclusions:
The authors concluded that a cumulative burden of CV risk factors from childhood is associated with worse midlife cognitive performance independent of exposure during adulthood.
Perspective:
This analysis of data from the Young Finns Study demonstrated a significant impact of childhood CV risk factors on some domains of neurocognitive testing in adults. Covariates used in the analysis included age, sex, baseline household income, antihypertensive and dyslipidemia medication, and diagnoses of CV diseases and type 1 and 2 diabetes mellitus. This study supports aggressive diagnosis and modification of cardiac risk factors in childhood in an attempt to optimize long-term neurocognitive outcomes. Limitations of the study include the possibility of residual confounding due to unmeasured factors as well as potentially for selection bias in the patients available for long-term follow-up. Finally, as this is an observational study, there is difficulty in demonstrating causality. However, existing population cohorts are the most realistic approach to determine the impact of early exposures on long-term adult issues.
Keywords: Antihypertensive Agents, Blood Pressure, Blood Pressure Determination, Body Mass Index, Cardiovascular Diseases, Child, Cholesterol, Cognition, Diabetes Mellitus, Heart Defects, Congenital, Hypercholesterolemia, Lipids, Memory, Episodic, Primary Prevention, Risk Factors, Smoking
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