Associations of Blood Pressure and Cholesterol Levels During Young Adulthood With Later Cardiovascular Events

Abstract

BACKGROUNDBlood pressure (BP) and cholesterol are major modifiable risk factors for cardiovascular disease (CVD), but effects of exposures during young adulthood on later life CVD risk have not been well quantified.OBJECTIVEThe authors sought to evaluate the independent associations between young adult exposures to risk factors and later life CVD risk, accounting for later life exposures.METHODSThe authors pooled data from 6 U.S. cohorts with observations spanning the life course from young adulthood to later life, and imputed risk factor trajectories for low-density lipoprotein (LDL) and high-density lipoprotein cholesterols, systolic and diastolic BP starting from age 18 years for every participant. Time-weighted average exposures to each risk factor during young (age 18 to 39 years) and later adulthood (age ≥40 years) were calculated and linked to subsequent risks of coronary heart disease (CHD), heart failure (HF), or stroke.RESULTSA total of 36,030 participants were included. During a median follow-up of 17 years, there were 4,570 CHD, 5,119 HF, and 2,862 stroke events. When young and later adult risk factors were considered jointly in the model, young adult LDL ≥100 mg/dl (compared with <100 mg/dl) was associated with a 64% increased risk for CHD, independent of later adult exposures. Similarly, young adult SBP ≥130 mm Hg (compared with <120 mm Hg) was associated with a 37% increased risk for HF, and young adult DBP ≥80 mm Hg (compared with <80 mm Hg) was associated with a 21% increased risk.CONCLUSIONSCumulative young adult exposures to elevated systolic BP, diastolic BP and LDL were associated with increased CVD risks in later life, independent of later adult exposures.

Association between high blood pressure and long term cardiovascular events in young adults: systematic review and meta-analysis

“…Therefore, we conducted sensitivity analyses across various scenarios to assess whether and to what extent the heterogeneity could be reduced. As a result, the heterogeneity reduced from substantial to moderate (supplementary appendix 3, table S2) when the analyses were confined to studies including only untreated participants81213192023 or when a mercury sphygmomanometer was used for blood pressure measurements 121314212223…”

Trajectories of early to mid-life adulthood BMI and incident diabetes: the China Health and Nutrition Survey

“…Six large community-based prospective cohorts identified that young adult exposures to major modifiable risk factors for cardiovascular disease (CVD) were associated with increased CVD risks in later life, independent of later adult exposures. 9 Except for the absolute level of BMI, longitudinal BMI trajectory across the lifecourse also plays an important role in the development of diabetes. [10][11][12][13][14] However, it is unclear whether the dynamic trends in body weight gain contribute to future diabetes risk, especially during young adulthood.…”

Hypertension and Hypercholesterolemia: is it Time for Anti-«Lipitensive» Therapy?

“…Кроме этого, необходимо отметить, что, в соответствии с данными исследований последних лет, воздействие повышенного уровня ХС ЛПНП и АД даже в относительно молодом возрасте существенно увеличивает риск развития ССЗ [29][30][31]. Так, в исследовании Y. Zhang и соавт., объединившем данные о более чем 36 тыс пациентов из 6 крупных когортных исследований (ARIC, CARDIA, FHS-O, HealthABC, MESA, CHS), уровни ХС ЛПНП≥2,6 ммоль/л в возрасте 18-39 лет Is it Time for Anti-«Lipitensive» Therapy?…”

“…в этом же возрасте -с увеличением риска развития сердечной недостаточности на 37% (ОР 1,37; 95%ДИ 1,17-1,71) по сравнению с АД<120 мм рт.ст. [31]. Следует подчеркнуть, что полученные ассоциации не зависели от значений ХС ЛПНП и АД в более поздний период жизни, в связи с чем закономерно возникает вопрос о необходимости коррекции этих факторов риска в молодом возрасте.…”