Programming of cardiovascular disease across the life-course

Introduction: Premature fatal cardiovascular disease rates have plateaued in the US. Identifying population distributions of short- and long-term predicted risk for atherosclerotic cardiovascular disease (ASCVD) can inform interventions and policy to improve cardiovascular health over the life course. Methods: Among nonpregnant participants age 30-59 years without prevalent CVD from the National Health and Nutrition Examination Surveys 2015-18, continuous 10 year (10Y) and 30 year (30Y) predicted ASCVD risk were assigned using the Pooled Cohort Equations and a 30-year competing risk model, respectively. Intermediate/high 10Y risk was defined as ≥7.5%, and high 30Y risk was chosen a priori as ≥20%, based on 2019 guideline levels for risk stratification. Participants were combined into low 10Y/low 30Y, low 10Y/high 30Y, and intermediate/high 10Y categories. We calculated and compared risk distributions overall and across race-sex, age, body mass index (BMI), and education using chi-square tests. Results: In 1495 NHANES participants age 30-59 years (representing 53,022,413 Americans), median 10Y risk was 2.3% and 30Y risk was 15.5%. Approximately 12% of individuals were already estimated to have intermediate/high 10Y risk. Of those at low 10Y risk, 30% had high 30Y predicted risk. Distributions differed significantly by sex, race, age, BMI, and education (P<0.01, Figure ). Black males more frequently had high 10Y risk compared with other race-sex groups. Older individuals, those with BMI ≥30 kg/m 2 , and with ≤high school education had a higher frequency of low 10Y/high 30Y risk. Conclusions: More than one-third of middle-aged U.S. adults have elevated short- or long-term predicted risk for ASCVD. While the majority of middle-aged US adults are at low 10Y risk, a large proportion among this subgroup are at high 30Y ASCVD risk, indicating a substantial need for enhanced clinical and population level prevention earlier in the life course.

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Health in a ‘post-transition’ Australia: adding years to life or life to years?

Australian Health Review ◽

10.1071/ah13114 ◽

2014 ◽

Vol 38 (1) ◽

pp. 1 ◽

Cited By ~ 5

Author(s):

Stephen J. Begg

Keyword(s):

Cardiovascular Disease ◽

Primary Prevention ◽

Life Expectancy ◽

Life Course ◽

Morbidity And Mortality ◽

Health Expectancy ◽

Average Life Span ◽

Mortality And Morbidity ◽

The Difference ◽

The Life Course

Objective To explore the likely impact of future trajectories of morbidity and mortality in Australia. Methods Estimates of mortality and morbidity were obtained from a previous assessment of Australia’s health from 1993 to 2003, including projections to 2023. Outcomes of interest were the difference between life expectancy (LE0) and health-adjusted life expectancy (i.e. absolute lost health expectancy (ALHE0)), ALHE0 as a proportion of LE0 and the partitioning of changes in ALHE0 into additive contributions from changes in age- and cause-specific mortality and morbidity. Results Actual and projected trajectories of mortality and morbidity resulted in an expansion of ALHE0 of 1.22 years between 1993 and 2023, which was equivalent to a relative expansion of 0.7% in morbidity over the life course. Most (93.8%) of this expansion was accounted for by cardiovascular disease, diabetes and cancer; of these, the only unfavourable trend of any note was increasing morbidity from diabetes. Conclusions Time spent with morbidity will most likely increase in terms of numbers of years lived and as a proportion of the average life span. This conclusion is based on the expectation that gains in LE0 will continue to exceed gains in ALHE0, and has important implications for public policy. What is known about the topic? Although the aging of Australia’s population as a result of declining birth and death rates is well understood, its relationship with levels of morbidity is not always fully appreciated. This is most noticeable in the policy discourse on primary prevention, in which such activities are sometimes portrayed as having unrealised potential with respect to alleviating growth in health service demand. What does this paper add? This paper sheds new light on these relationships by exploring the likely impact of future trajectories of both morbidity and mortality within an additive partitioning framework. The results suggest a modest expansion of morbidity over the life course, most of which is accounted for by only three causes. In two of these (cardiovascular disease and cancer), the underlying trends in both mortality and morbidity have been favourable for some time due, at least in part, to success in primary prevention. What are the implications for practitioners? Although there may be good arguments in favour of a greater focus on primary prevention as currently practiced, reducing overall demand for health services is unlikely to be one of them. To make such an argument valid, policy makers should consider shifting their attention to the effectiveness of primary prevention as it relates to causes other than cardiovascular disease and cancer, particularly those with a predominantly non-fatal impact, such as diabetes and degenerative diseases of old age.

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Life course traumas, phenotypic aging, and cardiovascular disease: retrospective analysis of 104,939 UKB participants

10.1101/2021.11.24.21266842 ◽

2021 ◽

Author(s):

Xingqi Cao ◽

Jingyun Zhang ◽

Chao Ma ◽

Xueqin Li ◽

Chia-Ling Kuo ◽

...

Keyword(s):

Cardiovascular Disease ◽

Life Course ◽

Cardiovascular Health ◽

Logistic Models ◽

Traumatic Experiences ◽

Mediation Analyses ◽

The Uk ◽

Childhood Traumas ◽

The Life Course ◽

Mental Health Questionnaire

Background: While childhood and adulthood traumatic experiences have been linked to subsequent cardiovascular disease (CVD), the relationship between life course traumas and CVD and the underpinning pathways are poorly understood. This study aimed to: (1) examine the associations of childhood, adulthood, and lifetime traumas with CVD; (2) examine the associations between diverse life course traumatic profiles and CVD; and (3) examine the extent to which Phenotypic Age (PhenoAge), a well-developed phenotypic aging measure, mediates these associations. Methods: We included 104,939 participants from the UK Biobank who completed the 2016 online mental health questionnaire. CVD outcomes including ischemic heart disease, myocardial infarction, and stroke were ascertained. Childhood, adulthood, and lifetime traumas were categorized into three subgroups (mild, moderate, and severe), respectively. Four life course traumatic profiles were defined as non-severe traumas across life course, non-severe childhood and severe adulthood traumas, severe childhood and non-severe adulthood traumas, and severe traumas across life course based on both childhood and adulthood traumas. PhenoAge was measured using an equation previously developed. Multivariable logistic models and formal mediation analyses were performed. Results: Of 104,939 participants, 7,398 (7.0%) were diagnosed with CVD. Subgroups of childhood, adulthood, and lifetime traumas were associated with CVD, respectively. Furthermore, life course traumatic profiles were significantly associated with CVD. For instance, compared with subgroups experiencing non-severe traumas across life course, those who experienced non-severe childhood and severe adulthood traumas, severe childhood and non-severe adulthood traumas, and severe traumas across life course had higher odd of CVD, with odds ratios of 1.07 (95% confidence interval [CI]: 1.00, 1.15), 1.17 (95% CI: 1.09, 1.25), and 1.33 (95% CI: 1.24, 1.43), respectively. Formal mediation analyses suggested that PhenoAge partially mediated the above associations. For instance, PhenoAge mediated 5.8% of increased CVD events in subgroups who experienced severe childhood traumas, relative to those experiencing mild childhood traumas. Conclusions: Childhood, adulthood, and lifetime traumas, as well as diverse life course traumatic profiles, were associated with CVD. Furthermore, phenotypic aging partially mediated these associations. These findings suggest a potential pathway from life course traumas to CVD through phenotypic aging, and underscore the importance of policy programs targeting traumatic events over the life course in ameliorating inequalities in cardiovascular health.

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Abstract 032: Life-Course Socioeconomic Position Relates to Higher Arterial Stiffness in Adults From the ELSA-Brasil Cohort Study

Circulation ◽

10.1161/circ.137.suppl_1.032 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Debora M Coelho ◽

Lidyane V Camelo ◽

Luisa C Brant ◽

Luana G Giatti ◽

Antonio L Ribeiro ◽

...

Keyword(s):

Cardiovascular Disease ◽

Cohort Study ◽

Arterial Stiffness ◽

Life Course ◽

Socioeconomic Position ◽

Maternal Education ◽

Adult Life ◽

Linear Regression Models ◽

Subclinical Cardiovascular Disease ◽

The Life Course

Background: Although the association between socioeconomic adversity and risk for cardiovascular disease (CVD) is established, little is known about the effect of socioeconomic disadvantages across the life-course on arterial stiffness, an important marker of subclinical cardiovascular disease (CVD). Objective: To investigate whether exposure to adverse socioeconomic position (SEP) throughout the life course and especially in early life, is associated with increased arterial stiffness in adults. In addition, we assessed whether increasing number of unfavorable SEP events during the life course is associated with higher arterial stiffness. Methods: A total of 14,497 adults from the ELSA-Brasil cohort study baseline (2008-2010), aged between 34 and 75 years (45.5% men, mean age: 51.9, SD: 9.09), with validated values of femoral carotid pulse wave velocity (cfPWV), and with information available about maternal education were included. ELSA-Brazil is a multicenter cohort of civil servants from universities and research institutions of six Brazilian cities that aims to investigate the determinants of cardiovascular disease. Arterial stiffness was measured by cfPWV. Childhood and adulthood SEP was measured by maternal education and participants’ own education, respectively. Accumulation of SEP disadvantages across the life course was evaluated using a score including maternal and participants’ own education. The following variables were used for adjustments: age, sex, race, mean arterial pressure, heart rate, smoking, physical activity, diabetes, antihypertensive use. Multiple linear regression models were used. Results: Both lower childhood and adulthood SEP were associated with higher cfPWV in adult life, although the association with childhood SEP was not independent of adulthood SEP. However, cfPWV increased with increasing number of unfavorable SEP during the life course. Individuals exposed to low SEP in childhood and adulthood presented an average increase of 0.23m/s (95% CI: 0.13-0.34) in cfPWV in relation to individuals with high SEP in both periods of life. After all adjustments this association remained statically significant (β = 0.18, 95% CI: 0.07-0.29). Conclusion: Accumulation of exposures to socioeconomic disadvantages throughout life was associated with higher cfPWV in adults. Thus, it may imply that longer exposure to social disadvantages throughout life accelerates arterial aging.

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How Are Epigenetic Modifications Related to Cardiovascular Disease in Older Adults?

International Journal of Molecular Sciences ◽

10.3390/ijms22189949 ◽

2021 ◽

Vol 22 (18) ◽

pp. 9949

Author(s):

Mojgan Gharipour ◽

Arya Mani ◽

Mona Amini Baghbahadorani ◽

Camila Kellen de Souza Cardoso ◽

Shayesteh Jahanfar ◽

...

Keyword(s):

Cardiovascular Disease ◽

Older Adults ◽

Environmental Factors ◽

Life Course ◽

Lifestyle Modification ◽

Epigenetic Modification ◽

Epigenetic Modifications ◽

Preventive Strategy ◽

Age Related ◽

The Life Course

The rate of aging has increased globally during recent decades and has led to a rising burden of age-related diseases such as cardiovascular disease (CVD). At the molecular level, epigenetic modifications have been shown recently to alter gene expression during the life course and impair cellular function. In this regard, several CVD risk factors, such as lifestyle and environmental factors, have emerged as key factors in epigenetic modifications within the cardiovascular system. In this study, we attempted to summarized recent evidence related to epigenetic modification, inflammation response, and CVD in older adults as well as the effect of lifestyle modification as a preventive strategy in this age group. Recent evidence showed that lifestyle and environmental factors may affect epigenetic mechanisms, such as DNA methylation, histone acetylation, and miRNA expression. Several substances or nutrients such as selenium, magnesium, curcumin, and caffeine (present in coffee and some teas) could regulate epigenetics. Similarly, physical inactivity, alcohol consumption, air pollutants, psychological stress, and shift working are well-known modifiers of epigenetic patterns. Understanding the exact ways that lifestyle and environmental factors could affect the expression of genes could help to influence the time of incidence and severity of aging-associated diseases. This review highlighted that a healthy lifestyle throughout the life course, such as a healthy diet rich in fibers, vitamins, and essential elements, and specific fatty acids, adequate physical activity and sleep, smoking cessation, and stress control, could be useful tools in preventing epigenetic changes that lead to impaired cardiovascular function.

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Impact of disasters, including pandemics, on cardiometabolic outcomes across the life-course: a systematic review

BMJ Open ◽

10.1136/bmjopen-2020-047152 ◽

2021 ◽

Vol 11 (5) ◽

pp. e047152

Author(s):

Vanessa De Rubeis ◽

Jinhee Lee ◽

Muhammad Saqib Anwer ◽

Yulika Yoshida-Montezuma ◽

Alessandra T Andreacchi ◽

...

Keyword(s):

Systematic Review ◽

Cardiovascular Disease ◽

Life Course ◽

Cardiometabolic Risk ◽

Disease Incidence ◽

Cardiometabolic Health ◽

Obesity And Diabetes ◽

The Life Course ◽

The Impact

BackgroundDisasters are events that disrupt the daily functioning of a community or society, and may increase long-term risk of adverse cardiometabolic outcomes, including cardiovascular disease, obesity and diabetes. The objective of this study was to conduct a systematic review to determine the impact of disasters, including pandemics, on cardiometabolic outcomes across the life-course.DesignA systematic search was conducted in May 2020 using two electronic databases, EMBASE and Medline. All studies were screened in duplicate at title and abstract, and full-text level. Studies were eligible for inclusion if they assessed the association between a population-level or community disaster and cardiometabolic outcomes ≥1 month following the disaster. There were no restrictions on age, year of publication, country or population. Data were extracted on study characteristics, exposure (eg, type of disaster, region, year), cardiometabolic outcomes and measures of effect. Study quality was evaluated using the Joanna Briggs Institute critical appraisal tools.ResultsA total of 58 studies were included, with 24 studies reporting the effects of exposure to disaster during pregnancy/childhood and 34 studies reporting the effects of exposure during adulthood. Studies included exposure to natural (n=35; 60%) and human-made (n=23; 40%) disasters, with only three (5%) of these studies evaluating previous pandemics. Most studies reported increased cardiometabolic risk, including increased cardiovascular disease incidence or mortality, diabetes and obesity, but not all. Few studies evaluated the biological mechanisms or high-risk subgroups that may be at a greater risk of negative health outcomes following disasters.ConclusionsThe findings from this study suggest that the burden of disasters extend beyond the known direct harm, and attention is needed on the detrimental indirect long-term effects on cardiometabolic health. Given the current COVID-19 pandemic, these findings may inform public health prevention strategies to mitigate the impact of future cardiometabolic risk.PROSPERO registration numberCRD42020186074.

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Prevalence of Cardiovascular Risk Factors in relation to Socio-demographic profile of the Life Course Study in Cardiovascular Disease Epidemiology Study (LIFECARE) Philippine Cohort

Acta Medica Philippina ◽

10.47895/amp.v48i2.1165 ◽

2014 ◽

Vol 48 (2) ◽

Author(s):

Felix Eduardo R. Punzalan ◽

Rody G. Sy ◽

Olivia T. Sison ◽

Nina T. Castillo-Carandang ◽

Wilbert Allan G. Gumatay ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Life Course ◽

Cardiovascular Risk Factors ◽

Epidemiology Study ◽

Demographic Profile ◽

Disease Epidemiology ◽

The Life Course

...

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Multiscale Risk Factors of Cardiovascular Disease: CLSA Analysis of Genetic and Psychosocial Factors

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.599671 ◽

2021 ◽

Vol 8 ◽

Author(s):

Gabriella Menniti ◽

Catherine Paquet ◽

Hannah Yang Han ◽

Laurette Dube ◽

Daiva E. Nielsen

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Depressive Symptoms ◽

Life Course ◽

Psychosocial Factors ◽

Social Isolation ◽

Peripheral Vascular ◽

Group 4 ◽

Socially Isolated ◽

The Life Course

Background: Cardiovascular disease (CVD) is a complex disease resulting from multiscale risk factors including genetics, age, and psychosocial factors (PSFs) such as depression and social isolation. However, previous research has lacked in operationalizing multiscale risk factors to determine individual and interactive associations over the life course. Therefore, this study aimed to evaluate individual and interactive associations of multiscale risk factors for CVD outcomes including genetics and PSFs at middle and older-aged stages of the life course.Methods: Baseline data from the Canadian Longitudinal Study on Aging (CLSA; n = 9,892 with genome-wide genotyping data) was used for this investigation. A 39 single nucleotide polymorphism polygenic risk score (PRS) for CVD was constructed. PSFs consisted of: (1) Depressive symptoms categorized into: “none” (Group 1, reference), “current” (Group 2), “clinical depression with no current symptoms” (Group 3), and “potential, recurrent depression” (Group 4); and (2) Social isolation index as a binary variable comprised of marital status, living arrangements, retirement status, contacts, and social participation. Heart-related disorders (HRD: myocardial infarction, angina and heart disease) was the primary outcome of interest and peripheral/vascular-related disorders (PVRD: stroke, peripheral vascular disease and hypertension) was the secondary outcome. Multivariable logistic regression models adjusted for socio-demographic factors were conducted stratified by age group (middle-aged: 45–69 years, older-aged: ≥70 years).Results: PRS was associated with HRD among middle- and older-aged participants [OR (95% confidence interval)] [1.06 (1.03–1.08), 1.06 (1.03–1.08), respectively]. Most depressive symptoms groups compared to the reference associated with HRD and PVRD, but only Group 4 associated with PVRD among older-aged [1.69 (1.08–2.64)]. Social isolation was associated with only PVRD among middle-aged [1.84 (1.04–3.26)]; however, socially isolated CLSA participants were underrepresented in the genotyped cohort (1.2%). No significant PRS*PSFs interactions were observed.Conclusions: Genetics and PSFs are independently associated with CVD. Varying observations across age groups underscores the need to advance research on multiscale risk factors operating both at a given point in time and over the life course. Future cohort studies may benefit from use of mobile assessment units to enable better reach to socially isolated participants for collection of biospecimens.

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