Early Childhood Cardiovascular Risk Linked to Adult Cardiovascular Events, Death

Researchers investigated whether cardiovascular risk factors in early childhood were associated with the development of cardiovascular disease later in adult life.

Early childhood cardiovascular (CV) risk factors, including body mass index (BMI), systolic blood pressure (BP), total cholesterol level, triglyceride level, and youth smoking, were found to be associated with adult CV events and death from CV causes prior to 60 years of age, according to study results published in The New England Journal of Medicine.

Researchers conducted a prospective cohort study using data from the International Childhood Cardiovascular Cohort (i3C) Consortium, which includes 7 cohorts in Australia, Finland, and the United States.

In the i3C Consortium, data on CV risk factors from early childhood through adolescence were collected and adult CV events were adjudicated. The current study used these data to explore the development of CV disease over the life course and to test the hypothesis that traditional CV risk factors in childhood (between 3 and 19 years of age) are associated with the future development of adult CV events. Study outcomes included fatal CV events and fatal or nonfatal CV events.

The study sample included a total of 38,589 participants. Overall, 49.7% (19,168 of 38,589) of the study participants were boys and 15.0% (5792 of 38,589) were Black. The mean age at which a study participant was seen during childhood was 11.8±3.1 years, whereas the mean age of the participants at the time of experiencing their CV event was 47.0±8.0 years. The patients who experienced CV events were more likely to be men, older, and to have a lower parental and personal education level compared with those who did not experience any CV events.

A total of 319 fatal CV events occurred among the 38,589 study participants.  The hazard ratios (HRs) for a fatal CV event in adulthood ranged from 1.30 (95% 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 HR for a fatal CV event with respect to the combined-risk z score was 2.71 (95% CI, 2.23-3.29) per unit increase, and the HR for a fatal or nonfatal CV event in adulthood was 2.75 (95% CI, 2.48-3.06) per unit increase.

The HRs and their 95% CIs in the analyses of fatal CV events were similar to those in the analyses of 779 fatal or nonfatal CV events that occurred among 20,656 participants who could be evaluated for this outcome.

In an analysis of 115 fatal CV events that occurred in a subgroup of 13,401 individuals (aged 31.0±5.6 years at the adult measurement) with data available on adult risk factors, the adjusted HR regarding the childhood combined-risk z score was 3.54 (95% CI, 2.57-4.87) per unit increase. The mutually adjusted HR with respect to change in combined-risk z score from childhood to adulthood was 2.88 (95% CI, 2.06-4.05) per unit increase. Results were similar in the analysis of 524 fatal or nonfatal CV events.

Study limitations included the fact that since 46.5% of the sample could not be located to determine nonfatal CV events, loss to follow-up was associated with a potential response bias. Further, the present study was not specifically powered to detect racial differences, as it did not include many Hispanic participants and focused on the experience of those in high-income countries.

“This prospective cohort study showed that the [CV] risk factors of [BMI], systolic [BP], total cholesterol level, triglyceride level, and youth smoking, particularly [when combined and] beginning in early childhood, were associated with adult [CV] events and death from [CV] causes before the age of 60 years,” the study authors wrote.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Jacobs Jr DR, Woo JG, Sinaiko AR, et al. Childhood cardiovascular risk factors and adult cardiovascular events. N Engl J Med. 2022;386(20):1877-1888. doi:10.1056/NEJMoa2109191