Childhood CV Risk Factors and Adult CV Events

Quick Takes

  • CV risk factors during childhood are associated with risk of CV events during adulthood.
  • Youth smoking was associated with a 60% increased risk for fatal CV events during adulthood.
  • Elevated BMI, systolic blood pressure, and lipids were also associated with CV events during adulthood.

Study Questions:

Is the presence of cardiovascular (CV) risk factors in childhood associated with CV clinical events in adulthood?


Data from the International Childhood Cardiovascular Cohorts (i3C) Consortium, a prospective cohort study that includes six cohorts from Australia, Finland, and the United States, were used for the present analysis. These cohorts collected data on CV risk factors from early childhood through adolescence and collected adjudicated CV events in adulthood. A total of 42,324 participants 3-19 years of age were enrolled from the 1970s through the 1990s for a mean follow-up of 35 years. Body mass index (BMI), systolic blood pressure, total cholesterol level, triglyceride level, and youth smoking were analyzed with the use of i3C-derived age- and sex-specific z scores and with a combined-risk z score that was calculated as the unweighted mean of the five risk z scores. An algebraically comparable adult combined-risk z score (before any CV event) was analyzed jointly with the childhood risk factors. Study outcomes were fatal CV events and fatal or nonfatal CV events, and analyses were performed after multiple imputation with the use of proportional-hazards regression.


A total of 38,589 participants were included, of which 49.7% were male and 15.0% were Black. Mean age of the participants during childhood was 11.8 ± 3.1 years. During follow-up, 319 fatal CV events were identified. The mean age of the participants at the time of their CV event was 47.0 ± 8.0 years. Participants with CV events were older, more likely to be male, and had a lower parental and personal education level than those without CV events. The hazard ratios for a fatal CV event in adulthood ranged from 1.30 (95% confidence interval [CI], 1.14-1.47) per unit increase in the z score for total cholesterol level to 1.61 (95% CI, 1.21-2.13) for youth smoking (yes vs. no). The hazard ratio for a fatal CV event with respect to the combined-risk z score (smoking, BMI, systolic blood pressure, triglycerides, and total cholesterol) was 2.71 (95% CI, 2.23-3.29) per unit increase.


The investigators concluded that in this prospective cohort study, childhood risk factors and the change in the combined-risk z score between childhood and adulthood were associated with CV events in midlife.


These data provide strong longitudinal evidence that CV health in childhood is important for CV health in adulthood. Preventing weight gain and smoking in particular are important CV risk factors to focus on during childhood.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Hypertriglyceridemia, Lipid Metabolism, Nonstatins, Smoking

Keywords: Adolescent, Blood Pressure, Body Mass Index, Cardiovascular Diseases, Child Health, Child, Preschool, Cholesterol, Heart Disease Risk Factors, Lipids, Pediatrics, Primary Prevention, Risk Factors, Smoking, Triglycerides, Weight Gain

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