The Case for Bringing Birthweight to Adult Cardiovascular Medicine

Pursuing functional biomarkers in complex disease: Focus on pulmonary arterial hypertension

A major gap in diagnosis, classification, risk stratification, and prediction of therapeutic response exists in pulmonary arterial hypertension (PAH), driven in part by a lack of functional biomarkers that are also disease-specific. In this regard, leveraging big data-omics analyses using innovative approaches that integrate network medicine and machine learning correlated with clinically useful indices or risk stratification scores is an approach well-positioned to advance PAH precision medicine. For example, machine learning applied to a panel of 48 cytokines, chemokines, and growth factors could prognosticate PAH patients with immune-dominant subphenotypes at elevated or low-risk for mortality. Here, we discuss strengths and weaknesses of the most current studies evaluating omics-derived biomarkers in PAH. Progress in this field is offset by studies with small sample size, pervasive limitations in bioinformatics, and lack of standardized methods for data processing and interpretation. Future success in this field, in turn, is likely to hinge on mechanistic validation of data outputs in order to couple functional biomarker data with target-specific therapeutics in clinical practice.

Early-life determinants of childhood plasma insulin levels: implications for primordial prevention of diabetes

BACKGROUND

We earlier reported prematurity as an independent risk factor for elevated insulin levels. Investigation is still lacking on the influence of prenatal and perinatal factors on childhood insulin levels.

METHODS

In this secondary analysis of a prospective birth cohort, plasma insulin levels were measured at birth and early childhood. Regression models identified early-life factors associated with the primary outcome: log-transformed childhood plasma insulin levels.

RESULTS

One thousand one hundred and nine children had insulin levels at birth and 825 at both time points. Compared to term, preterm infants had higher plasma insulin levels (geometric mean) at birth (612, 95% CI 552-679 vs. 372, 95% CI 345-402 pmol/ml) and in early childhood (547, 95% CI 494-605 vs. 445, 95% CI 417-475 pmol/ml). Factors associated with higher early childhood insulin levels included higher insulin level at birth, black race, female sex, maternal smoking during pregnancy, maternal perceived stress, in utero drug exposure, maternal pregestational diabetes mellitus, and maternal preconception overweight and obesity.

CONCLUSIONS

In this high-risk US birth cohort, we identified multiple prenatal and perinatal risk factors for higher early childhood insulin levels, in addition to prematurity. These findings lend support to primordial preventive strategies for diabetes mellitus.

IMPACT

In this secondary analysis of a large prospective study from a high-risk racially diverse cohort, we identify biological and social factors that contribute to elevated levels of plasma insulin in early childhood. Our study also investigates factors affecting plasma insulin in preterm infants along with comorbidities commonly seen during the neonatal intensive care stay. Our work reaffirms the importance of Developmental Origins of Health and Disease with regards to in utero programming of insulin levels. Our work supports the possibility that primordial preventive strategies for diabetes mellitus in high-risk populations may need to begin as early as the prenatal period.

Childhood obesity and adverse cardiometabolic risk in large for gestational age infants and potential early preventive strategies: a narrative review

Accumulating evidence indicates that obesity and cardiometabolic risks become established early in life due to developmental programming and infants born as large for gestational age (LGA) are particularly at risk. This review summarizes the recent literature connecting LGA infants and early childhood obesity and cardiometabolic risk and explores potential preventive interventions in early infancy. With the rising obesity rates in women of childbearing age, the LGA birth rate is about 10%. Recent literature continues to support the higher rates of obesity in LGA infants. However, there is a knowledge gap for their lifetime risk for adverse cardiometabolic outcomes. Potential factors that may modify the risk in early infancy include catch-down early postnatal growth, reduction in body fat growth trajectory, longer breastfeeding duration, and presence of a healthy gut microbiome. The early postnatal period may be a critical window of opportunity for active interventions to mitigate or prevent obesity and potential adverse metabolic consequences in later life. A variety of promising candidate biomarkers for the early identification of metabolic alterations in LGA infants is also discussed. IMPACT: LGA infants are the greatest risk category for future obesity, especially if they experience rapid postnatal growth during infancy. Potential risk modifying secondary prevention strategies in early infancy in LGA infants include catch-down early postnatal growth, reduction in body fat growth trajectory, longer breastfeeding duration, and presence of a healthy gut microbiome. LGA infants may be potential low-hanging fruit targets for early preventive interventions in the fight against childhood obesity.

Birthweight predicts glomerular filtration rate in adult-life: population based cross sectional study

INTRODUCTION

Worldwide, there is a global progressive rise of chronic kidney disease. In parallel, children born after intra-uterine growth retardation are surviving to adult-life and beyond. This study describes the association of birthweight with and estimated glomerular filtration rate (eGFR).

METHODS

Australian Diabetes, Obesity and Lifestyle (AusDiab) study participants were asked to complete a birthweight questionnaire. The associations between birthweight and eGFR were determined.

RESULTS

A total of 4502 reported information related to their birthweight, with the other responders did not provide a value. The birthweight of the participants ranged from 0.4 to 7.0 kg with a mean-(SD) of 3.37 (0.7) kg. The mean (95%CI) birthweight was lower for females, 3.28 (0.6) kg, when compared to males, 3.5 (0.7) kg. Eight percent had a birthweight less than 2.5 kg. The eGFR was strongly and positively associated with birthweight, with people in the lowest sex-specific birthweight-quintiles having the lowest mean eGFR. This relationship persisted with adjustment for confounding factors. The OR(CI) for eGFR <10th-percentile (<61.4 ml/min for females and <73.4 for males) for people in the lowest vs. the higher birthweight-quintile was 2.19 (95%CI 1.14-4.2) for females and 2.37 (1.1-5.3) for males, after adjustment for other factors.

CONCLUSIONS

Birthweight had a positive relationship with eGFR. Possible explanations include an association of birthweight with nephron-endowment. From a global health perspective but more in developing countries and in populations in epidemiologic transition, where substantially lower birthweights coexist with recently improved infant and adult survivals, the overall impact of this phenomenon on the population health profile could be more substantial.

Network medicine in Cardiovascular Research

The ability to generate multi-omics data coupled with deeply characterizing the clinical phenotype of individual patients promises to improve understanding of complex cardiovascular pathobiology. There remains an important disconnection between the magnitude and granularity of these data and our ability to improve phenotype-genotype correlations for complex cardiovascular diseases. This shortcoming may be due to limitations associated with traditional reductionist analytical methods, which tend to emphasize a single molecular event in the pathogenesis of diseases more aptly characterized by crosstalk between overlapping molecular pathways. Network medicine is a rapidly growing discipline that considers diseases as the consequences of perturbed interactions between multiple interconnected biological components. This powerful integrative approach has enabled a number of important discoveries in complex disease mechanisms. In this review, we introduce the basic concepts of network medicine and highlight specific examples by which this approach has accelerated cardiovascular research. We also review how network medicine is well-positioned to promote rational drug design for patients with cardiovascular diseases, with particular emphasis on advancing precision medicine.

Birthweight predicts adult cardiovascular disorders: Population based cross sectional survey

BACKGROUND

Cardiovascular disease (CVD) is the primary cause of death in the developed-countries and mostly in the poorer areas of the country, and in lower income-groups.

HYPOTHESIS

Birthweight predicts adult development of angina, coronary heart disease, stroke, and combination of all CVD.

METHODS

The AusDiab is a cross-sectional study of Australians aged 25 years or over. Data on age, sex, previous-CVD, smoking-status, alcohol-intake, time-spent on watching television and physical-activity, total house-income, dwelling-type and education-level were collected by interviewer- administered-questionnaires.

RESULTS

Four thousand five hundred and two had birthweights (mean (SD) of 3.4(0.7) kg). Females in the lowest birthweight-quintile were at least 1.23, 1.48, 1.65, and 1.23 times more likely to have angina, CAD, stroke, and CVS compared to the referent group ≥3.72 kg with P = .123, .09, .099, and 0.176, respectively. Similarly, males in the lowest-birthweight-quintile were 1.23, 1.30, 1.39, and 1.26 times more likely to have angina, CAD, stroke, and CVS compared to the referent-group ≥4.05 kg with P = .231, .087, .102, and .123, respectively. Females with low birth weight (LBW) were at least 1.39, 1.40, 2.30, and 1.47 times more likely to have angina, CAD, stroke and CVS compared to those ≥2.5 kg with P = .06, .19, .03, and .13, respectively. Similarly, males with LBW were 1.76, 1.48, 3.34, and 1.70 times more likely to have angina, CAD, stroke, and CVS compared to those ≥2.5 kg with P = .14, .13, .03, and .08, respectively.

CONCLUSION

there was a negative relationship between birth weight and angina, CAD, stroke, and the overall CVS. It would be prudent, to adopt policies of intensified whole of life surveillance of lower-birthweight people, anticipating this risk.