Ideal cardiovascular health and intermediate risk phenotypes in child-parent dyads: the Longitudinal Study of Australian Children

摘要

Background: The concept of ideal cardiovascular (CV) health, first introduced by the American Heart Association (AHA) in 2010, summarises seven health behaviors (body mass index, physical activity, non-smoking, and diet) and factors (blood pressure, glucose, and cholesterol levels) that are first established in childhood. We investigated the association between ideal CV health and intermediate CV risk phenotypes in a population-based sample of 11-12 year old Australian children and their mid-life parents. Methods: Data from 1874 families participating in the cross-sectional Child Health CheckPoint, nested within the Longitudinal Study of Australian Children, were obtained during a single assessment center visit and used to generate ideal CV health scores. We used pre-defined cut-offs to dichotomise participants into ideal, or non-ideal health for each CV metric; the sum of ideal health over seven metrics determined their ideal CV health score, ranging from 0 (poor health) to 7 (ideal health). This score was used as a quasi-continuous exposure in linear regression models to predict three intermediate cardiovascular risk outcomes — carotid intima-media thickness, carotid-femoral pulse wave velocity, and carotid artery elasticity — separately in children and parents. Complete case analysis was used to generate these data, and will be supplemented with multiple imputation to account for potential bias from missing data in final analysis. Results: Ideal CV health (score of 7) was found in 6.6% of children and 1.0% of their parents; 76.9% and 30.5% respectively had a score of 5 or higher. Parent non-ideal health was associated with child non-ideal health in each of the seven metrics except physical activity (odds ratios from logistic regression ranged from 1.56-10.83 in analyses adjusted for child and parental age, sex and socioeconomic position). Ideal CV health score strongly predicted CV outcomes in parents (P< 0.001) and children (P < 0.002, except for child carotid intima-media thickness (P = 0.74)) (Figure). In multivariable analyses, blood pressure and body mass index status predicted intermediate cardiovascular risk outcomes independently of other ideal CV health factors and behaviors, and potential confounders such as age, sex, and socioeconomic position. Associations in parents explained more variance in outcomes than in children (R in parents 0.21-0.32, compared to R2 in children 0.01-0.11). Conclusion: Ideal cardiovascular health is infrequent even in mid-childhood, and is rare with increasing age. Even by 11-12 years of age, lower ideal CV health scores predict worse intermediate CV risk phenotypes, suggesting that early life interventions, especially addressing childhood hypertension and obesity, are required to reduce the growing burden of CV disease. Moreover, our observation that both structural and functional phenotypes are associated in adulthood, but only functional phenotypes are associated in childhood imply that there is an opportunity to prevent structural vascular changes in mid-childhood.