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Wu F, Jacobs DR, Daniels SR, Kähönen M, Woo JG, Sinaiko AR, Viikari JSA, Bazzano LA, Steinberger J, Urbina EM, Venn AJ, Raitakari OT, Dwyer T, Juonala M, Magnussen CG. Non-High-Density Lipoprotein Cholesterol Levels From Childhood to Adulthood and Cardiovascular Disease Events. JAMA 2024:2817700. [PMID: 38607340 DOI: 10.1001/jama.2024.4819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Importance Elevated non-high-density lipoprotein cholesterol (non-HDL-C; a recommended measure of lipid-related cardiovascular risk) is common in children and increases risk of adult cardiovascular disease (CVD). Whether resolution of elevated childhood non-HDL-C levels by adulthood is associated with reduced risk of clinical CVD events is unknown. Objective To examine the associations of non-HDL-C status between childhood and adulthood with incident CVD events. Design, Setting, and Participants Individual participant data from 6 prospective cohorts of children (mean age at baseline, 10.7 years) in the US and Finland. Recruitment took place between 1970 and 1996, with a final follow-up in 2019. Exposures Child (age 3-19 years) and adult (age 20-40 years) non-HDL-C age- and sex-specific z scores and categories according to clinical guideline-recommended cutoffs for dyslipidemia. Main Outcomes and Measures Incident fatal and nonfatal CVD events adjudicated by medical records. Results Over a mean length of follow-up of 8.9 years after age 40 years, 147 CVD events occurred among 5121 participants (60% women; 15% Black). Both childhood and adult non-HDL-C levels were associated with increased risk of CVD events (hazard ratio [HR], 1.42 [95% CI, 1.18-1.70] and HR, 1.50 [95% CI, 1.26-1.78] for a 1-unit increase in z score, respectively), but the association for childhood non-HDL-C was reduced when adjusted for adult levels (HR, 1.12 [95% CI, 0.89-1.41]). A complementary analysis showed that both childhood non-HDL-C levels and the change between childhood and adulthood were independently associated with the outcome, suggesting that from a preventive perspective, both childhood non-HDL-C levels and the change into adulthood are informative. Compared with those whose non-HDL-C levels remained within the guideline-recommended range in childhood and adulthood, participants who had incident non-HDL-C dyslipidemia from childhood to adulthood and those with persistent dyslipidemia had increased risks of CVD events (HR, 2.17 [95% CI, 1.00-4.69] and HR, 5.17 [95% CI, 2.80-9.56], respectively). Individuals who had dyslipidemic non-HDL-C in childhood but whose non-HDL-C levels were within the guideline-recommended range in adulthood did not have a significantly increased risk (HR, 1.13 [95% CI, 0.50-2.56]). Conclusions and Relevance Individuals with persistent non-HDL-C dyslipidemia from childhood to adulthood had an increased risk of CVD events, but those in whom dyslipidemic non-HDL-C levels resolve by adulthood have similar risk to individuals who were never dyslipidemic. These findings suggest that interventions to prevent and reduce elevated childhood non-HDL-C levels may help prevent premature CVD.
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Affiliation(s)
- Feitong Wu
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Stephen R Daniels
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Jessica G Woo
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Jorma S A Viikari
- Department of Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Lydia A Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Julia Steinberger
- Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis
| | - Elaine M Urbina
- The Heart Institute, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Alison J Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Olli T Raitakari
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
- InFLAMES Research Flagship, University of Turku, Turku, Finland
| | - Terence Dwyer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Costan G Magnussen
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
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Ketterl TG, Chow EJ, Koves IH, Goodman P, Leisenring WM, Ballard S, Dengel DR, Moran A, Sinaiko AR, Steinberger J, Baker KS. Impact of Hematopoietic Cell Transplantation on Cardiovascular Risk Factors and Insulin Sensitivity. Transplant Cell Ther 2024; 30:243.e1-243.e13. [PMID: 37935316 PMCID: PMC10872357 DOI: 10.1016/j.jtct.2023.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 11/09/2023]
Abstract
The use of hematopoietic cell transplantation (HCT) for treating malignant conditions in children has increased over the past five decades, leading to a growing population of long-term survivors.This population of childhood HCT survivors faces increased risks of adverse medical effects due to cancer treatments, including adverse cardiovascular disease (CVD) risk factors such as metabolic syndrome, insulin resistance. but the impact of exposure to HCT preparative conditioning regimen has not been clearly delineated. These risk factors, including obesity, dyslipidemia, hypertension, and insulin resistance (IR), are significant contributors to premature cardiovascular disease and represent a leading cause of non-relapse deaths in childhood cancer and HCT survivors. This study aimed to assess the early development of CVD risk factors and their relationship to insulin resistance in a large population of pediatric and young adult HCT survivors of childhood hematologic malignancies. The study compared their cardiovascular risk profiles, insulin resistance (measured by euglycemic hyperinsulinemic clamp studies), and body composition (determined by dual X-ray absorptiometry - DXA) with a cohort of sibling controls. We enrolled 151 HCT recipients (26.36 ±0.90 years at study enrollment; time since HCT of 2.6-31.5 years) and 92 sibling controls to complete at cardiovascular risk assessment including insulin sensitivity by hyperinsulinemic euglycemic clamp, anthropometry, body composition by dual X-ray absorptiometry, blood pressure, and serum biomarkers. We used linear models to test for mean differences in all continuous outcomes between survivors and siblings, accounting for intra-family correlations with generalized estimating equations. Recipients of HCT were found to have lower insulin sensitivity and more likely to have adverse CVD risk factors in comparison to their healthy siblings. Significantly higher percent fat mass and visceral adipose tissue, and significantly lower lean body mass were noted in HCT recipients than sibling controls despite having a similar body mass index between the two groups. Total body irradiation in the conditioning regimen was one of the strongest factors associated with lower insulin sensitivity, dyslipidemia and abnormal body composition leading to sarcopenic obesity. This study reveals that pediatric and young adult HCT survivors are more insulin resistant and have a higher prevalence of adverse cardiovascular risk factors compared to sibling controls. The presence of cardiovascular risk factors at a relatively young age raises concerns about an escalating trajectory of cardiovascular disease in this population. Therefore, regular monitoring of HCT survivors for cardiometabolic risk factors and early intervention will be crucial for preventing cardiovascular-related complications in the future. The findings underscore the importance of survivorship care for pediatric and young adult HCT survivors, with a focus on managing cardiovascular risk factors and promoting a healthy lifestyle to mitigate long-term adverse effects. Early identification and targeted interventions can significantly improve the long-term health outcomes of this vulnerable population, reducing the burden of cardiovascular disease and related complications.
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Affiliation(s)
- Tyler G Ketterl
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Pediatric Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington.
| | - Eric J Chow
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Pediatric Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington
| | - Ildi H Koves
- Pediatric Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington
| | - Pam Goodman
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Wendy M Leisenring
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Sheri Ballard
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Donald R Dengel
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota
| | - Antoinette Moran
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | - Alan R Sinaiko
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | - Julia Steinberger
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | - K Scott Baker
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Pediatric Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington
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Wu F, Juonala M, Jacobs DR, Daniels SR, Kähönen M, Woo JG, Sinaiko AR, Viikari JSA, Bazzano LA, Burns TL, Steinberger J, Urbina EM, Venn AJ, Raitakari OT, Dwyer T, Magnussen CG. Childhood Non-HDL Cholesterol and LDL Cholesterol and Adult Atherosclerotic Cardiovascular Events. Circulation 2024; 149:217-226. [PMID: 38014550 DOI: 10.1161/circulationaha.123.064296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Although low-density lipoprotein cholesterol (LDL-C) remains the primary cholesterol target in clinical practice in children and adults, non-high-density lipoprotein cholesterol (non-HDL-C) has been suggested as a more accurate measure of atherosclerotic cardiovascular disease (ASCVD) risk. We examined the associations of childhood non-HDL-C and LDL-C levels with adult ASCVD events and determined whether non-HDL-C has better utility than LDL-C in predicting adult ASCVD events. METHODS This prospective cohort study included 21 126 participants from the i3C Consortium (International Childhood Cardiovascular Cohorts). Proportional hazards regressions were used to estimate the risk for incident fatal and fatal/nonfatal ASCVD events associated with childhood non-HDL-C and LDL-C levels (age- and sex-specific z scores; concordant/discordant categories defined by guideline-recommended cutoffs), adjusted for sex, Black race, cohort, age at and calendar year of child measurement, body mass index, and systolic blood pressure. Predictive utility was determined by the C index. RESULTS After an average follow-up of 35 years, 153 fatal ASCVD events occurred in 21 126 participants (mean age at childhood visits, 11.9 years), and 352 fatal/nonfatal ASCVD events occurred in a subset of 11 296 participants who could be evaluated for this outcome. Childhood non-HDL-C and LDL-C levels were each associated with higher risk of fatal and fatal/nonfatal ASCVD events (hazard ratio ranged from 1.27 [95% CI, 1.14-1.41] to 1.35 [95% CI, 1.13-1.60] per unit increase in the risk factor z score). Non-HDL-C had better discriminative utility than LDL-C (difference in C index, 0.0054 [95% CI, 0.0006-0.0102] and 0.0038 [95% CI, 0.0008-0.0068] for fatal and fatal/nonfatal events, respectively). The discordant group with elevated non-HDL-C and normal LDL-C had a higher risk of ASCVD events compared with the concordant group with normal non-HDL-C and LDL-C (fatal events: hazard ratio, 1.90 [95% CI, 0.98-3.70]; fatal/nonfatal events: hazard ratio, 1.94 [95% CI, 1.23-3.06]). CONCLUSIONS Childhood non-HDL-C and LDL-C levels are associated with ASCVD events in midlife. Non-HDL-C is better than LDL-C in predicting adult ASCVD events, particularly among individuals who had normal LDL-C but elevated non-HDL-C. These findings suggest that both non-HDL-C and LDL-C are useful in identifying children at higher risk of ASCVD events, but non-HDL-C may provide added prognostic information when it is discordantly higher than the corresponding LDL-C and has the practical advantage of being determined without a fasting sample.
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Affiliation(s)
- Feitong Wu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (F.W., A.J.V., T.D., C.G.M.)
- Baker Heart and Diabetes Institute, Melbourne, Australia (F.W., C.G.M.)
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia (F.W.)
| | - Markus Juonala
- Department of Medicine, University of Turku, Finland (M.J., J.S.J.V.)
- Division of Medicine, Turku University Hospital, Finland (M.J., J.S.J.V.)
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (D.R.J.)
| | - Stephen R Daniels
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora (S.R.D.)
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University, Finland (M.K.)
- Department of Clinical Physiology, Tampere University Hospital, Finland (M.K.)
| | - Jessica G Woo
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, OH (J.G.W.)
| | - Alan R Sinaiko
- University of Minnesota Medical School, Minneapolis (A.R.S.)
| | - Jorma S A Viikari
- Department of Medicine, University of Turku, Finland (M.J., J.S.J.V.)
- Division of Medicine, Turku University Hospital, Finland (M.J., J.S.J.V.)
| | - Lydia A Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (L.A.B.)
| | - Trudy L Burns
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (T.L.B.)
| | - Julia Steinberger
- Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis (J.S.)
| | - Elaine M Urbina
- The Heart Institute, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, OH (E.M.U.)
| | - Alison J Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (F.W., A.J.V., T.D., C.G.M.)
| | - Olli T Raitakari
- Centre for Population Health Research, University of Turku and Turku University Hospital, Finland (O.T.R., C.G.M.)
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland (O.T.R., C.G.M.)
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Finland (O.T.R.)
- InFLAMES Research Flagship, University of Turku, Finland (O.T.R.)
| | - Terence Dwyer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (F.W., A.J.V., T.D., C.G.M.)
- The Nuffield Department of Women's & Reproductive Health, University of Oxford, UK (T.D.)
- Murdoch Children's Research Institute, Melbourne, Australia (T.D.)
| | - Costan G Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (F.W., A.J.V., T.D., C.G.M.)
- Baker Heart and Diabetes Institute, Melbourne, Australia (F.W., C.G.M.)
- Centre for Population Health Research, University of Turku and Turku University Hospital, Finland (O.T.R., C.G.M.)
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland (O.T.R., C.G.M.)
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Ehrhardt MJ, Leerink JM, Mulder RL, Mavinkurve-Groothuis A, Kok W, Nohria A, Nathan PC, Merkx R, de Baat E, Asogwa OA, Skinner R, Wallace H, Lieke Feijen EAM, de Ville de Goyet M, Prasad M, Bárdi E, Pavasovic V, van der Pal H, Fresneau B, Demoor-Goldschmidt C, Hennewig U, Steinberger J, Plummer C, Chen MH, Teske AJ, Haddy N, van Dalen EC, Constine LS, Chow EJ, Levitt G, Hudson MM, Kremer LCM, Armenian SH. Systematic review and updated recommendations for cardiomyopathy surveillance for survivors of childhood, adolescent, and young adult cancer from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol 2023; 24:e108-e120. [PMID: 37052966 DOI: 10.1016/s1470-2045(23)00012-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/07/2022] [Accepted: 01/10/2023] [Indexed: 02/16/2023]
Abstract
Survivors of childhood, adolescent, and young adult cancer, previously treated with anthracycline chemotherapy (including mitoxantrone) or radiotherapy in which the heart was exposed, are at increased risk of cardiomyopathy. Symptomatic cardiomyopathy is typically preceded by a series of gradually progressive, asymptomatic changes in structure and function of the heart that can be ameliorated with treatment, prompting specialist organisations to endorse guidelines on cardiac surveillance in at-risk survivors of cancer. In 2015, the International Late Effects of Childhood Cancer Guideline Harmonization Group compiled these guidelines into a uniform set of recommendations applicable to a broad spectrum of clinical environments with varying resource availabilities. Since then, additional studies have provided insight into dose thresholds associated with a risk of asymptomatic and symptomatic cardiomyopathy, have characterised risk over time, and have established the cost-effectiveness of different surveillance strategies. This systematic Review and guideline provides updated recommendations based on the evidence published up to September, 2020.
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Raitakari O, Kartiosuo N, Pahkala K, Hutri-Kähönen N, Bazzano LA, Chen W, Urbina EM, Jacobs DR, Sinaiko A, Steinberger J, Burns T, Daniels SR, Venn A, Woo JG, Dwyer T, Juonala M, Viikari J. Lipoprotein(a) in Youth and Prediction of Major Cardiovascular Outcomes in Adulthood. Circulation 2023; 147:23-31. [PMID: 36440577 PMCID: PMC9797445 DOI: 10.1161/circulationaha.122.060667] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/17/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Elevated lipoprotein(a) [Lp(a)] is a common risk factor for cardiovascular disease outcomes with unknown mechanisms. We examined its potential role in identifying youths who are at increased risk of developing adult atherosclerotic cardiovascular disease (ASCVD). METHODS Lp(a) levels measured in youth 9 to 24 years of age were linked to adult ASCVD and carotid intima-media thickness in the YFS (Cardiovascular Risk in Young Finns Study), in which 95 of the original 3596 participants (2.7%) recruited as children have been diagnosed with ASCVD at a median of 47 years of age. Results observed in YFS were replicated with the use of data for White participants from the BHS (Bogalusa Heart Study). In BHS, 587 White individuals had data on youth Lp(a) (measured at 8-17 years of age) and information on adult events, including 15 cases and 572 noncases. Analyses were performed with the use of Cox proportional hazard regression. RESULTS In YFS, those who had been exposed to high Lp(a) level in youth [defined as Lp(a) ≥30 mg/dL] had ≈2 times greater risk of developing adult ASCVD compared with nonexposed individuals (hazard ratio, 2.0 [95% CI, 1.4-2.6]). Youth risk factors, including Lp(a), low-density lipoprotein cholesterol, body mass index, and smoking, were all independently associated with higher risk. In BHS, in an age- and sex-adjusted model, White individuals who had been exposed to high Lp(a) had 2.5 times greater risk (95% CI, 0.9-6.8) of developing adult ASCVD compared with nonexposed individuals. When also adjusted for low-density lipoprotein cholesterol and body mass index, the risk associated with high Lp(a) remained unchanged (hazard ratio, 2.4 [95% CI, 0.8-7.3]). In a multivariable model for pooled data, individuals exposed to high Lp(a) had 2.0 times greater risk (95% CI, 1.0-3.7) of developing adult ASCVD compared with nonexposed individuals. No association was detected between youth Lp(a) and adult carotid artery thickness in either cohort or pooled data. CONCLUSIONS Elevated Lp(a) level identified in youth is a risk factor for adult atherosclerotic cardiovascular outcomes but not for increased carotid intima-media thickness.
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Affiliation(s)
- Olli Raitakari
- Centre for Population Health Research, University of Turku and Turku University Hospital, Finland (O.R., N.K., K.P.)
- Research Centre of Applied and Preventive Cardiovascular Medicine (O.R., N.K., K.P.), University of Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine (O.R.), Turku University Hospital, Finland
| | - Noora Kartiosuo
- Centre for Population Health Research, University of Turku and Turku University Hospital, Finland (O.R., N.K., K.P.)
- Research Centre of Applied and Preventive Cardiovascular Medicine (O.R., N.K., K.P.), University of Turku, Finland
| | - Katja Pahkala
- Centre for Population Health Research, University of Turku and Turku University Hospital, Finland (O.R., N.K., K.P.)
- Research Centre of Applied and Preventive Cardiovascular Medicine (O.R., N.K., K.P.), University of Turku, Finland
- Paavo Nurmi Centre and Unit for Health and Physical Activity (K.P.), University of Turku, Finland
| | - Nina Hutri-Kähönen
- Tampere Centre for Skills Training and Simulation, Tampere University, Finland (N.H.-K.)
| | - Lydia A Bazzano
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (L.A.B., W.C.)
| | - Wei Chen
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (L.A.B., W.C.)
| | - Elaine M Urbina
- Department of Pediatrics, University of Cincinnati College of Medicine, OH (E.M.U., J.G.W.)
- The Heart Institute (E.M.U.), Cincinnati Children's Hospital Medical Center, OH
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (D.R.J.)
| | - Alan Sinaiko
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis (A.S., J.S.)
| | - Julia Steinberger
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis (A.S., J.S.)
| | - Trudy Burns
- Department of Medicine (M.J., J.V.), University of Turku, Finland
| | - Stephen R Daniels
- Department of Pediatrics, University of Colorado School of Medicine, Aurora (S.R.D.)
- Children's Hospital Colorado, Anschutz Medical Campus, Aurora (S.R.D.)
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (A.V., T.D.)
| | - Jessica G Woo
- Department of Pediatrics, University of Cincinnati College of Medicine, OH (E.M.U., J.G.W.)
- Division of Biostatistics and Epidemiology (J.G.W.), Cincinnati Children's Hospital Medical Center, OH
| | - Terry Dwyer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (A.V., T.D.)
- Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia (T.D.)
- Nuffield Department of Women's & Reproductive Health, University of Oxford, United Kingdom (T.D.)
| | - Markus Juonala
- Department of Medicine (M.J., J.V.), University of Turku, Finland
- Division of Medicine (M.J., J.V.), Turku University Hospital, Finland
| | - Jorma Viikari
- Department of Medicine (M.J., J.V.), University of Turku, Finland
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Gonzalez-Holguera J, Gaille M, del Rio Carral M, Steinberger J, Marti J, Bühler N, Kaufmann A, Chiapperino L, Vicedo-Cabrera AM, Schwarz J, Depoux A, Panese F, Chèvre N, Senn N. Corrigendum: Translating planetary health principles into sustainable primary care services. Front Public Health 2022; 10:1075712. [DOI: 10.3389/fpubh.2022.1075712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022] Open
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Gonzalez-Holguera J, Gaille M, del Rio Carral M, Steinberger J, Marti J, Bühler N, Kaufmann A, Chiapperino L, Vicedo-Cabrera AM, Schwarz J, Depoux A, Panese F, Chèvre N, Senn N. Translating Planetary Health Principles Into Sustainable Primary Care Services. Front Public Health 2022; 10:931212. [PMID: 35937241 PMCID: PMC9355637 DOI: 10.3389/fpubh.2022.931212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/13/2022] [Indexed: 12/27/2022] Open
Abstract
Global anthropogenic environmental degradations such as climate change are increasingly recognized as critical public health issues, on which human beings should urgently act in order to preserve sustainable conditions of living on Earth. "Planetary Health" is a breakthrough concept and emerging research field based on the recognition of the interdependent relationships between living organisms-both human and non-human-and their ecosystems. In that regards, there have been numerous calls by healthcare professionals for a greater recognition and adoption of Planetary Health perspective. At the same time, current Western healthcare systems are facing their limits when it comes to providing affordable, equitable and sustainable healthcare services. Furthermore, while hospital-centrism remains the dominant model of Western health systems, primary care and public health continue to be largely undervalued by policy makers. While healthcare services will have to adapt to the sanitary impacts of environmental degradations, they should also ambition to accompany and accelerate the societal transformations required to re-inscribe the functioning of human societies within planetary boundaries. The entire health system requires profound transformations to achieve this, with obviously a key role for public health. But we argue that the first line of care represented by primary care might also have an important role to play, with its holistic, interdisciplinary, and longitudinal approach to patients, strongly grounded in their living environments and communities. This will require however to redefine the roles, activities and organization of primary care actors to better integrate socio-environmental determinants of health, strengthen interprofessional collaborations, including non-medical collaborations and more generally develop new, environmentally-centered models of care. Furthermore, a planetary health perspective translated in primary care will require the strengthening of synergies between institutions and actors in the field of health and sustainability.
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Affiliation(s)
| | - Marie Gaille
- Laboratory SPHERE, UMR 7219, University Paris Diderot CNRS, Paris, France
| | | | - Julia Steinberger
- Institute of Geography and Sustainability, University of Lausanne, Lausanne, Switzerland
| | - Joachim Marti
- Department of Epidemiology and Health Systems, University Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Nolwenn Bühler
- STS Lab, Institute of Social Sciences, University of Lausanne, Lausanne, Switzerland
| | - Alain Kaufmann
- ColLaboratoire (ColLAB), University of Lausanne, Lausanne, Switzerland
| | - Luca Chiapperino
- STS Lab, Institute of Social Sciences, University of Lausanne, Lausanne, Switzerland
| | - Ana Maria Vicedo-Cabrera
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Joelle Schwarz
- Department of Family Medicine, University Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Anneliese Depoux
- Centre Virchow-Villermé and Centre des Politiques de la Terre, Université Paris Cité, Paris, France
| | - Francesco Panese
- Institute of Social Sciences, University of Lausanne, Lausanne, Switzerland
| | - Nathalie Chèvre
- Faculty of Geosciences and the Environment, Institute of Earth Surface Dynamics (IDYST), University of Lausanne, Lausanne, Switzerland
| | - Nicolas Senn
- Department of Family Medicine, University Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
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Cleland V, Tian J, Buscot MJ, Magnussen CG, Bazzano L, Burns TL, Daniels S, Dwyer T, Hutri-Kahonen N, Ikonen J, Jacobs D, Juonala M, Prineas R, Raitakari O, Sinaiko A, Steinberger J, Urbina EM, Woo JG, Venn A. Body-mass index trajectories from childhood to mid-adulthood and their sociodemographic predictors: Evidence from the International Childhood Cardiovascular Cohort (i3C) Consortium. EClinicalMedicine 2022; 48:101440. [PMID: 35706485 PMCID: PMC9112099 DOI: 10.1016/j.eclinm.2022.101440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/30/2022] [Accepted: 04/20/2022] [Indexed: 11/27/2022] Open
Abstract
Background Understanding lifecourse trajectories of body-mass index (BMI) is important for identifying groups at high risk of poor health and potential target points for intervention. This study aimed to describe BMI trajectories from childhood to mid-adulthood in four population-based cohorts established in the 1970s and 1980s and to identify childhood sociodemographic factors related to trajectory membership. Methods Between Dec 17, 1970 and Dec 15, 1994, data were collected at the first visit from 9830 participants from the International Childhood Cardiovascular Cohort (i3C) Consortium, which includes participants from Australia (1985), Finland (1980) and the USA (1970-1994). Participants had at least three measures of height and weight, including one in childhood (6-18 years) and one in adulthood (>18 years), and were aged 30-49 years at last measurement. Latent Class Growth Mixture Modelling was used to identify lifecourse BMI trajectory groups and log multinomial regression models were fit to identify their childhood sociodemographic predictors. Findings Five consistent BMI trajectory groups were identified amongst the four cohorts: persistently low (35.9-58.6%), improving from high (0.7-4.8%), progressing to moderate (9.3-43.7%), progressing to high (1.1-6.0%), and progressing to very high (0.7-1.3%). An additional three BMI trajectory groups were identified in some, but not all, cohorts: adult onset high (three cohorts; 1.8-20.7%), progressing to moderate-high (two cohorts; 5.2-13.8%), and relapsing yo-yoers (alternating upward and downward; one cohort; 1.3%). In pooled analyses, each predictor variable in childhood, including age, gender, parental education and race, was associated with increased likelihood of belonging to the most (e.g., improving from high) and least (e.g., progressing to very high) favourable BMI trajectory groups, suggesting a U-shaped (or inverse U-shaped) pattern of association. Interpretation Five consistent BMI trajectory groups were identified across four cohorts from Australia, Finland, and the USA, mainly across two eras of birth. While most participants remained on a persistently low trajectory (50%), many demonstrated worsening BMI trajectories (47%), with only few demonstrating improving trajectories (<5%). Age, gender, parental education, and race appear to be important predictors of BMI trajectory group membership and need consideration in preventive and management strategies. Funding This study was supported by funding from the National Institutes of Health, National Heart, Lung and Blood Institute (grant number R01 HL121230).
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Affiliation(s)
- Verity Cleland
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, Tasmania 7000, Australia
| | - Jing Tian
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, Tasmania 7000, Australia
| | - Marie-Jeanne Buscot
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, Tasmania 7000, Australia
| | - Costan G. Magnussen
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, Tasmania 7000, Australia
- Centre for Population Health Research and Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Lydia Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Trudy L. Burns
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Stephen Daniels
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Terence Dwyer
- Nuffield Department of Women's and Reproductive Health, University of Oxford, UK
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Nina Hutri-Kahonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Johanna Ikonen
- Centre for Population Health Research and Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - David Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Markus Juonala
- Department of Internal Medicine, Division of Medicine, University of Turku, Turku University Hospital, Turku, Finland
| | - Ronald Prineas
- Wake Forest School of Medicine, Division of Public Health Sciences, Winston-Salem, NC, USA
| | - Olli Raitakari
- Centre for Population Health Research and Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku and Turku University Hospital, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Alan Sinaiko
- Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Julia Steinberger
- Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Elaine M. Urbina
- The Heart Institute, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jessica G. Woo
- Division of Biostatistics and Epidemiology and Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, Tasmania 7000, Australia
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Jacobs DR, Woo JG, Sinaiko AR, Daniels SR, Ikonen J, Juonala M, Kartiosuo N, Lehtimäki T, Magnussen CG, Viikari JSA, Zhang N, Bazzano LA, Burns TL, Prineas RJ, Steinberger J, Urbina EM, Venn AJ, Raitakari OT, Dwyer T. Childhood Cardiovascular Risk Factors and Adult Cardiovascular Events. N Engl J Med 2022; 386:1877-1888. [PMID: 35373933 PMCID: PMC9563825 DOI: 10.1056/nejmoa2109191] [Citation(s) in RCA: 180] [Impact Index Per Article: 90.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Childhood cardiovascular risk factors predict subclinical adult cardiovascular disease, but links to clinical events are unclear. METHODS In a prospective cohort study involving participants in the International Childhood Cardiovascular Cohort (i3C) Consortium, we evaluated whether childhood risk factors (at the ages of 3 to 19 years) were associated with cardiovascular events in adulthood after a mean follow-up of 35 years. Body-mass index, systolic blood pressure, total cholesterol level, triglyceride level, and youth smoking were analyzed with the use of i3C-derived age- and sex-specific z scores and with a combined-risk z score that was calculated as the unweighted mean of the five risk z scores. An algebraically comparable adult combined-risk z score (before any cardiovascular event) was analyzed jointly with the childhood risk factors. Study outcomes were fatal cardiovascular events and fatal or nonfatal cardiovascular events, and analyses were performed after multiple imputation with the use of proportional-hazards regression. RESULTS In the analysis of 319 fatal cardiovascular events that occurred among 38,589 participants (49.7% male and 15.0% Black; mean [±SD] age at childhood visits, 11.8±3.1 years), the hazard ratios for a fatal cardiovascular event in adulthood ranged from 1.30 (95% confidence interval [CI], 1.14 to 1.47) per unit increase in the z score for total cholesterol level to 1.61 (95% CI, 1.21 to 2.13) for youth smoking (yes vs. no). The hazard ratio for a fatal cardiovascular event with respect to the combined-risk z score was 2.71 (95% CI, 2.23 to 3.29) per unit increase. The hazard ratios and their 95% confidence intervals in the analyses of fatal cardiovascular events were similar to those in the analyses of 779 fatal or nonfatal cardiovascular events that occurred among 20,656 participants who could be evaluated for this outcome. In the analysis of 115 fatal cardiovascular events that occurred in a subgroup of 13,401 participants (31.0±5.6 years of age at the adult measurement) who had data on adult risk factors, the adjusted hazard ratio with respect to the childhood combined-risk z score was 3.54 (95% CI, 2.57 to 4.87) per unit increase, and the mutually adjusted hazard ratio with respect to the change in the combined-risk z score from childhood to adulthood was 2.88 (95% CI, 2.06 to 4.05) per unit increase. The results were similar in the analysis of 524 fatal or nonfatal cardiovascular events. CONCLUSIONS In this prospective cohort study, childhood risk factors and the change in the combined-risk z score between childhood and adulthood were associated with cardiovascular events in midlife. (Funded by the National Institutes of Health.).
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Affiliation(s)
- David R Jacobs
- From the Division of Epidemiology and Community Health, School of Public Health (D.R.J.), and the Department of Pediatrics, University of Minnesota Medical School (A.R.S., J.S.), University of Minnesota, Minneapolis; the Division of Biostatistics and Epidemiology (J.G.W., N.Z.), and the Heart Institute (E.M.U.), Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine (J.G.W., N.Z., E.M.U.) - both in Cincinnati; the Department of Pediatrics, University of Colorado School of Medicine, and Anschutz Medical Campus, Children's Hospital Colorado - both in Aurora (S.R.D.); the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Research Center of Applied and Preventive Cardiovascular Medicine (J.I., N.K., C.G.M., O.T.R.), and the Departments of Medicine (M.J., J.S.A.V.) and Mathematics and Statistics (N.K.), University of Turku, and the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Division of Medicine (M.J., J.S.A.V.), and the Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, and the Department of Clinical Chemistry, Fimlab Laboratories, and the Finnish Cardiovascular Research Center, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (T.L.) - all in Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS (C.G.M., A.J.V., T.D.), and the Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC (T.D.) - both in Australia; the School of Public Health and Tropical Medicine, Tulane University, New Orleans (L.A.B.); the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (T.L.B.); the Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (R.J.P.); and the Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom (T.D.)
| | - Jessica G Woo
- From the Division of Epidemiology and Community Health, School of Public Health (D.R.J.), and the Department of Pediatrics, University of Minnesota Medical School (A.R.S., J.S.), University of Minnesota, Minneapolis; the Division of Biostatistics and Epidemiology (J.G.W., N.Z.), and the Heart Institute (E.M.U.), Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine (J.G.W., N.Z., E.M.U.) - both in Cincinnati; the Department of Pediatrics, University of Colorado School of Medicine, and Anschutz Medical Campus, Children's Hospital Colorado - both in Aurora (S.R.D.); the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Research Center of Applied and Preventive Cardiovascular Medicine (J.I., N.K., C.G.M., O.T.R.), and the Departments of Medicine (M.J., J.S.A.V.) and Mathematics and Statistics (N.K.), University of Turku, and the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Division of Medicine (M.J., J.S.A.V.), and the Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, and the Department of Clinical Chemistry, Fimlab Laboratories, and the Finnish Cardiovascular Research Center, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (T.L.) - all in Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS (C.G.M., A.J.V., T.D.), and the Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC (T.D.) - both in Australia; the School of Public Health and Tropical Medicine, Tulane University, New Orleans (L.A.B.); the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (T.L.B.); the Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (R.J.P.); and the Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom (T.D.)
| | - Alan R Sinaiko
- From the Division of Epidemiology and Community Health, School of Public Health (D.R.J.), and the Department of Pediatrics, University of Minnesota Medical School (A.R.S., J.S.), University of Minnesota, Minneapolis; the Division of Biostatistics and Epidemiology (J.G.W., N.Z.), and the Heart Institute (E.M.U.), Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine (J.G.W., N.Z., E.M.U.) - both in Cincinnati; the Department of Pediatrics, University of Colorado School of Medicine, and Anschutz Medical Campus, Children's Hospital Colorado - both in Aurora (S.R.D.); the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Research Center of Applied and Preventive Cardiovascular Medicine (J.I., N.K., C.G.M., O.T.R.), and the Departments of Medicine (M.J., J.S.A.V.) and Mathematics and Statistics (N.K.), University of Turku, and the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Division of Medicine (M.J., J.S.A.V.), and the Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, and the Department of Clinical Chemistry, Fimlab Laboratories, and the Finnish Cardiovascular Research Center, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (T.L.) - all in Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS (C.G.M., A.J.V., T.D.), and the Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC (T.D.) - both in Australia; the School of Public Health and Tropical Medicine, Tulane University, New Orleans (L.A.B.); the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (T.L.B.); the Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (R.J.P.); and the Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom (T.D.)
| | - Stephen R Daniels
- From the Division of Epidemiology and Community Health, School of Public Health (D.R.J.), and the Department of Pediatrics, University of Minnesota Medical School (A.R.S., J.S.), University of Minnesota, Minneapolis; the Division of Biostatistics and Epidemiology (J.G.W., N.Z.), and the Heart Institute (E.M.U.), Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine (J.G.W., N.Z., E.M.U.) - both in Cincinnati; the Department of Pediatrics, University of Colorado School of Medicine, and Anschutz Medical Campus, Children's Hospital Colorado - both in Aurora (S.R.D.); the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Research Center of Applied and Preventive Cardiovascular Medicine (J.I., N.K., C.G.M., O.T.R.), and the Departments of Medicine (M.J., J.S.A.V.) and Mathematics and Statistics (N.K.), University of Turku, and the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Division of Medicine (M.J., J.S.A.V.), and the Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, and the Department of Clinical Chemistry, Fimlab Laboratories, and the Finnish Cardiovascular Research Center, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (T.L.) - all in Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS (C.G.M., A.J.V., T.D.), and the Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC (T.D.) - both in Australia; the School of Public Health and Tropical Medicine, Tulane University, New Orleans (L.A.B.); the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (T.L.B.); the Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (R.J.P.); and the Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom (T.D.)
| | - Johanna Ikonen
- From the Division of Epidemiology and Community Health, School of Public Health (D.R.J.), and the Department of Pediatrics, University of Minnesota Medical School (A.R.S., J.S.), University of Minnesota, Minneapolis; the Division of Biostatistics and Epidemiology (J.G.W., N.Z.), and the Heart Institute (E.M.U.), Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine (J.G.W., N.Z., E.M.U.) - both in Cincinnati; the Department of Pediatrics, University of Colorado School of Medicine, and Anschutz Medical Campus, Children's Hospital Colorado - both in Aurora (S.R.D.); the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Research Center of Applied and Preventive Cardiovascular Medicine (J.I., N.K., C.G.M., O.T.R.), and the Departments of Medicine (M.J., J.S.A.V.) and Mathematics and Statistics (N.K.), University of Turku, and the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Division of Medicine (M.J., J.S.A.V.), and the Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, and the Department of Clinical Chemistry, Fimlab Laboratories, and the Finnish Cardiovascular Research Center, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (T.L.) - all in Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS (C.G.M., A.J.V., T.D.), and the Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC (T.D.) - both in Australia; the School of Public Health and Tropical Medicine, Tulane University, New Orleans (L.A.B.); the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (T.L.B.); the Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (R.J.P.); and the Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom (T.D.)
| | - Markus Juonala
- From the Division of Epidemiology and Community Health, School of Public Health (D.R.J.), and the Department of Pediatrics, University of Minnesota Medical School (A.R.S., J.S.), University of Minnesota, Minneapolis; the Division of Biostatistics and Epidemiology (J.G.W., N.Z.), and the Heart Institute (E.M.U.), Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine (J.G.W., N.Z., E.M.U.) - both in Cincinnati; the Department of Pediatrics, University of Colorado School of Medicine, and Anschutz Medical Campus, Children's Hospital Colorado - both in Aurora (S.R.D.); the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Research Center of Applied and Preventive Cardiovascular Medicine (J.I., N.K., C.G.M., O.T.R.), and the Departments of Medicine (M.J., J.S.A.V.) and Mathematics and Statistics (N.K.), University of Turku, and the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Division of Medicine (M.J., J.S.A.V.), and the Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, and the Department of Clinical Chemistry, Fimlab Laboratories, and the Finnish Cardiovascular Research Center, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (T.L.) - all in Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS (C.G.M., A.J.V., T.D.), and the Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC (T.D.) - both in Australia; the School of Public Health and Tropical Medicine, Tulane University, New Orleans (L.A.B.); the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (T.L.B.); the Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (R.J.P.); and the Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom (T.D.)
| | - Noora Kartiosuo
- From the Division of Epidemiology and Community Health, School of Public Health (D.R.J.), and the Department of Pediatrics, University of Minnesota Medical School (A.R.S., J.S.), University of Minnesota, Minneapolis; the Division of Biostatistics and Epidemiology (J.G.W., N.Z.), and the Heart Institute (E.M.U.), Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine (J.G.W., N.Z., E.M.U.) - both in Cincinnati; the Department of Pediatrics, University of Colorado School of Medicine, and Anschutz Medical Campus, Children's Hospital Colorado - both in Aurora (S.R.D.); the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Research Center of Applied and Preventive Cardiovascular Medicine (J.I., N.K., C.G.M., O.T.R.), and the Departments of Medicine (M.J., J.S.A.V.) and Mathematics and Statistics (N.K.), University of Turku, and the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Division of Medicine (M.J., J.S.A.V.), and the Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, and the Department of Clinical Chemistry, Fimlab Laboratories, and the Finnish Cardiovascular Research Center, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (T.L.) - all in Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS (C.G.M., A.J.V., T.D.), and the Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC (T.D.) - both in Australia; the School of Public Health and Tropical Medicine, Tulane University, New Orleans (L.A.B.); the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (T.L.B.); the Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (R.J.P.); and the Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom (T.D.)
| | - Terho Lehtimäki
- From the Division of Epidemiology and Community Health, School of Public Health (D.R.J.), and the Department of Pediatrics, University of Minnesota Medical School (A.R.S., J.S.), University of Minnesota, Minneapolis; the Division of Biostatistics and Epidemiology (J.G.W., N.Z.), and the Heart Institute (E.M.U.), Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine (J.G.W., N.Z., E.M.U.) - both in Cincinnati; the Department of Pediatrics, University of Colorado School of Medicine, and Anschutz Medical Campus, Children's Hospital Colorado - both in Aurora (S.R.D.); the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Research Center of Applied and Preventive Cardiovascular Medicine (J.I., N.K., C.G.M., O.T.R.), and the Departments of Medicine (M.J., J.S.A.V.) and Mathematics and Statistics (N.K.), University of Turku, and the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Division of Medicine (M.J., J.S.A.V.), and the Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, and the Department of Clinical Chemistry, Fimlab Laboratories, and the Finnish Cardiovascular Research Center, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (T.L.) - all in Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS (C.G.M., A.J.V., T.D.), and the Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC (T.D.) - both in Australia; the School of Public Health and Tropical Medicine, Tulane University, New Orleans (L.A.B.); the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (T.L.B.); the Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (R.J.P.); and the Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom (T.D.)
| | - Costan G Magnussen
- From the Division of Epidemiology and Community Health, School of Public Health (D.R.J.), and the Department of Pediatrics, University of Minnesota Medical School (A.R.S., J.S.), University of Minnesota, Minneapolis; the Division of Biostatistics and Epidemiology (J.G.W., N.Z.), and the Heart Institute (E.M.U.), Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine (J.G.W., N.Z., E.M.U.) - both in Cincinnati; the Department of Pediatrics, University of Colorado School of Medicine, and Anschutz Medical Campus, Children's Hospital Colorado - both in Aurora (S.R.D.); the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Research Center of Applied and Preventive Cardiovascular Medicine (J.I., N.K., C.G.M., O.T.R.), and the Departments of Medicine (M.J., J.S.A.V.) and Mathematics and Statistics (N.K.), University of Turku, and the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Division of Medicine (M.J., J.S.A.V.), and the Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, and the Department of Clinical Chemistry, Fimlab Laboratories, and the Finnish Cardiovascular Research Center, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (T.L.) - all in Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS (C.G.M., A.J.V., T.D.), and the Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC (T.D.) - both in Australia; the School of Public Health and Tropical Medicine, Tulane University, New Orleans (L.A.B.); the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (T.L.B.); the Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (R.J.P.); and the Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom (T.D.)
| | - Jorma S A Viikari
- From the Division of Epidemiology and Community Health, School of Public Health (D.R.J.), and the Department of Pediatrics, University of Minnesota Medical School (A.R.S., J.S.), University of Minnesota, Minneapolis; the Division of Biostatistics and Epidemiology (J.G.W., N.Z.), and the Heart Institute (E.M.U.), Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine (J.G.W., N.Z., E.M.U.) - both in Cincinnati; the Department of Pediatrics, University of Colorado School of Medicine, and Anschutz Medical Campus, Children's Hospital Colorado - both in Aurora (S.R.D.); the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Research Center of Applied and Preventive Cardiovascular Medicine (J.I., N.K., C.G.M., O.T.R.), and the Departments of Medicine (M.J., J.S.A.V.) and Mathematics and Statistics (N.K.), University of Turku, and the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Division of Medicine (M.J., J.S.A.V.), and the Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, and the Department of Clinical Chemistry, Fimlab Laboratories, and the Finnish Cardiovascular Research Center, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (T.L.) - all in Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS (C.G.M., A.J.V., T.D.), and the Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC (T.D.) - both in Australia; the School of Public Health and Tropical Medicine, Tulane University, New Orleans (L.A.B.); the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (T.L.B.); the Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (R.J.P.); and the Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom (T.D.)
| | - Nanhua Zhang
- From the Division of Epidemiology and Community Health, School of Public Health (D.R.J.), and the Department of Pediatrics, University of Minnesota Medical School (A.R.S., J.S.), University of Minnesota, Minneapolis; the Division of Biostatistics and Epidemiology (J.G.W., N.Z.), and the Heart Institute (E.M.U.), Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine (J.G.W., N.Z., E.M.U.) - both in Cincinnati; the Department of Pediatrics, University of Colorado School of Medicine, and Anschutz Medical Campus, Children's Hospital Colorado - both in Aurora (S.R.D.); the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Research Center of Applied and Preventive Cardiovascular Medicine (J.I., N.K., C.G.M., O.T.R.), and the Departments of Medicine (M.J., J.S.A.V.) and Mathematics and Statistics (N.K.), University of Turku, and the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Division of Medicine (M.J., J.S.A.V.), and the Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, and the Department of Clinical Chemistry, Fimlab Laboratories, and the Finnish Cardiovascular Research Center, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (T.L.) - all in Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS (C.G.M., A.J.V., T.D.), and the Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC (T.D.) - both in Australia; the School of Public Health and Tropical Medicine, Tulane University, New Orleans (L.A.B.); the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (T.L.B.); the Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (R.J.P.); and the Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom (T.D.)
| | - Lydia A Bazzano
- From the Division of Epidemiology and Community Health, School of Public Health (D.R.J.), and the Department of Pediatrics, University of Minnesota Medical School (A.R.S., J.S.), University of Minnesota, Minneapolis; the Division of Biostatistics and Epidemiology (J.G.W., N.Z.), and the Heart Institute (E.M.U.), Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine (J.G.W., N.Z., E.M.U.) - both in Cincinnati; the Department of Pediatrics, University of Colorado School of Medicine, and Anschutz Medical Campus, Children's Hospital Colorado - both in Aurora (S.R.D.); the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Research Center of Applied and Preventive Cardiovascular Medicine (J.I., N.K., C.G.M., O.T.R.), and the Departments of Medicine (M.J., J.S.A.V.) and Mathematics and Statistics (N.K.), University of Turku, and the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Division of Medicine (M.J., J.S.A.V.), and the Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, and the Department of Clinical Chemistry, Fimlab Laboratories, and the Finnish Cardiovascular Research Center, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (T.L.) - all in Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS (C.G.M., A.J.V., T.D.), and the Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC (T.D.) - both in Australia; the School of Public Health and Tropical Medicine, Tulane University, New Orleans (L.A.B.); the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (T.L.B.); the Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (R.J.P.); and the Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom (T.D.)
| | - Trudy L Burns
- From the Division of Epidemiology and Community Health, School of Public Health (D.R.J.), and the Department of Pediatrics, University of Minnesota Medical School (A.R.S., J.S.), University of Minnesota, Minneapolis; the Division of Biostatistics and Epidemiology (J.G.W., N.Z.), and the Heart Institute (E.M.U.), Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine (J.G.W., N.Z., E.M.U.) - both in Cincinnati; the Department of Pediatrics, University of Colorado School of Medicine, and Anschutz Medical Campus, Children's Hospital Colorado - both in Aurora (S.R.D.); the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Research Center of Applied and Preventive Cardiovascular Medicine (J.I., N.K., C.G.M., O.T.R.), and the Departments of Medicine (M.J., J.S.A.V.) and Mathematics and Statistics (N.K.), University of Turku, and the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Division of Medicine (M.J., J.S.A.V.), and the Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, and the Department of Clinical Chemistry, Fimlab Laboratories, and the Finnish Cardiovascular Research Center, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (T.L.) - all in Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS (C.G.M., A.J.V., T.D.), and the Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC (T.D.) - both in Australia; the School of Public Health and Tropical Medicine, Tulane University, New Orleans (L.A.B.); the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (T.L.B.); the Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (R.J.P.); and the Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom (T.D.)
| | - Ronald J Prineas
- From the Division of Epidemiology and Community Health, School of Public Health (D.R.J.), and the Department of Pediatrics, University of Minnesota Medical School (A.R.S., J.S.), University of Minnesota, Minneapolis; the Division of Biostatistics and Epidemiology (J.G.W., N.Z.), and the Heart Institute (E.M.U.), Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine (J.G.W., N.Z., E.M.U.) - both in Cincinnati; the Department of Pediatrics, University of Colorado School of Medicine, and Anschutz Medical Campus, Children's Hospital Colorado - both in Aurora (S.R.D.); the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Research Center of Applied and Preventive Cardiovascular Medicine (J.I., N.K., C.G.M., O.T.R.), and the Departments of Medicine (M.J., J.S.A.V.) and Mathematics and Statistics (N.K.), University of Turku, and the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Division of Medicine (M.J., J.S.A.V.), and the Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, and the Department of Clinical Chemistry, Fimlab Laboratories, and the Finnish Cardiovascular Research Center, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (T.L.) - all in Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS (C.G.M., A.J.V., T.D.), and the Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC (T.D.) - both in Australia; the School of Public Health and Tropical Medicine, Tulane University, New Orleans (L.A.B.); the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (T.L.B.); the Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (R.J.P.); and the Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom (T.D.)
| | - Julia Steinberger
- From the Division of Epidemiology and Community Health, School of Public Health (D.R.J.), and the Department of Pediatrics, University of Minnesota Medical School (A.R.S., J.S.), University of Minnesota, Minneapolis; the Division of Biostatistics and Epidemiology (J.G.W., N.Z.), and the Heart Institute (E.M.U.), Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine (J.G.W., N.Z., E.M.U.) - both in Cincinnati; the Department of Pediatrics, University of Colorado School of Medicine, and Anschutz Medical Campus, Children's Hospital Colorado - both in Aurora (S.R.D.); the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Research Center of Applied and Preventive Cardiovascular Medicine (J.I., N.K., C.G.M., O.T.R.), and the Departments of Medicine (M.J., J.S.A.V.) and Mathematics and Statistics (N.K.), University of Turku, and the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Division of Medicine (M.J., J.S.A.V.), and the Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, and the Department of Clinical Chemistry, Fimlab Laboratories, and the Finnish Cardiovascular Research Center, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (T.L.) - all in Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS (C.G.M., A.J.V., T.D.), and the Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC (T.D.) - both in Australia; the School of Public Health and Tropical Medicine, Tulane University, New Orleans (L.A.B.); the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (T.L.B.); the Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (R.J.P.); and the Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom (T.D.)
| | - Elaine M Urbina
- From the Division of Epidemiology and Community Health, School of Public Health (D.R.J.), and the Department of Pediatrics, University of Minnesota Medical School (A.R.S., J.S.), University of Minnesota, Minneapolis; the Division of Biostatistics and Epidemiology (J.G.W., N.Z.), and the Heart Institute (E.M.U.), Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine (J.G.W., N.Z., E.M.U.) - both in Cincinnati; the Department of Pediatrics, University of Colorado School of Medicine, and Anschutz Medical Campus, Children's Hospital Colorado - both in Aurora (S.R.D.); the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Research Center of Applied and Preventive Cardiovascular Medicine (J.I., N.K., C.G.M., O.T.R.), and the Departments of Medicine (M.J., J.S.A.V.) and Mathematics and Statistics (N.K.), University of Turku, and the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Division of Medicine (M.J., J.S.A.V.), and the Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, and the Department of Clinical Chemistry, Fimlab Laboratories, and the Finnish Cardiovascular Research Center, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (T.L.) - all in Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS (C.G.M., A.J.V., T.D.), and the Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC (T.D.) - both in Australia; the School of Public Health and Tropical Medicine, Tulane University, New Orleans (L.A.B.); the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (T.L.B.); the Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (R.J.P.); and the Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom (T.D.)
| | - Alison J Venn
- From the Division of Epidemiology and Community Health, School of Public Health (D.R.J.), and the Department of Pediatrics, University of Minnesota Medical School (A.R.S., J.S.), University of Minnesota, Minneapolis; the Division of Biostatistics and Epidemiology (J.G.W., N.Z.), and the Heart Institute (E.M.U.), Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine (J.G.W., N.Z., E.M.U.) - both in Cincinnati; the Department of Pediatrics, University of Colorado School of Medicine, and Anschutz Medical Campus, Children's Hospital Colorado - both in Aurora (S.R.D.); the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Research Center of Applied and Preventive Cardiovascular Medicine (J.I., N.K., C.G.M., O.T.R.), and the Departments of Medicine (M.J., J.S.A.V.) and Mathematics and Statistics (N.K.), University of Turku, and the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Division of Medicine (M.J., J.S.A.V.), and the Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, and the Department of Clinical Chemistry, Fimlab Laboratories, and the Finnish Cardiovascular Research Center, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (T.L.) - all in Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS (C.G.M., A.J.V., T.D.), and the Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC (T.D.) - both in Australia; the School of Public Health and Tropical Medicine, Tulane University, New Orleans (L.A.B.); the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (T.L.B.); the Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (R.J.P.); and the Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom (T.D.)
| | - Olli T Raitakari
- From the Division of Epidemiology and Community Health, School of Public Health (D.R.J.), and the Department of Pediatrics, University of Minnesota Medical School (A.R.S., J.S.), University of Minnesota, Minneapolis; the Division of Biostatistics and Epidemiology (J.G.W., N.Z.), and the Heart Institute (E.M.U.), Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine (J.G.W., N.Z., E.M.U.) - both in Cincinnati; the Department of Pediatrics, University of Colorado School of Medicine, and Anschutz Medical Campus, Children's Hospital Colorado - both in Aurora (S.R.D.); the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Research Center of Applied and Preventive Cardiovascular Medicine (J.I., N.K., C.G.M., O.T.R.), and the Departments of Medicine (M.J., J.S.A.V.) and Mathematics and Statistics (N.K.), University of Turku, and the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Division of Medicine (M.J., J.S.A.V.), and the Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, and the Department of Clinical Chemistry, Fimlab Laboratories, and the Finnish Cardiovascular Research Center, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (T.L.) - all in Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS (C.G.M., A.J.V., T.D.), and the Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC (T.D.) - both in Australia; the School of Public Health and Tropical Medicine, Tulane University, New Orleans (L.A.B.); the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (T.L.B.); the Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (R.J.P.); and the Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom (T.D.)
| | - Terence Dwyer
- From the Division of Epidemiology and Community Health, School of Public Health (D.R.J.), and the Department of Pediatrics, University of Minnesota Medical School (A.R.S., J.S.), University of Minnesota, Minneapolis; the Division of Biostatistics and Epidemiology (J.G.W., N.Z.), and the Heart Institute (E.M.U.), Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine (J.G.W., N.Z., E.M.U.) - both in Cincinnati; the Department of Pediatrics, University of Colorado School of Medicine, and Anschutz Medical Campus, Children's Hospital Colorado - both in Aurora (S.R.D.); the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Research Center of Applied and Preventive Cardiovascular Medicine (J.I., N.K., C.G.M., O.T.R.), and the Departments of Medicine (M.J., J.S.A.V.) and Mathematics and Statistics (N.K.), University of Turku, and the Center for Population Health Research (J.I., N.K., C.G.M., O.T.R.), the Division of Medicine (M.J., J.S.A.V.), and the Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, and the Department of Clinical Chemistry, Fimlab Laboratories, and the Finnish Cardiovascular Research Center, and the Faculty of Medicine and Health Technology, Tampere University, Tampere (T.L.) - all in Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS (C.G.M., A.J.V., T.D.), and the Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC (T.D.) - both in Australia; the School of Public Health and Tropical Medicine, Tulane University, New Orleans (L.A.B.); the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (T.L.B.); the Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC (R.J.P.); and the Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom (T.D.)
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Roelofs EJ, Dengel DR, Wang Q, Hodges JS, Steinberger J, Baker KS. The Role of Follicle-stimulating Hormone in Vascular Dysfunction Observed in Hematopoietic Cell Transplant Recipients. J Pediatr Hematol Oncol 2022; 44:e695-e700. [PMID: 34699464 PMCID: PMC8957511 DOI: 10.1097/mph.0000000000002355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022]
Abstract
Childhood cancer survivors who receive a hematopoietic cell transplantation (HCT) are at increased risk for follicle-stimulating hormone (FSH) abnormalities, which may have a substantial negative impact on vascular function. The purpose of this study was to examine the association of vascular function with FSH in HCT recipients, non-HCT recipients and healthy controls. The study included childhood cancer survivors who were HCT recipients (n=24) and non-HCT recipients (n=308), and a control group of healthy siblings (n=211) all between 9 and 18 years old. Vascular measures of carotid artery structure and function (compliance and distensibility), brachial artery flow-mediated dilation and endothelial-independent dilation were measured using ultrasound imaging. A fasting blood sample was collected to measure hormone levels. FSH was significantly higher in HCT recipients compared with non-HCT recipients and healthy controls (P<0.01). Carotid compliance and distensibility were significantly lower in HCT and non-HCT recipients compared with healthy controls (P<0.05). Higher FSH was associated with decreased carotid compliance (P<0.05). This study's results suggest that higher levels of FSH in HCT recipients may result in significant reductions in vascular function compared with non-HCT recipients and healthy controls. Therefore, gonadotropin endocrine dysfunction, particularly abnormal FSH levels, may be an underlying mechanism of vascular dysfunction.
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Affiliation(s)
| | | | - Qi Wang
- Biostatistical Design and Analysis Center
| | | | - Julia Steinberger
- Division of Pediatric Cardiology, University of Minnesota Medical Center, Minneapolis, MN
| | - K Scott Baker
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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11
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Khoury M, Khoury P, Bazzano L, Burns TL, Daniels S, Dwyer T, Ikonen J, Jacobs DR, Juonala M, Kähönen M, Prineas R, Raitakari OT, Steinberger J, Venn A, Viikari J, Woo JG, Sinaiko A, Urbina EM. Prevalence Implications of the 2017 American Academy of Pediatrics Hypertension Guideline and Associations with Adult Hypertension. J Pediatr 2022; 241:22-28.e4. [PMID: 34619113 PMCID: PMC8924915 DOI: 10.1016/j.jpeds.2021.09.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 09/15/2021] [Accepted: 09/29/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the impact of the 2017 American Academy of Pediatrics hypertension Clinical Practice Guideline (CPG), compared with the previous guideline ("Fourth Report"), on the frequency of hypertensive blood pressure (BP) measurements in childhood and associations with hypertension in adulthood using data from the International Childhood Cardiovascular Cohort Consortium. STUDY DESIGN Childhood BPs were categorized in normal, prehypertensive/elevated, and hypertensive (stage 1 and 2) ranges using the Fourth Report and the CPG. Participants were contacted in adulthood to assess self-reported hypertension. The associations between childhood hypertensive range BPs and self-reported adult hypertension were evaluated. RESULTS Data were available for 34 014 youth (10.4 ± 3.1 years, 50.6% female) with 92 751 BP assessments. Compared with the Fourth Report, the CPG increased hypertensive readings from 7.6% to 13.5% and from 1.3% to 2.5% for stage 1 and 2 hypertensive range, respectively (P < .0001). Of 12 761 adults (48.8 ± 7.9 years, 43% male), 3839 (30.1%) had self-reported hypertension. The sensitivity for predicting adult hypertension among those with hypertensive range BPs at any point in childhood, as defined by the Fourth Report and the CPG, respectively, was 13.4% and 22.4% (specificity 92.3% and 85.9%, P < .001), with no significant impact on positive and negative predictive values. Associations with self-reported adult hypertension were similar and weak (c-statistic range 0.61-0.68) for hypertensive range BPs as defined by the Fourth Report and CPG. CONCLUSIONS The CPG significantly increased the prevalence of childhood BPs in hypertensive ranges and improved the sensitivity, without an overall strengthened association, of predicting self-reported adult hypertension.
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Affiliation(s)
- Michael Khoury
- Department of Pediatrics, University of Alberta, Edmonton, Canada.
| | - Philip Khoury
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Lydia Bazzano
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Trudy L. Burns
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | | | - Terence Dwyer
- Oxford Martin School, Oxford University, Oxford, United Kingdom
| | - Johanna Ikonen
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland,Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | | | - Markus Juonala
- Department of Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ronald Prineas
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Olli T. Raitakari
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland,Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | | | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Jorma Viikari
- Department of Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Jessica G. Woo
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,University of Cincinnati College of Medicine, Cincinnati OH
| | | | - Elaine M. Urbina
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,University of Cincinnati College of Medicine, Cincinnati OH
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12
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Nuotio J, Laitinen TT, Sinaiko AR, Woo JG, Urbina EM, Jacobs DR, Steinberger J, Prineas RJ, Sabin MA, Burgner DP, Minn H, Burns TL, Bazzano LA, Venn AJ, Viikari JSA, Hutri-Kähönen N, Daniels SR, Raitakari OT, Magnussen CG, Juonala M, Dwyer T. Obesity during childhood is associated with higher cancer mortality rate during adulthood: the i3C Consortium. Int J Obes (Lond) 2022; 46:393-399. [PMID: 34728776 PMCID: PMC8794778 DOI: 10.1038/s41366-021-01000-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/04/2021] [Accepted: 10/13/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND In high-income countries, cancer is the leading cause of death among middle-aged adults. Prospective data on the effects of childhood risk exposures on subsequent cancer mortality are scarce. METHODS We examined whether childhood body mass index (BMI), blood pressure, glucose and lipid levels were associated with adult cancer mortality, using data from 21,012 children enrolled aged 3-19 years in seven prospective cohort studies from the U.S., Australia, and Finland that have followed participants from childhood into adulthood. Cancer mortality (cancer as a primary or secondary cause of death) was captured using registries. RESULTS 354 cancer deaths occurred over the follow-up. In age-, sex, and cohort-adjusted analyses, childhood BMI (Hazard ratio [HR], 1.13; 95% confidence interval [CI] 1.03-1.24 per 1-SD increase) and childhood glucose (HR 1.22; 95%CI 1.01-1.47 per 1-SD increase), were associated with subsequent cancer mortality. In a multivariable analysis adjusted for age, sex, cohort, and childhood measures of fasting glucose, total cholesterol, triglycerides, and systolic blood pressure, childhood BMI remained as an independent predictor of subsequent cancer mortality (HR, 1.24; 95%CI, 1.03-1.49). The association of childhood BMI and subsequent cancer mortality persisted after adjustment for adulthood BMI (HR for childhood BMI, 1.35; 95%CI 1.12-1.63). CONCLUSIONS Higher childhood BMI was independently associated with increased overall cancer mortality.
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Affiliation(s)
- Joel Nuotio
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland.
| | - Tomi T Laitinen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Paavo Nurmi Centre, Sports and Exercise Medicine Unit, Department of Physical Activity and Health, University of Turku, Turku, Finland
| | - Alan R Sinaiko
- Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Jessica G Woo
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Elaine M Urbina
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Julia Steinberger
- Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Ronald J Prineas
- Division of Public Health Science, Wake Forest University, Winston-Salem, NC, USA
| | - Matthew A Sabin
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Department of Endocrinology and Diabetes, The Royal Children's Hospital, Parkville, VIC, Australia
| | - David P Burgner
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Heikki Minn
- Department of Oncology, Turku University Hospital, Turku, Finland
| | - Trudy L Burns
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Lydia A Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Alison J Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Jorma S A Viikari
- Department of Internal Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Nina Hutri-Kähönen
- Department of Pediatrics, Tampere University Hospital, and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Stephen R Daniels
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Costan G Magnussen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Markus Juonala
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Internal Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
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13
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Roelofs EJ, Dengel DR, Wang Q, Hodges JS, Steinberger J, Baker S. The role of FSH in body composition in hematopoietic cell transplant recipients. Pediatr Transplant 2022; 26:e14130. [PMID: 34486806 DOI: 10.1111/petr.14130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/03/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Childhood cancer survivors who received a hematopoietic cell transplantation (HCT) are at increased risk for follicle-stimulating hormone (FSH) abnormalities, which may have a significant negative impact on bone health and body composition. This study's purpose was to examine FSH and body composition in HCT recipients, non-HCT recipients and healthy controls. METHODS The study included HCT recipients (n = 24), non-HCT recipients (n = 309), and a control group of healthy siblings (n = 211) all aged 9-18 years. A fasting blood sample was collected to measure FSH. All participants underwent a dual X-ray absorptiometry scan to assess total and regional percent fat, lean mass (LM), fat mass (FM), bone mineral content (BMC), bone mineral density (BMD), and visceral adipose tissue (VAT) mass. RESULTS FSH was significantly higher in HCT recipients compared to non-HCT recipients and healthy controls. HCT recipients had significantly lower total body weight, total LM, arm and leg LM, BMC and BMD compared to non-HCT recipients and healthy controls (p < .05). Non-HCT recipients had significantly higher total, trunk, android, gynoid, arm and leg FM compared to healthy controls. Also, healthy controls had significantly lower VAT mass compared to non-HCT recipients. CONCLUSIONS This study's results show that HCT recipients have significant reductions in BMD, worse body composition, and abnormal FSH levels compared to non-HCT recipients and healthy controls.
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Affiliation(s)
- Erica J Roelofs
- School of Kinesiology, University of Minnesota, Minneapolis, MN, USA
| | - Donald R Dengel
- School of Kinesiology, University of Minnesota, Minneapolis, MN, USA
| | - Qi Wang
- Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis, MN, USA
| | - James S Hodges
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | | | - Scott Baker
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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14
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Siddeek H, Lunos S, Thomas AS, McCracken C, Steinberger J, Kochilas L. Long Term Outcomes of Tetralogy of Fallot With Absent Pulmonary Valve (from the Pediatric Cardiac Care Consortium). Am J Cardiol 2021; 158:118-123. [PMID: 34511183 PMCID: PMC8614622 DOI: 10.1016/j.amjcard.2021.07.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 11/30/2022]
Abstract
Tetralogy of Fallot with absent pulmonary valve (TOF-APV) is a rare form of tetralogy with unique challenges due to the combination of pulmonary annular stenosis, severe pulmonary regurgitation, and airway compression secondary to aneurysmal dilatation of the pulmonary arteries. Data on the long-term outcomes of repaired TOF-APV are scarce. We used the Pediatric Cardiac Care Consortium (PCCC), a large US-based registry, to describe the postrepair transplant-free survival of patients with TOF-APV. We queried the PCCC for patients operated for TOF-APV between 1982 and 2003. Death or transplant events were ascertained from the PCCC and by linkage with the US National Death Index and the Organ Procurement Transplantation Network through December 2019. A total of 126 patients were identified with TOF-APV repair (primary n = 119, staged n = 7). The majority of them were repaired with a right ventricular to pulmonary artery conduit (n = 80, 64%) and 43 (34%) with transannular patch. In-hospital mortality occurred in 31 patients (25%); post discharge and over a median period of 19 years (IQR 0.37 to 23.7 years), 5 patients died and 2 underwent heart transplant, one of whom subsequently died. The 25-year transplant-free survival post discharge after TOF-APV repair was 92%, which was similar with the outcome of patients with simple TOF undergoing non-valve sparing procedures (94% log-rank test p = 0.455; aHR 1.37; 95% CI: 0.63 to 2.97, p = 0.432). In conclusion, early in-hospital mortality is high for TOF-APV; however, once repaired and survived to discharge, long term survival is similar to simple TOF with non-valve sparing procedures.
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Affiliation(s)
- Hani Siddeek
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota; Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah.
| | - Scott Lunos
- University of Minnesota Clinical and Translational Science Institute, Biostatistical Design and Analysis Center, Minneapolis, Minnesota
| | - Amanda S Thomas
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Courtney McCracken
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Center for Research and Evaluation, Kaiser Permanente of Georgia
| | - Julia Steinberger
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | - Lazaros Kochilas
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta & Sibley Heart Center Cardiology, Atlanta, Georgia
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15
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Harville EW, Crook CE, Bazzano LA, Woo JG, Burns TL, Raitakari O, Urbina EM, Venn A, Jacobs DR, Steinberger J, Sinaiko A, Dwyer T, Juonala M. Cardiovascular risk factors before and during pregnancy: Does pregnancy unmask or initiate risk? J Obstet Gynaecol Res 2021; 47:3849-3856. [PMID: 34482586 DOI: 10.1111/jog.14971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/21/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To understand if pregnancy unmasks previously silent cardiovascular (CV) adverse factors, or initiates lasting injury. METHODS Pre-pregnancy and during pregnancy CV risk factors (blood pressure, fasting lipids, and glucose) from 296 women belonging to studies in the International Childhood Cardiovascular Cohort (i3C) Consortium, a group of studies assessing the relationship between child and adolescent CV risk factors and adult outcomes, were used. Correlation coefficients between the pre- and during pregnancy measures were calculated, and the mean difference between the measures was modeled with adjustment for age, body mass index, race, smoking, and study. RESULTS Measures were strongly correlated at pre- and during-pregnancy visits (p < 0.01), with r of between 0.30 and 0.55. In most cases, the difference between pre-pregnancy and during-pregnancy did not differ significantly from 0 after adjustment for confounders. Stratification by gestational age indicated stronger correlations with measurements obtained during the first and second trimesters than the third. The correlation did not differ by the time elapsed between the pre-pregnancy and pregnancy visits. CONCLUSIONS Pre- and during-pregnancy CV risk factors are moderately well correlated. This may indicate that susceptible women enter pregnancy with higher risk rather than pregnancy inducing new vascular or metabolic effects.
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Affiliation(s)
- Emily W Harville
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Carrie E Crook
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Lydia A Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Jessica G Woo
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Trudy L Burns
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Olli Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Elaine M Urbina
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - David R Jacobs
- Division of Epidemiology and Community Health, University of Minnesota, School of Public Health, Minneapolis, Minnesota, USA
| | - Julia Steinberger
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Alan Sinaiko
- Division of Epidemiology and Community Health, University of Minnesota, School of Public Health, Minneapolis, Minnesota, USA
| | - Terence Dwyer
- George Institute for Global Health, University of Oxford, Oxford, UK
| | - Markus Juonala
- Department of Medicine, University of Turku and Division of Medicine, Turku University Hospital, Turku, Finland
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16
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Dwyer T, Raitakari OT, Jacobs D, Woo JG, Urbina EM, Bazzano L, Juonala M, Viikari J, Chen W, Prineas R, Steinberger J, Daniels S, Sinaiko A, Venn A, Burns TL, Hu T. 684Childhood Risk Factors and Adult Cardiovascular Disease Outcomes The International Childhood Cardiovascular Cohort (i3C) Consortium. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atherosclerosis develops silently for decades before adult cardiovascular disease (aCVD) occurs. There is currently no evidence directly linking childhood risk factors to aCVD outcomes.
Methods
i3C is an international consortium of 7 cohorts involving 40,709 participants enrolled between 1970-95 in childhood (age 3-19) who underwent measurement for BMI, SBP, total cholesterol, and triglycerides, and smoking (the last mostly in adolescence). Participants were followed by direct contact and review of medical records or death registry ascertainment through adulthood in 2014-19. 20,560 participants were found and interviewed or had died in the approximately 40 years since enrollment; 738 had a CVD event, confirmed by medical record review (n = 449) or death certificate ICD code (n = 289).
Results
Estimated hazard ratios (HRs) for childhood risk factors and their confidence intervals are displayed in the table below. The CIs excluded 1.0 for all these variables in the univariable analysis and, although the HRs were reduced in multivariable analysis which included all of these risk factors, the CIs still excluded 1.0.
Conclusion
Exposure to CVD risk factors in youth predicts adult CVD with implications for primordial CVD prevention.
Key messages
Intervention to reduce CVD risk factors in childhood is likely to reduce risk of adult CVD
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Affiliation(s)
- Terence Dwyer
- Murdoch Children’s Research Institute, Melbourne, Australia
- Emeritus Professor of Epidemiology, University of Oxford, Oxford, United Kingdom
- Oxford Martin Fellow, Oxford Martin School, University of Oxford, Oxford, United Kingdom
- Honorary Professorial Fellow, Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Olli T. Raitakari
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - David Jacobs
- Division of Epidemiology and community health, school of public health, University of Minnesota, Minneapolis, USA
| | - Jessica G. Woo
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Elaine M. Urbina
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, USA
| | - Lydia Bazzano
- Department of Epidemiology, Tulane University Health Sciences Center, Tulane University, New Orleans, USA
| | - Markus Juonala
- Department of Internal Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Jorma Viikari
- Department of Medicine (M.J., J.S.A.V.), University of Turku, Turku, Finland
| | - Wei Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
| | - Ronald Prineas
- Wake Forest University School of Medicine, Winston Salem, USA
| | - Julia Steinberger
- University of Minnesota Masonic Children's Hospital, Minneapolis, USA
| | | | - Alan Sinaiko
- University of Minnesota Masonic Children's Hospital, Minneapolis, USA
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Trudy L. Burns
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, USA
| | - Tian Hu
- Division of Epidemiology and community health, school of public health, University of Minnesota, Minneapolis, USA
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17
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Baldry E, Redlinger-Grosse K, MacFarlane I, Walters ST, Ash E, Steinberger J, Murdy K, Cragun D, Allen-Tice C, Zierhut H. Outcomes from a pilot genetic counseling intervention using motivational interviewing and the extended parallel process model to increase cascade cholesterol screening. J Genet Couns 2021; 31:164-175. [PMID: 34260792 DOI: 10.1002/jgc4.1466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 06/01/2021] [Accepted: 06/14/2021] [Indexed: 12/26/2022]
Abstract
Familial hypercholesterolemia (FH) is an inherited condition resulting in increased risk of premature cardiovascular disease. This risk can be reduced with early diagnosis and treatment, but it can be challenging to identify individuals with FH. Cascade screening, the most efficient and cost-effective identification method, requires FH patients to communicate with their at-risk family and encourage them to pursue screening. Beyond FH, patients with conditions increasing disease risk to family members report barriers to the communication process such as insufficient knowledge of the condition and discomfort informing relatives. We conducted a pilot study of a genetic counseling intervention incorporating behavior-change principles from motivational interviewing (MI) and the extended parallel process model (EPPM) to help parents of children with FH overcome these barriers and improve cascade screening rates for FH. Of the 13 participants who completed the intervention and post-intervention surveys, 6 reported contacting and/or screening additional relatives. A large effect size in increasing communication and screening was observed (η2 = 0.20), with the mean percent of at-risk relatives contacted rising from 33% to 45%, and the mean percent screened rising from 32% to 42%. On average, 2.23 new relatives were contacted and 2.46 were screened, per participant, by the end of the study. Direct content analysis revealed that despite the open-ended nature of the goal-setting process, participant goals fell into two categories including those who set goals focused on communicating with and screening family members (n = 9) and those who set goals only focused on managing FH (n = 4). Overall, the communication and screening rates reported after the intervention were higher than previous observations in adult FH populations. These results suggest this EPPM/MI genetic counseling intervention could be a useful tool for increasing communication and cascade screening for FH. With further research on goal-setting techniques, the intervention could be refined and replicated to identify more individuals affected by FH or modified for use with other actionable genetic conditions.
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Affiliation(s)
- Emma Baldry
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
| | - Krista Redlinger-Grosse
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
| | - Ian MacFarlane
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
| | - Scott T Walters
- Health Sciences Center, University of North Texas, Fort Worth, TX, USA
| | - Erin Ash
- Sarah Lawrence College, Broxville, NY, USA
| | - Julia Steinberger
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Kari Murdy
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Deborah Cragun
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Carly Allen-Tice
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
| | - Heather Zierhut
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
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18
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Abstract
BACKGROUND The intrauterine environment is a key determinant for long-term health outcomes. Adverse fetal environments, such as maternal diabetes, obesity and placental insufficiency are strongly associated with long-term health risks in children. Little is known about differences in fetal cardiac output hemodynamics of diabetic mothers (DM) vs. non-diabetic mothers (NDM). Our study aims to investigate the left-sided, right-sided, and combined cardiac output (CCO) in fetuses of DM vs. NDM. METHODS Retrospective data were collected in fetuses of DM (N = 532) and NDM (103) at mean gestational age 24 weeks. Examination included 2D echo and pulse wave Doppler. Wilcoxon rank sum tests and Chi-square tests were used to test for distribution difference of maternal and fetal continuous and categorical measures respectively between DM and NDM. Intraclass correlation coefficients were calculated to assess intra-observer reliability of fetal cardiac measurements. RESULTS DM mothers had higher mean weight (89.7±22.2 kg) than NDM (76.8±19.8 kg), p < 0.0001 and higher mean BMI (33.4±7.5) than NDM (28.3±5.8), p < 0.0001. C-section delivery occurred in 66% of DM vs. 35% of NDM fetuses. Fetuses of DM mothers had significantly larger semilunar valve diameter, higher left ventricular (LV) output, higher combined cardiac output and lower right ventricle /left ventricle ratio compared to NDM. CONCLUSION The greater CCO (adjusted for fetal weight), left sided cardiac output in the fetuses of DM, compared to NDM, represent differences in cardiac adaptation to the diabetic environment.
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Affiliation(s)
- S L Narasimhan
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A Eid
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A Bhatia
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - C Davey
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J Steinberger
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
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19
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Urbina EM, Khoury PR, Bazzano LA, Burns TL, Dwyer T, Jacobs DR, Juonala M, Prineas RJ, Raitakari OT, Sinaiko A, Steinberger J, Venn A, Woo JG. Abstract 067: Does BP Trajectory Across Childhood Predict Adult HTN?
The International Childhood CV Cohorts Consortium. Circulation 2021. [DOI: 10.1161/circ.143.suppl_1.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The relationship between single measures of systolic blood pressure (SBP) in youth and adult levels is weak. We sought to define trajectories of SBP over childhood to determine ability to predict adult hypertension (HTN). In the International Childhood CV Cohort (i3C) Consortium, we constructed SBP trajectories in 11,482 participants (mean age 8.0 + 2.0 years at time of first measure, 47% male, 25% non-Caucasian) who had at least 3 SBPs in youth between the ages of 4 and <20 years assessed with at least 5 years between measures. To account for differences in normal BP by age, sex and height, trajectories were constructed using SBP percentile as defined by the 2017 Clinical Practice Guideline for BP management in youth. We then assessed HTN status (by survey) at mean age 46.7 years in 5,357 of the participants (mean age at first assessment 8.1 + 1.9 years, at self-assessment of HTN 46.7 + 5.7 years. 41% male, 23% non-Caucasian). SAS Proc Traj was employed to construct models with differing numbers of trajectories where all individual trajectories were significant (whether linear, quadratic or cubic). Model fit for each number of trajectories (up to 9) was assessed and trajectories were examined for clinical relevance. The final model selected included 6 trajectories. The prevalence of adult HTN was lowest in the group with low SBP across childhood and adolescence (Low-Low = 20%) and was highest in the group with persistently high SBP (High-High, 49%, chi square <0.001). At first assessment, participants in the High-High group were slightly older (8.7 vs 7.7 years), heavier (BMI 65.2 vs 45.1%), had higher BP (112/61 vs 90/48 mmHg; 27% vs 86% for SBP) and, higher Tchol, LDL, TG, Insulin, Glucose and lower HDL although means were within normal limits (all p<0.001). We conclude that trajectories of BP across childhood may identify youth at high risk for development of HTN in adulthood.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Alison Venn
- Menzies Institute for Med Resea, Hobart, Australia
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20
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Bluwstein J, Asiyanbi AP, Dutta A, Huff A, Lund JF, De Rosa SP, Steinberger J. Commentary: Underestimating the Challenges of Avoiding a Ghastly Future. Front Conserv Sci 2021. [DOI: 10.3389/fcosc.2021.666910] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Myers F, Aggarwal V, Bass JL, Berry JM, Knutson S, Narasimhan S, Steinberger J, Ambrose M, Shah KM, Hiremath G. Anatomic Approach and Outcomes in Children Undergoing Percutaneous Pericardiocentesis. Pediatr Cardiol 2021; 42:918-925. [PMID: 33590324 DOI: 10.1007/s00246-021-02563-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
Pericardiocentesis is traditionally performed using a subxiphoid approach. Hepatomegaly or loculated and noncircumferential effusions warrant nonstandard approaches to drain effusions; echocardiographic guidance has made these less traditional, non-subxiphoid approaches feasible. The study is aimed at comparing clinical outcomes of the subxiphoid and non-subxiphoid approaches to percutaneous pericardiocentesis in a pediatric population. This is a retrospective chart review of all children undergoing percutaneous pericardiocentesis from August 2008 to December 2019 at a single-center. A total of 104 patients underwent echocardiography-guided pericardiocentesis during the timeframe. Additionally, fluoroscopy was also used in 80 patients. Hematopoietic stem cell transplantation was the most common underlying diagnosis (n = 53, 50.9%). A non-subxiphoid approach was used in 58.6% (n = 61) of patients. The fifth and sixth intercostal spaces were the most commonly used (n = 17 each). The non-subxiphoid group tended to be older (95.9 vs. 21.7 months, p = 0.006) and weighed more (23.6 vs. 11.2 kgs, p = 0.013) as compared to the subxiphoid group. Non-subxiphoid approach was associated with shorter procedure times (21 vs. 37 min, p = 0.005). No major complications were seen. Five minor complications occurred and were equally distributed in the two groups. Complications were more likely in younger patients (p = 0.047). The technique and anatomic approach to pericardiocentesis, and the location or size of effusion did not influence the risk of complications. Echocardiography-guided percutaneous pericardiocentesis in children was associated with low complication rates in this single-center pediatric experience. The use of a non-traditional, non-subxiphoid approach was associated with shorter procedure times and did not significantly affect complication rates.
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Affiliation(s)
- Faith Myers
- Division of Pediatric Cardiology, Department of Pediatrics, Masonic Children's Hospital, University of Minnesota, 2450 Riverside Ave, East Building Room MB547, Minneapolis, MN, 55454, USA
| | - Varun Aggarwal
- Division of Pediatric Cardiology, Department of Pediatrics, Masonic Children's Hospital, University of Minnesota, 2450 Riverside Ave, East Building Room MB547, Minneapolis, MN, 55454, USA
| | - John L Bass
- Division of Pediatric Cardiology, Department of Pediatrics, Masonic Children's Hospital, University of Minnesota, 2450 Riverside Ave, East Building Room MB547, Minneapolis, MN, 55454, USA
| | - James M Berry
- Division of Pediatric Cardiology, Department of Pediatrics, Masonic Children's Hospital, University of Minnesota, 2450 Riverside Ave, East Building Room MB547, Minneapolis, MN, 55454, USA
| | - Stacie Knutson
- Division of Pediatric Cardiology, Department of Pediatrics, Masonic Children's Hospital, University of Minnesota, 2450 Riverside Ave, East Building Room MB547, Minneapolis, MN, 55454, USA
| | - Shanti Narasimhan
- Division of Pediatric Cardiology, Department of Pediatrics, Masonic Children's Hospital, University of Minnesota, 2450 Riverside Ave, East Building Room MB547, Minneapolis, MN, 55454, USA
| | - Julia Steinberger
- Division of Pediatric Cardiology, Department of Pediatrics, Masonic Children's Hospital, University of Minnesota, 2450 Riverside Ave, East Building Room MB547, Minneapolis, MN, 55454, USA
| | - Matthew Ambrose
- Division of Pediatric Cardiology, Department of Pediatrics, Masonic Children's Hospital, University of Minnesota, 2450 Riverside Ave, East Building Room MB547, Minneapolis, MN, 55454, USA
| | - Kavisha M Shah
- Division of Pediatric Cardiology, Department of Pediatrics, Masonic Children's Hospital, University of Minnesota, 2450 Riverside Ave, East Building Room MB547, Minneapolis, MN, 55454, USA
| | - Gurumurthy Hiremath
- Division of Pediatric Cardiology, Department of Pediatrics, Masonic Children's Hospital, University of Minnesota, 2450 Riverside Ave, East Building Room MB547, Minneapolis, MN, 55454, USA.
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22
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Siddeek H, Jimenez E, Ambrose M, Braunlin E, Steinberger J, Bass J, Cortez D. Pediatric Micra leadless pacemaker implantation via internal jugular and femoral vein: a single center, US experience. Future Cardiol 2021; 17:1116-1122. [PMID: 33463371 DOI: 10.2217/fca-2020-0169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: In the pediatric population, conventional transvenous and epicardial pacemaker systems carry complications such as lead distortion due to growth/activity, in addition to other lead/pocket complications. Materials & methods: A retrospective review of pediatric leadless pacing at the University of Minnesota Masonic Children's Hospital from 2018 to 2020 was performed. Rationale for pacing, demographics of patients, thresholds and longevity of devices were recorded. Results: Seven leadless pacemaker insertions and one removal were performed successfully, in patients weighing between 19 kg and 58 kg. Three patients had Micra implantation via internal jugular vein. One pericardial effusion occurred perioperatively in a 19 kg patient with baseline thrombocytopenia, sideroblastic anemia and Pearson Marrow Pancreas syndrome. Conclusion: Leadless pacemaker implantation/early retrieval is feasible in pediatric patients.
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Affiliation(s)
- Hani Siddeek
- Pediatric Cardiology, University of Minnesota/Masonic Children's Hospital, MN 55454, USA
| | - Erick Jimenez
- Pediatric Cardiology, University of Minnesota/Masonic Children's Hospital, MN 55454, USA
| | - Matthew Ambrose
- Pediatric Cardiology, University of Minnesota/Masonic Children's Hospital, MN 55454, USA
| | - Elizabeth Braunlin
- Pediatric Cardiology, University of Minnesota/Masonic Children's Hospital, MN 55454, USA
| | - Julia Steinberger
- Pediatric Cardiology, University of Minnesota/Masonic Children's Hospital, MN 55454, USA
| | - John Bass
- Pediatric Cardiology, University of Minnesota/Masonic Children's Hospital, MN 55454, USA
| | - Daniel Cortez
- Pediatric Cardiology, University of Minnesota/Masonic Children's Hospital, MN 55454, USA.,Clinical Sciences, Lunds University, Lund, Sweden
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23
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Hu T, Jacobs DR, Sinaiko AR, Bazzano LA, Burns TL, Daniels SR, Dwyer T, Hutri-Kähönen N, Juonala M, Murdy KA, Prineas RJ, Raitakari OT, Urbina EM, Venn A, Woo JG, Steinberger J. Childhood BMI and Fasting Glucose and Insulin Predict Adult Type 2 Diabetes: The International Childhood Cardiovascular Cohort (i3C) Consortium. Diabetes Care 2020; 43:2821-2829. [PMID: 32873588 PMCID: PMC7576414 DOI: 10.2337/dc20-0822] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/07/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine childhood BMI, fasting glucose, and insulin in relation to incident adult type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS We used data from the International Childhood Cardiovascular Cohort (i3C) Consortium. Data included childhood (age 3-19 years) measurements obtained during the 1970s-1990s; a health questionnaire, including self-report of adult T2DM (occurrence age, medication use) obtained at mean age 40 years; and a medical diagnosis registry (Finland). RESULTS The sample included 6,738 participants. Of these, 436 (6.5%) reported onset of T2DM between ages 20 and 59 (mean 40.8) years, and 86% of them reported use of a confirmed antidiabetic medication. BMI and glucose (age and sex standardized) were associated with incident T2DM after adjustment for cohort, country, sex, race, age, and calendar year of measurement. Increasing levels of childhood BMI and glucose were related to an incrementally increased risk of T2DM beginning at age 30 years, beginning at cut points <95th percentile for BMI and <100 mg/dL for glucose. Insulin was positively associated with adult T2DM after adjustment for BMI and glucose and added to T2DM discrimination. CONCLUSIONS Childhood BMI and glucose are predictors of adult T2DM at levels previously considered to be within the normal range. These easy-to-apply measurements are appealing from a clinical perspective. Fasting insulin has the potential to be an additional predictor.
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Affiliation(s)
- Tian Hu
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Alan R Sinaiko
- Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis, MN
| | - Lydia A Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Trudy L Burns
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
| | - Stephen R Daniels
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Terry Dwyer
- Oxford Martin School, Oxford University, Oxford, U.K
| | - Nina Hutri-Kähönen
- Department of Pediatrics, Tampere University Hospital, and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Markus Juonala
- Department of Internal Medicine, University of Turku, Turku, Finland.,Division of Medicine, Turku University Hospital, Turku, Finland.,Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Kari A Murdy
- Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis, MN
| | - Ronald J Prineas
- Division of Public Health Science, Wake Forest University, Winston-Salem, NC
| | - Olli T Raitakari
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland.,Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Elaine M Urbina
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Jessica G Woo
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Julia Steinberger
- Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis, MN
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24
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Hu T, Gall SL, Widome R, Bazzano LA, Burns TL, Daniels SR, Dwyer T, Ikonen J, Juonala M, Kähönen M, Prineas RJ, Raitakari O, Sinaiko AR, Steinberger J, Urbina EM, Venn A, Viikari J, Woo JG, Jacobs DR. Childhood/Adolescent Smoking and Adult Smoking and Cessation: The International Childhood Cardiovascular Cohort (i3C) Consortium. J Am Heart Assoc 2020; 9:e014381. [PMID: 32264731 PMCID: PMC7428613 DOI: 10.1161/jaha.119.014381] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Despite declining US adolescent smoking prevalence from 40% among 12th graders in 1995 to around 10% in 2018, adolescent smoking is still a significant problem. Using the International Childhood Cardiovascular Cohort (i3C) Consortium, which includes 7 international cohorts recruited in childhood and followed into adulthood, the present study was designed to confirm the important relation between adolescent smoking and daily adult smoking and present new data on adult smoking into the forties and comparison of smoking in the United States, Finland, and Australia. Methods and Results Childhood smoking experience during ages 6 to 19 in the 1970s and 1980s was classifiable in 6687 i3C participants who also provided smoking status in their twenties and forties through 2011–2018. Prevalence of daily smoking in their twenties was directly related to degree of smoking during adolescence and inversely related to the age at which that smoking experience occurred (P trend, <0.001). Similar patterns were observed for prediction of smoking during age forties. Among the 2465 smokers in their twenties, cessation by their forties was generally inverse to degree of smoking in ages 6 to 19 (P trend, <0.001). Prevalence of smoking during adolescence and adulthood was similar among US, Finnish, and Australian participants. Conclusions These long‐term follow‐up data show that smoking intensity increased throughout adolescence. Prevalence of adult smoking and cessation by the forties were both correlated with levels of childhood smoking intensity. These data lend support to preventive strategies designed to reduce, delay, or eliminate any youth access to cigarettes.
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Affiliation(s)
- Tian Hu
- Division of Epidemiology and Community Health School of Public Health University of Minnesota Minneapolis MN
| | - Seana L Gall
- Menzies Institute for Medical Research University of Tasmania Hobart Australia
| | - Rachel Widome
- Division of Epidemiology and Community Health School of Public Health University of Minnesota Minneapolis MN
| | - Lydia A Bazzano
- Department of Epidemiology School of Public Health and Tropical Medicine Tulane University New Orleans LA
| | - Trudy L Burns
- Department of Epidemiology College of Public Health University of Iowa Iowa City IA
| | - Stephen R Daniels
- Department of Pediatrics University of Colorado School of Medicine Aurora CO
| | - Terence Dwyer
- Oxford Martin School Oxford University Oxford United Kingdom
| | - Johanna Ikonen
- Research Centre of Applied and Preventive Cardiovascular Medicine University of Turku Finland
| | - Markus Juonala
- Department of Internal Medicine University of Turku Finland.,Division of Medicine Turku University Hospital Turku Finland.,Murdoch Children's Research Institute Parkville Victoria Australia
| | - Mika Kähönen
- Department of Clinical Physiology Tampere University Hospital Tampere Finland.,Faculty of Medicine and Health Technology University of Tampere Finland
| | - Ronald J Prineas
- Division of Public Health Science Wake Forest University Winston-Salem NC
| | - Olli Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine University of Turku Finland
| | - Alan R Sinaiko
- Department of Pediatrics University of Minnesota School of Medicine Minneapolis MN
| | - Julia Steinberger
- Department of Pediatrics University of Minnesota School of Medicine Minneapolis MN
| | - Elaine M Urbina
- The Heart Institute Cincinnati Children's Hospital Medical Center Cincinnati OH.,Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH
| | - Alison Venn
- Menzies Institute for Medical Research University of Tasmania Hobart Australia
| | - Jorma Viikari
- Department of Internal Medicine University of Turku Finland.,Division of Medicine Turku University Hospital Turku Finland
| | - Jessica G Woo
- Division of Biostatistics and Epidemiology Cincinnati Children's Hospital Medical Center Cincinnati OH.,Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH
| | - David R Jacobs
- Division of Epidemiology and Community Health School of Public Health University of Minnesota Minneapolis MN
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25
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Juonala M, Wu F, Sinaiko A, Woo JG, Urbina EM, Jacobs D, Steinberger J, Prineas R, Koskinen J, Sabin MA, Burgner DP, Burns TL, Bazzano L, Venn A, Viikari JS, Hutri-Kähönen N, Daniels SR, Dwyer T, Raitakari OT, Magnussen CG. Non-HDL Cholesterol Levels in Childhood and Carotid Intima-Media Thickness in Adulthood. Pediatrics 2020; 145:peds.2019-2114. [PMID: 32209701 PMCID: PMC7111486 DOI: 10.1542/peds.2019-2114] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Elevated non-high-density lipoprotein cholesterol (HDL-C) levels are used to identify children at increased cardiovascular risk, but the use of non-HDL-C in childhood to predict atherosclerosis is unclear. We examined whether the National Heart, Lung, and Blood Institute classification of youth non-HDL-C status predicts high common carotid artery intima-media thickness in adulthood. METHODS We analyzed data from 4 prospective cohorts among 4582 children aged 3 to 19 years who were remeasured as adults (mean follow-up of 26 years). Non-HDL-C status in youth and adulthood was classified according to cut points of the National Heart, Lung, and Blood Institute and the National Cholesterol Education Program Adult Treatment Panel III. High carotid intima-media thickness (cIMT) in adulthood was defined as at or above the study visit-, age-, sex-, race-, and cohort-specific 90th percentile of intima-media thickness. RESULTS In a log-binomial regression analysis adjusted with age at baseline, sex, cohort, length of follow-up, baseline BMI, and systolic blood pressure, children with dyslipidemic non-HDL-C were at increased risk of high cIMT in adulthood (relative risk [RR], 1.29; 95% confidence interval [CI], 1.07-1.55). Compared with the persistent normal group, the persistent dyslipidemia group (RR, 1.80; 95% CI, 1.37-2.37) and incident dyslipidemia (normal to dyslipidemia) groups (RR, 1.45; 95% CI, 1.07-1.96) had increased risk of high cIMT in adulthood, but the risk was attenuated for the resolution (dyslipidemia to normal) group (RR, 1.17; 95% CI, 0.97-1.41). CONCLUSIONS Dyslipidemic non-HDL-C levels predict youth at risk for developing high cIMT in adulthood. Those who resolve their non-HDL-C dyslipidemia by adulthood have normalized risk of developing high cIMT in adulthood.
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Affiliation(s)
- Markus Juonala
- Department of Medicine, University of Turku and Division of Medicine, Turku University Hospital, .,Contributed equally as co-first authors
| | - Feitong Wu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia;,Contributed equally as co-first authors
| | - Alan Sinaiko
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Jessica G. Woo
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and College of Medicine, University of Cincinnati and
| | - Elaine M. Urbina
- Division of Cardiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - David Jacobs
- Division of Epidemiology and Community Health, School of Public Health and
| | - Julia Steinberger
- Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota
| | - Ronald Prineas
- Division of Public Health Sciences, School of Medicine, Wake Forest University, Winston‐Salem, North Carolina
| | - Juha Koskinen
- Heart Center, Kymenlaakso Central Hospital, Kotka, Finland
| | - Matthew A. Sabin
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia
| | - David P. Burgner
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia
| | - Trudy L. Burns
- Department of Pediatrics, University of Melbourne, Parkville, Australia;,Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Lydia Bazzano
- Departments of Epidemiology and Biostatistics and Bioinformatics, Tulane University Health Sciences Center, Tulane University, New Orleans, Louisiana
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Jorma S.A. Viikari
- Department of Medicine, University of Turku and Division of Medicine, Turku University Hospital
| | - Nina Hutri-Kähönen
- Department of Pediatrics, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Stephen R. Daniels
- Department of Pediatrics, Children’s Hospital Colorado and School of Medicine, University of Colorado, Aurora, Colorado; and
| | - Terence Dwyer
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| | - Olli T. Raitakari
- Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, and,Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Costan G. Magnussen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland;,Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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26
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Wang RY, Rudser KD, Dengel DR, Evanoff N, Steinberger J, Movsesyan N, Garrett R, Christensen K, Boylan D, Braddock SR, Shinawi M, Gan Q, Montaño AM. Abnormally increased carotid intima media-thickness and elasticity in patients with Morquio A disease. Orphanet J Rare Dis 2020; 15:73. [PMID: 32183856 PMCID: PMC7079365 DOI: 10.1186/s13023-020-1331-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 02/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Cardiovascular disease frequently causes morbidity and mortality in mucopolysaccharidoses (MPS); however, cardiovascular anatomy and dysfunction in MPS IVA (Morquio A disease) is not well described. Consequently, the study aimed to compare carotid artery structure and elasticity of MPS IVA patients with other MPS patients and healthy control subjects, and quantitate frequency of MPS IVA cardiac structural and functional abnormalities. Methods Prospective, multi-center echocardiogram and carotid ultrasound evaluations of 12 Morquio A patients were compared with other MPS and healthy control subjects. Average differences between groups were adjusted for age, sex, and height with robust variance estimation for confidence intervals and P-values. Results Morquio A patients demonstrated significantly higher (P < 0.001) adjusted carotid intima-media thickness (cIMT), mean (SD) of 0.56 mm (0.03) compared to control subjects, 0.44 mm (0.04). The Morquio A cohort had significantly greater adjusted carotid elasticity (carotid cross-sectional compliance + 43%, P < 0.001; carotid incremental elastic modulus − 33%, P = 0.003) than control subjects and other MPS patients. Aortic root dilatation was noted in 56% of the Morquio A cohort, which also had highly prevalent mitral (73%) and aortic (82%) valve thickening, though hemodynamically significant valve dysfunction was less frequent (9%). Conclusions Increased carotid elasticity in Morquio A patients is an unexpected contrast to the reduced elasticity observed in other MPS. These Morquio A cIMT findings corroborate MPS IVA arterial post-mortem reports and are consistent with cIMT of other MPS. Aortic root dilatation in Morquio A indicates arterial elastin dysfunction, but their carotid hyperelasticity indicates other vascular intima/media components, such as proteoglycans, may also influence artery function. Studying MPS I and IVA model systems may uniquely illuminate the function of glycosaminoglycan-bearing proteoglycans in arterial health.
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Affiliation(s)
- Raymond Y Wang
- Division of Metabolic Disorders, CHOC Children's Specialists, Orange, CA, USA. .,Department of Pediatrics, University of California-Irvine School of Medicine, Orange, CA, USA.
| | - Kyle D Rudser
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Donald R Dengel
- School of Kinesiology, College of Education and Human Development, University of Minnesota, Minneapolis, MN, USA
| | - Nicholas Evanoff
- School of Kinesiology, College of Education and Human Development, University of Minnesota, Minneapolis, MN, USA
| | - Julia Steinberger
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Nina Movsesyan
- Research Institute, CHOC Children's Hospital, Orange, CA, USA
| | - Robert Garrett
- Department of Radiology, School of Medicine, Saint Louis University, Saint Louis, MO, USA
| | - Katherine Christensen
- Department of Pediatrics, Doisy Research Center, School of Medicine, Saint Louis University, St. Louis, MO, USA
| | - Deborah Boylan
- SSM Cardinal Glennon Children's Hospital, Saint Louis, MO, USA
| | - Stephen R Braddock
- Department of Pediatrics, Doisy Research Center, School of Medicine, Saint Louis University, St. Louis, MO, USA
| | - Marwan Shinawi
- Department of Pediatrics, Division of Genetics and Genomic Medicine, Washington University School of Medicine, Saint Louis, MO, USA
| | - Qi Gan
- Department of Pediatrics, Doisy Research Center, School of Medicine, Saint Louis University, St. Louis, MO, USA
| | - Adriana M Montaño
- Department of Pediatrics, Doisy Research Center, School of Medicine, Saint Louis University, St. Louis, MO, USA. .,Department of Biochemistry and Molecular Biology, School of Medicine, Saint Louis University, Saint Louis, MO, USA.
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27
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Siddeek H, Steinberger J, McCracken C, Thomas A, Lunos S, Kochilas L. LONG-TERM OUTCOMES OF TETRALOGY OF FALLOT WITH ABSENT PULMONARY VALVE: A STUDY FROM THE PEDIATRIC CARDIAC CARE CONSORTIUM. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31210-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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28
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de Ferranti SD, Steinberger J, Ameduri R, Baker A, Gooding H, Kelly AS, Mietus-Snyder M, Mitsnefes MM, Peterson AL, St-Pierre J, Urbina EM, Zachariah JP, Zaidi AN. Cardiovascular Risk Reduction in High-Risk Pediatric Patients: A Scientific Statement From the American Heart Association. Circulation 2019; 139:e603-e634. [PMID: 30798614 DOI: 10.1161/cir.0000000000000618] [Citation(s) in RCA: 197] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This scientific statement presents considerations for clinical management regarding the assessment and risk reduction of select pediatric populations at high risk for premature cardiovascular disease, including acquired arteriosclerosis or atherosclerosis. For each topic, the evidence for accelerated acquired coronary artery disease and stroke in childhood and adolescence and the evidence for benefit of interventions in youth will be reviewed. Children and adolescents may be at higher risk for cardiovascular disease because of significant atherosclerotic or arteriosclerotic risk factors, high-risk conditions that promote atherosclerosis, or coronary artery or other cardiac or vascular abnormalities that make the individual more vulnerable to the adverse effects of traditional cardiovascular risk factors. Existing scientific statements and guidelines will be referenced when applicable, and suggestions for risk identification and reduction specific to each setting will be described. This statement is directed toward pediatric cardiologists, primary care providers, and subspecialists who provide clinical care for these young patients. The focus will be on management and justification for management, minimizing information on pathophysiology and epidemiology.
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29
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Koskinen J, Juonala M, Dwyer T, Venn A, Petkeviciene J, Čeponienė I, Bazzano L, Chen W, Sabin MA, Burns TL, Viikari JSA, Woo JG, Urbina EM, Prineas R, Hutri-Kähönen N, Sinaiko A, Jacobs DR, Steinberger J, Daniels S, Raitakari O, Magnussen CG. Utility of Different Blood Pressure Measurement Components in Childhood to Predict Adult Carotid Intima-Media Thickness. Hypertension 2019; 73:335-341. [PMID: 30580683 DOI: 10.1161/hypertensionaha.118.12225] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Childhood blood pressure (BP) levels predict adult subclinical atherosclerosis. However, the best childhood BP component for prediction has not been determined. This study comprised 5925 participants aged 3 to 18 years from 6 cohorts who were followed into adulthood (mean follow-up 25.8±6.2 years). Childhood BP was measured by using a standard mercury sphygmomanometer in all cohorts. Study-specific carotid intima-media thickness ≥90th percentile was used to define subclinical atherosclerosis. Per SD change in the predictor, childhood systolic BP (SBP; age- and sex-adjusted odds ratio [95% CI], 1.24 [1.13-1.37]), mean arterial pressure (1.10 [1.07-1.13]), and pulse pressure (1.15 [1.05-1.27]) were associated with increased adulthood intima-media thickness. In age- and sex-adjusted analyses, area under the receiver operating characteristic curves for SBP ( C value [95% CI], 0.677 [0.657-0.704]) showed significantly improved prediction compared with diastolic BP (0.669 [0.646-0.693], P=0.006) or mean arterial pressure (0.674 [0.653-0.699], P=0.01). Pulse pressure provided a C value that was not different from SBP (0.676 [0.653-0.699], P=0.16). Combining different BP components did not improve prediction over SBP measurement alone. Based on the associations with adult carotid intima-media thickness, cut points for elevated SBP were 105 mm Hg for 3- to 6-year-old boys, 108 mm Hg for 3- to 6-year-old girls, 108 mm Hg for 7- to 12-year-old boys, 106 mm Hg for 7- to 12-year-old girls, 123 mm Hg for 13- to 18-year-old boys, and 115 mm Hg for 13- to 18-year-old girls. Our analyses suggest that several childhood BP measurement components are related to adulthood carotid intima-media thickness. Of these, SBP provided the best predictive ability.
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Affiliation(s)
- Juha Koskinen
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (J.K., O.R., C.G.M.), University of Turku, Finland.,Heart Center, Kymenlaakso Central Hospital, Kotka, Finland (J.K.)
| | - Markus Juonala
- Department of Medicine (M.J., J.S.A.V.), University of Turku, Finland.,Division of Medicine (M.J., J.S.A.V.), Turku University Hospital, Finland.,Murdoch Childrens Research Institute, Parkville, Victoria, Australia (M.J.)
| | - Terence Dwyer
- George Institute, University of Oxford, United Kingdom (T.D.)
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (A.V., C.G.M.)
| | - Janina Petkeviciene
- Faculty of Public Health, Medical Academy (J.P.), Lithuanian University of Health Sciences, Kaunas
| | - Indrė Čeponienė
- Department of Cardiology, Medical Academy (I.C.), Lithuanian University of Health Sciences, Kaunas
| | - Lydia Bazzano
- Department of Epidemiology and Department Biostatistics and Bioinformatics, Tulane University Health Sciences Center (L.B.), Tulane University, New Orleans, LA
| | - Wei Chen
- Department of Epidemiology, Tulane Center for Cardiovascular Health (W.C.), Tulane University, New Orleans, LA
| | - Matthew A Sabin
- Royal Children's Hospital, Parkville, Australia (M.A.S.).,Department of Pediatrics, University of Melbourne, Parkville, Australia (M.A.S.)
| | - Trudy L Burns
- Department of Epidemiology, College of Public Health, University of Iowa (T.L.B.)
| | - Jorma S A Viikari
- Department of Medicine (M.J., J.S.A.V.), University of Turku, Finland.,Division of Medicine (M.J., J.S.A.V.), Turku University Hospital, Finland
| | - Jessica G Woo
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH (J.G.W.)
| | - Elaine M Urbina
- The Heart Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH (E.M.U.)
| | - Ronald Prineas
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (R.P.)
| | - Nina Hutri-Kähönen
- Department of Pediatrics, University of Tampere School of Medicine and Tampere University Hospital, Finland (N.H.-K.)
| | - Alan Sinaiko
- Department of Pediatrics (A.S.), University of Minnesota, Minneapolis
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health (D.R.J.), University of Minnesota, Minneapolis
| | - Julia Steinberger
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital (J.S.)
| | - Stephen Daniels
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (S.D.)
| | - Olli Raitakari
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (J.K., O.R., C.G.M.), University of Turku, Finland.,Department of Clinical Physiology and Nuclear Medicine, University of Turku (O.R.), Turku University Hospital, Finland
| | - Costan G Magnussen
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (J.K., O.R., C.G.M.), University of Turku, Finland.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (A.V., C.G.M.)
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30
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Urbina EM, Khoury PR, Bazzano L, Burns TL, Daniels S, Dwyer T, Hu T, Jacobs DR, Juonala M, Prineas R, Raitakari O, Steinberger J, Venn A, Woo JG, Sinaiko A. Relation of Blood Pressure in Childhood to Self-Reported Hypertension in Adulthood. Hypertension 2019; 73:1224-1230. [PMID: 31067199 DOI: 10.1161/hypertensionaha.118.12334] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Blood pressure (BP) tracking (maintaining a BP percentile) across life is not well defined but is important in predicting which children will become hypertensive adults. We computed BP tracking in subjects with BP measured in childhood and adulthood and performed logistic regression to determine the ability of childhood BP to predict adult hypertension (N=5035, 46.7 years, 74.2% white, 17.7% black; 39.6% male). Prevalence of hypertension was 29%. Correlations between systolic BP for child and adolescent were r=0.48; for adolescent and young adult were r=0.40, and for child and young adult were r=0.24 (all P<0.0001). Participants self-reporting adult hypertension were less likely to be white (38.7% black, 27.6% white, 20.9% other; P<0.0001) and female (26.4% females, 32.9% male, P<0.0001). Participants with adult hypertension were more likely to have higher BP and adiposity by age 10 years and abnormal lipids and glucose by age 16 years. There was a graded increase in the frequency of self-reported adult hypertension across the BP change groups, even within the persistently normotensive group (X2<0.0001) from 19% in children with a systolic BP% persistently below the median to 80% for individuals with elevated BP in both childhood and adolescence. Although our precision to predict which individual child is at risk of adult BP-related cardiovascular disease is weak, an increase in systolic BP and body mass index percentile from childhood to adolescence should signal a need for lifestyle intervention to prevent future sustained hypertension-related cardiovascular disease.
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Affiliation(s)
- Elaine M Urbina
- From the Heart Institute, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics (E.M.U., P.R.K.), University of Cincinnati College of Medicine, OH
| | - Philip R Khoury
- From the Heart Institute, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics (E.M.U., P.R.K.), University of Cincinnati College of Medicine, OH
| | | | - Trudy L Burns
- Department of Epidemiology, College of Public Health, University of Iowa (T.L.B.)
| | - Stephen Daniels
- Department of Pediatrics, University of Colorado School of Medicine, Aurora (S.D.)
| | | | - Tian Hu
- Division of Epidemiology and Community Health, School of Public Health (T.H., D.R.J.), University of Minnesota, Minneapolis
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health (T.H., D.R.J.), University of Minnesota, Minneapolis
| | - Markus Juonala
- Department of Internal Medicine (M.J.), University of Turku, Finland.,Division of Medicine (M.J.), Turku University Hospital, Finland.,Murdoch Children's Research Institute, Parkville, Victoria, Australia (M.J.)
| | - Ronald Prineas
- Division of Public Health Sciences, Wake Forest University School of Medicin-Winston Salem, NC (R.P.)
| | - Olli Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine (O.R.), University of Turku, Finland.,Department of Clinical Physiology and Nuclear Medicine (O.R.), Turku University Hospital, Finland
| | - Julia Steinberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical School (J.S.), University of Minnesota, Minneapolis
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (A.V.)
| | - Jessica G Woo
- Division of Biostatistics and Epidemiology Children's Hospital Medical Center, and Department of Pediatrics (J.G.W.), University of Cincinnati College of Medicine, OH
| | - Alan Sinaiko
- Division of Nephrology (A.S.), University of Minnesota Medical School, Minneapolis
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Dwyer T, Viikari J, Sinaiko A, Burns T, Daniels S, Juonala M, Woo J, Urbina E, Steinberger J, Hu T, Raitakari O. In Memoriam for Gerald Berenson. Hypertension 2019; 73:936-937. [PMID: 30969859 DOI: 10.1161/hypertensionaha.119.12474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Terence Dwyer
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| | - Jorma Viikari
- Department of Medicine, University of Turku, Turku, Finland
| | - Alan Sinaiko
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| | - Trudy Burns
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
| | - Stephen Daniels
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland
| | - Jessica Woo
- University of Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Elaine Urbina
- University of Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Julia Steinberger
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| | - Tian Hu
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Olli Raitakari
- Centre for Population Health Research, University of Turku and Turku University Hospital, Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland, the i3C Research Group
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Kartiosuo N, Ramakrishnan R, Lemeshow S, Juonala M, Burns TL, Woo JG, Jacobs DR, Daniels SR, Venn A, Steinberger J, Urbina EM, Bazzano L, Sabin MA, Hu T, Prineas RJ, Sinaiko AR, Pahkala K, Raitakari O, Dwyer T. Predicting overweight and obesity in young adulthood from childhood body-mass index: comparison of cutoffs derived from longitudinal and cross-sectional data. The Lancet Child & Adolescent Health 2019; 3:795-802. [DOI: 10.1016/s2352-4642(19)30204-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/29/2019] [Accepted: 06/07/2019] [Indexed: 10/26/2022]
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Ryder JR, Jacobs DR, Sinaiko AR, Kornblum AP, Steinberger J. Longitudinal Changes in Weight Status from Childhood and Adolescence to Adulthood. J Pediatr 2019; 214:187-192.e2. [PMID: 31493910 DOI: 10.1016/j.jpeds.2019.07.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 06/13/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To study the change in body mass index (BMI) from childhood and adolescence and development of obesity into adulthood. STUDY DESIGN We performed a longitudinal study of 480 individuals (49% male; 67% white) with height and weight measures in childhood (mean age 7 years), repeated in adolescence (mean age 16 years) and adulthood (mean age 39 years). Weight status in childhood was defined as low normal weight (0-<50 BMI percentile); high normal weight (50-<85 BMI percentile); overweight (85-<95 BMI percentile); obese (≥95 BMI percentile). Adult weight status was defined as normal weight (18.5-<25 kg/m2); overweight (25-<30 kg/m2); obese (>30 kg/m2). RESULTS Adult obesity (%) increased with weight status in childhood (low normal weight 17%; high normal weight 40%; overweight 59%; obesity 85%) and similarly with adolescence. Children in a lower category in adolescence than in childhood had lower risk of having adult obesity than did those who maintained their childhood category. Among adults with obesity, 59% (111 out of 187) were normal weight as children, with 75% (83 out of 111) from the high normal weight children; and 50% of adults with obesity were normal weight (n = 94/187) as adolescents, with 84% (81 out of 94) from the high normal weight adolescents. Only 6% of 143 normal weight adults had either overweight (n = 9) or obesity (n = 0) during childhood. CONCLUSIONS This study shows the high risk for adult obesity in children and adolescents who have overweight or obesity. A majority of adults with obesity had a 50-85 BMI percentile as children. Those who did not move to higher weight status between childhood and adolescence had lower probability of adult obesity.
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Affiliation(s)
- Justin R Ryder
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN; Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, MN.
| | - David R Jacobs
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Alan R Sinaiko
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| | - Annabel P Kornblum
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| | - Julia Steinberger
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
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Yan Y, Bazzano LA, Juonala M, Raitakari OT, Viikari JSA, Prineas R, Dwyer T, Sinaiko A, Burns TL, Daniels SR, Woo JG, Khoury PR, Urbina EM, Jacobs DR, Hu T, Steinberger J, Venn A, Chen W. Long-Term Burden of Increased Body Mass Index from Childhood on Adult Dyslipidemia: The i3C Consortium Study. J Clin Med 2019; 8:jcm8101725. [PMID: 31635325 PMCID: PMC6832308 DOI: 10.3390/jcm8101725] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/08/2019] [Accepted: 10/15/2019] [Indexed: 02/07/2023] Open
Abstract
Background: Data are limited regarding the association of cumulative burden and trajectory of body mass index (BMI) from early life with adult lipid disorders. Methods: The study cohort consisted of 5195 adults who had BMI repeatedly measured 4 to 21 times from childhood and had blood lipid measurements of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) and information on lipid-lowering medications in the last adult survey. The area under the curve (AUC) was calculated as a measure of long-term burden (total AUC) and trends (incremental AUC) of BMI. Results: Participants with dyslipidemia, high LDL-C, low HDL-C and high TG had consistently and significantly higher BMI levels from childhood to adulthood compared to those with normal lipid levels. After adjusting for age, race, sex, and cohort, increased risk of adult dyslipidemia was significantly associated with higher values of childhood BMI, adulthood BMI, total AUC and incremental AUC, with odds ratio (95% confidence interval) = 1.22 (1.15–1.29), 1.85 (1.74–1.97), 1.61 (1.52–1.71), and 1.59 (1.50–1.69), respectively, and p < 0.001 for all. The association patterns were similar in most race–sex subgroups. Conclusions: Adults with dyslipidemia versus normal lipid levels have consistently higher levels and distinct life-course trajectories of BMI, suggesting that the impact of excessive body weight on dyslipidemia originates in early life.
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Affiliation(s)
- Yinkun Yan
- Department of Epidemiology, School of Public Health & Tropical Medicine, Tulane University, New Orleans, LA 70112, USA.
| | - Lydia A Bazzano
- Department of Epidemiology, School of Public Health & Tropical Medicine, Tulane University, New Orleans, LA 70112, USA.
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku 20500, Finland.
- Division of Medicine, Turku University Hospital, Turku 20521, Finland.
- Murdoch Children's Research Institute, Parkville, Victoria 3052, Australia.
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku FI-20520, Finland.
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku 20521, Finland.
| | - Jorma S A Viikari
- Department of Medicine, University of Turku, Turku 20500, Finland.
- Division of Medicine, Turku University Hospital, Turku 20521, Finland.
| | - Ronald Prineas
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA.
| | - Terence Dwyer
- George Institute, University of Oxford, Oxford OX1 2BQ, UK.
| | - Alan Sinaiko
- Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Trudy L Burns
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA 52246, USA.
| | - Stephen R Daniels
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA.
| | - Jessica G Woo
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA.
| | - Philip R Khoury
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA.
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
| | - Elaine M Urbina
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA.
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Tian Hu
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Julia Steinberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart TAS 7000, Australia.
| | - Wei Chen
- Department of Epidemiology, School of Public Health & Tropical Medicine, Tulane University, New Orleans, LA 70112, USA.
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Dwyer T, Jacobs DR, Woo JG, Urbina EM, Bazzano L, Juonala M, Viikari JS, Chen W, Prineas RJ, Steinberger J, Daniels S, Sinaiko A, Venn A, Burns T, Raitakari OT. 1447Childhood risk factors and cardiovascular disease outcomes in adulthood. Preliminary findings from the International Childhood Cardiovascular Cohort (i3C) Consortium. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atherosclerosis develops decades before clinical cardiovascular disease (cCVD) occurs. Longitudinally, childhood risk factors predict adult pre-clinical atherosclerosis. There is currently no evidence directly linking childhood risk factors to cCVD.
Purpose
To provide the first direct evidence of any association between known risk factors for CVD when measured in childhood and adult CVD incidence and death.
Methods
Using i3C Consortium data, we linked childhood risk factors to adult cCVD. cCVD events were ascertained by participant re-contact in the US and Australia, medically adjudicated hospital records; and using the Finnish national health registry. Of 16,964 adult participants (mean age 49 years) examined during ages 3–19, 201 people with any cCVD event (70% coronary artery, 25% cerebrovascular, and 5% peripheral artery disease) have been determined. The analysis included Cox proportional hazard models. Each model was adjusted for childhood age, age at followup, sex and cohort/race. Continuous childhood variables were z-scored for each participant's last repeated measure during childhood.
Results
Childhood body mass index (BMI), serum total cholesterol (TC) and triglycerides, and systolic blood pressure were positively associated with adult cCVD events (P<0.0001). Smoking in childhood was associated with nearly 50% increased risk of adult cCVD (P=0.08). BMI; TC remained significant in the simultaneous risk factor model. The adjudication pipeline suggests that over 500 hospitalized cCVD events will be found on completion. Regression using the full set of imputed events yielded similar findings. Analysis of deaths is in process.
Childhood risk factor link to adult CVD Childhood risk variable Single risk factors models Simultaneous risk factor model n cCVD events/N at risk Hazard ratio (95% Confidence limits) p n cCVD events/N at risk Hazard ratio (95% Confidence limits) p Body Mass Index 201/16964 1.52 (1.33–1.73) <0.0001 142/11124 1.37 (1.14–1.64) 0.0008 Total cholesterol 191/13778 1.32 (1.14–1.52) 0.0001 " 1.21 (1.02–1.43) 0.03 Triglycerides 191/13654 1.17 (1.04–1.33) 0.01 " 1.04 (0.88–1.24) 0.6 Systolic blood pressure 190/14883 1.28 (1.11–1.48) 0.0007 " 1.18 (0.99–1.42) 0.07 Regular smoking ≥1/day 151/13436 1.44 (0.96–2.16) 0.08 " 1.43 (0.94–2.17) 0.10 Hazard ratios = increased risk per one standard deviation increase in continuous risk variables. E.g. every ∼0.9 mmol/L or ∼33 mg/dL increase in childhood total cholesterol is associated with a ∼32% and 21% increase in adult CVD risk in single and simultaneous risk factor models respectively. “Simultaneous risk factor model” recognizes that the risk factors are causally connected.
Conclusion
Childhood CVD risk factors predicts adult cCVD with implications for primordial CVD prevention.
Acknowledgement/Funding
National Heart, Lung, and Blood Institute (NHLBI)
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Affiliation(s)
- T Dwyer
- University of Oxford, The George Institute for Global Health, Nuffield Department of Women's & Reproductive Health, Oxford, United Kingdom
| | - D R Jacobs
- University of Minnesota, Minneapolis, United States of America
| | - J G Woo
- Cincinnati Children's Hospital Medical Center, Cincinnati, United States of America
| | - E M Urbina
- Cincinnati Children's Hospital Medical Center, Cincinnati, United States of America
| | - L Bazzano
- Tulane University, New Orleans, United States of America
| | | | | | - W Chen
- Tulane University, New Orleans, United States of America
| | - R J Prineas
- Wake Forest University, Winston-Salem, United States of America
| | - J Steinberger
- University of Minnesota, Minneapolis, United States of America
| | - S Daniels
- Children's Hospital Colorado, Aurora, United States of America
| | - A Sinaiko
- University of Minnesota, Minneapolis, United States of America
| | - A Venn
- University of Tasmania, Hobart, Australia
| | - T Burns
- University of Iowa, Iowa City, United States of America
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Daniels SR, Pratt CA, Hollister EB, Labarthe D, Cohen DA, Walker JR, Beech BM, Balagopal PB, Beebe DW, Gillman MW, Goodrich JM, Jaquish C, Kit B, Miller AL, Olds D, Oken E, Rajakumar K, Sherwood NE, Spruijt-Metz D, Steinberger J, Suglia SF, Teitelbaum SL, Urbina EM, Van Horn L, Ward D, Young ME. Promoting Cardiovascular Health in Early Childhood and Transitions in Childhood through Adolescence: A Workshop Report. J Pediatr 2019; 209:240-251.e1. [PMID: 30904171 DOI: 10.1016/j.jpeds.2019.01.042] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/08/2019] [Accepted: 01/23/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Stephen R Daniels
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Charlotte A Pratt
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, MD.
| | - Emily B Hollister
- Department of Information Technology & Analytics, Diversigen, Inc, Houston, TX
| | - Darwin Labarthe
- Department of Preventive Medicine, Northwestern Feinberg School of Medicine, Chicago, IL
| | | | - Jenelle R Walker
- Center for Translation Research and Implementation Science, NHLBI, Bethesda, MD
| | - Bettina M Beech
- Department of Pediatrics and Family Medicine, University of Mississippi Medical Centre, Jackson, MS
| | - P Babu Balagopal
- Nemours Children's Clinic, Mayo Clinic College of Medicine, Rochester, MN
| | - Dean W Beebe
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Matthew W Gillman
- Office of the Director, National Institutes of Health (NIH), Bethesda, MD
| | - Jaclyn M Goodrich
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI
| | - Cashell Jaquish
- Division of Cardiovascular Sciences, NHLBI, NIH, Bethesda, MD
| | - Brian Kit
- Division of Cardiovascular Sciences, NHLBI, NIH, Bethesda, MD
| | - Alison L Miller
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI
| | - David Olds
- Prevention Research Center for Family and Child Health, University of Colorado, Denver, CO
| | - Emily Oken
- Department of Population Medicine, Harvard Pilgrim Health Care Inc, Wellesley, MA
| | - Kumaravel Rajakumar
- Division of General Academic Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Nancy E Sherwood
- School of Public Health, University of Minnesota, Minneapolis, MN
| | - Donna Spruijt-Metz
- Dornsife Center for Economic and Social Research, University of Southern California, Los Angeles, CA
| | | | - Shakira F Suglia
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
| | - Susan L Teitelbaum
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Elaine M Urbina
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern Feinberg School of Medicine, University, Chicago, IL
| | - Dianne Ward
- Department of Nutrition, University of North Carolina, Chapel Hill, NC
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Steinberger J. School screening for cardiovascular risk. J Pediatr 2019; 208:1-2. [PMID: 31027615 DOI: 10.1016/j.jpeds.2019.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Steinberger J. Preeclampsia and cardiovascular risk in offspring. J Pediatr 2019; 208:1-2. [PMID: 31027612 DOI: 10.1016/j.jpeds.2019.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Wurtmann E, Steinberger J, Veach PM, Khan M, Zierhut H. Risk Communication in Families of Children with Familial Hypercholesterolemia: Identifying Motivators and Barriers to Cascade Screening to Improve Diagnosis at a Single Medical Center. J Genet Couns 2018; 28:10.1007/s10897-018-0290-0. [PMID: 30109451 DOI: 10.1007/s10897-018-0290-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/02/2018] [Indexed: 11/25/2022]
Abstract
Familial hypercholesterolemia (FH) is severely underdiagnosed in the USA; yet, factors influencing family notification about risk for FH in the US pediatric setting have not been well elucidated. Most previous research on these factors has occurred in adult patient populations in European countries with organized cascade screening programs; therefore, we sought to characterize parent experiences with cascade screening in the US pediatric setting. A quantitative survey measuring family notification of FH risk information was administered to 38 parents of children with FH identified within a pediatric cardiology clinic. Participants were also asked if family notification was impacted by intrapersonal, interpersonal, institutional, community, and public policy factors identified previously in other populations. Notification of at least one of the proband's living grandparents or aunts/uncles was reported by 76% (n = 25/33) and 71% (n = 24/34) of participants, respectively. The most common reason for notification was to protect relatives from heart disease. Two of the most common reasons participants did not notify relatives were a lack of information about FH and concern that the relative would have difficulty understanding the information. Yet, only a minority of participants (39%) accessed institutional resources such as educational materials to share with relatives or assistance drafting a family letter that could address these barriers. Based on the identified barriers and motivators for family communication, we suggest facilitators to improve implementation of cascade screening.
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Affiliation(s)
- Elisabeth Wurtmann
- Department of Genetics, Cell Biology, and Development, University of Minnesota, 6-160 Jackson Hall, 321 Church St SE, Minneapolis, MN, 55455, USA
| | - Julia Steinberger
- Division of Cardiology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Pat McCarthy Veach
- Department of Genetics, Cell Biology, and Development, University of Minnesota, 6-160 Jackson Hall, 321 Church St SE, Minneapolis, MN, 55455, USA
| | - Mindi Khan
- Division of Cardiology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Heather Zierhut
- Department of Genetics, Cell Biology, and Development, University of Minnesota, 6-160 Jackson Hall, 321 Church St SE, Minneapolis, MN, 55455, USA.
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Dengel DR, Kelly AS, Zhang L, Wang Q, Hodges JS, Steinberger J, Baker KS. Vascular Structure and Function in Cancer Survivors after Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2018; 25:151-156. [PMID: 30103017 DOI: 10.1016/j.bbmt.2018.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 08/03/2018] [Indexed: 11/13/2022]
Abstract
This study examined the effects of hematopoietic cell transplantation (HCT) and associated preparative regimens on vascular structure and function. Measures of carotid artery stiffness and brachial artery endothelial-dependent dilation were obtained in patients who had survived ≥ 2 years after HCT for hematologic malignancy and were diagnosed at ≤21 years. HCT survivors (n = 108) were examined: 66 received total body irradiation (TBI) alone or with a low-dose cranial radiation boost (TBI±LD-CRT), 19 received TBI plus high-dose cranial radiation (TBI+HD-CRT), and 23 received a chemotherapy-only preparative regimen (CHEMO). Siblings (n = 83) were invited to participate as control subjects. Although endothelial-dependent dilation did not differ between siblings and HCT survivors, carotid cross-sectional compliance, cross-sectional distensibility, diameter compliance, and diameter distensibility were greater in siblings than HCT survivors. Comparing the HCT preparative regimens, carotid cross-sectional compliance, cross-sectional distensibility, diameter compliance, diameter distensibility, and incremental elastic modulus were significantly lower in the TBI+HD-CRT group compared with siblings or with TBI±LD-CRT and CHEMO treatment groups. Cross-sectional distensibility and diameter compliance were significantly lower in the TBI±LD-CRT group compared with siblings. TBI±LD-CRT and CHEMO groups did not differ from each other in these vascular measures. HCT preparative regimens containing TBI+HD-CRT resulted in greater arterial decrements, indicating increased risk for cardiovascular disease.
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Affiliation(s)
- Donald R Dengel
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota.
| | - Aaron S Kelly
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Lei Zhang
- Biostatistical Design and Analysis Center, Clinical and Translational Sciences Institute, University of Minnesota, Minneapolis, Minnesota
| | - Qi Wang
- Biostatistical Design and Analysis Center, Clinical and Translational Sciences Institute, University of Minnesota, Minneapolis, Minnesota
| | - James S Hodges
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Julia Steinberger
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - K Scott Baker
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Braunlin E, Steinberger J, DeFor T, Orchard P, Kelly AS. Metabolic Syndrome and Cardiovascular Risk Factors after Hematopoietic Cell Transplantation in Severe Mucopolysaccharidosis Type I (Hurler Syndrome). Biol Blood Marrow Transplant 2018; 24:1289-1293. [DOI: 10.1016/j.bbmt.2018.01.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 01/20/2018] [Indexed: 01/08/2023]
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Sinaiko AR, Jacobs DR, Woo JG, Bazzano L, Burns T, Hu T, Juonala M, Prineas R, Raitakari O, Steinberger J, Urbina E, Venn A, Jaquish C, Dwyer T. The International Childhood Cardiovascular Cohort (i3C) consortium outcomes study of childhood cardiovascular risk factors and adult cardiovascular morbidity and mortality: Design and recruitment. Contemp Clin Trials 2018; 69:55-64. [PMID: 29684544 DOI: 10.1016/j.cct.2018.04.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/09/2018] [Accepted: 04/18/2018] [Indexed: 12/29/2022]
Abstract
Although it is widely thought that childhood levels of cardiovascular (CV) risk factors are related to adult CV disease, longitudinal data directly linking the two are lacking. This paper describes the design and organization of the International Childhood Cardiovascular Cohort Consortium Outcomes Study (i3C Outcomes), the first longitudinal cohort study designed to locate adults with detailed, repeated, childhood biological, physical, and socioeconomic measurements and a harmonized database. I3C Outcomes uses a Heart Health Survey (HHS) to obtain information on adult CV endpoints, using mail, email, telephone, and clinic visits in the United States (U.S.) and Australia and a national health database in Finland. Microsoft Access, REsearch Data Capture (REDCap) (U.S.), LimeSurvey (Australia), and Medidata™ Rave data systems are used to collect, transfer and organize data. Self-reported CV events are adjudicated via hospital and doctor-released medical records. After the first two study years, participants (N = 10,968) were more likely to be female (56% vs. 48%), non-Hispanic white (90% vs. 80%), and older (10.4 ± 3.8 years vs. 9.4 ± 3.3 years) at their initial childhood study visit than the currently non-recruited cohort members. Over 48% of cohort members seen during both adulthood and childhood have been found and recruited, to date, vs. 5% of those not seen since childhood. Self-reported prevalences were 0.7% Type 1 Diabetes, 7.5% Type 2 Diabetes, 33% hypertension, and 12.8% CV event. 32% of CV events were judged to be true. I3C Outcomes is uniquely able to establish evidence-based guidelines for child health care and to clarify relations to adult CV disease.
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Affiliation(s)
- Alan R Sinaiko
- University of Minnesota Medical School, Department of Pediatrics, 2450 Riverside Avenue, East Building, MB689, Minneapolis, MN 55454, United States.
| | - David R Jacobs
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN, United States.
| | - Jessica G Woo
- University of Cincinnati Children's Hospital Medical Center, Department of Biostatistics and Epidemiology, Cincinnati, OH 45229, United States.
| | - Lydia Bazzano
- Tulane University, School of Public Health and Tropical Medicine, Department of Epidemiology, New Orleans, LA 70112, United States.
| | - Trudy Burns
- University of Iowa, College of Public Health, Department of Epidemiology, Iowa City, IA 52242, United States.
| | - Tian Hu
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN, United States.
| | - Markus Juonala
- University of Turku, Department of Medicine, Turku, Finland.
| | - Ronald Prineas
- Wake Forest School of Medicine, Division of Public Health, Winston Salem, NC, United States.
| | - Olli Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.
| | - Julia Steinberger
- University of Minnesota Medical School, Department of Pediatrics, Minneapolis, MN, United States.
| | - Elaine Urbina
- University of Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States.
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - Cashell Jaquish
- National Heart, Lung, and Blood Institute, National Institutes of Health, Washington D.C., United States.
| | - Terry Dwyer
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom.
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Harbin MM, Zavala H, Ryder JR, Steinberger J, Sinaiko AR, Jacobs DR, Dengel DR. Associations of sex, age and adiposity in endothelium-independent dilation in children. Physiol Meas 2018; 39:045002. [PMID: 29513264 PMCID: PMC5975258 DOI: 10.1088/1361-6579/aab4cf] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To examine the association of age, sex, and obesity status on endothelial-independent dilation (EID) among children and adolescents. STUDY DESIGN This study examined 264 children (143 males) between 8 to 18 years old (mean ± SD: age = 14.3 ± 2.7 years). Endothelial-independent dilation was assessed via ultrasound imaging of the brachial artery following administration of 0.3 milligrams of sublingual nitroglycerin. A one-way analysis of variance with Bonferroni post hoc comparisons assessed sex-differences in percent peak EID dilation (EID%-peak) and EID area under the curve (EID%-AUC), while analysis of covariance (ANCOVA) adjusted for race, age, body mass index percentile (BMI-percentile), and brachial artery diameter. Multiple linear regression evaluated the association of sex, age, BMI-percentile, percent body fat (%BF), and brachial artery diameter on EID. RESULTS Prior to adjustment, EID%-peak was significantly higher among females than males (mean ± SE: 26.9 ± 0.5% versus 22.9 ± 0.6%, p < 0.001, respectively); similar findings for EID%-AUC (4214% ± 105%·s versus 3398% ± 97%·s, p < 0.001) were observed. After adjusting for covariates, EID%-AUC remained consistent (p = 0.03) while EID%-peak was not significantly different between sexes (p = 0.21). EID%-peak was significantly higher among normal weight compared to obese participants (p = 0.04), while no differences were observed between obesity status after adjustment for brachial artery diameter (p = 0.64). Both unadjusted (p = 0.16) and adjusted EID%-AUC (p = 0.24) was not significantly different between obesity status. BMI-percentile was not associated with EID%-peak (p = 0.76) or EID%-AUC (p = 0.30). Additionally, %BF was not associated with EID%-peak (p = 0.56) or EID%-AUC (p = 0.15). After adjusting for brachial artery diameter, BMI-percentile, and age, males had lower EID%-AUC (p = 0.03) and lower but not significant EID%-peak (p = 0.21). SIGNIFICANCE Vascular smooth muscle function was significantly lower among male children and adolescents, which is suggestive that impaired EID and increased cardiovascular disease risk among males may begin in childhood. Interestingly, obesity status and BMI-percentile was not associated with EID in children and adolescents after adjusting for brachial artery diameter.
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Affiliation(s)
- Michelle M. Harbin
- Laboratory of Integrative Human Physiology, School of Kinesiology, University of Minnesota, Minneapolis, Minnesota, 55455
| | - Hanan Zavala
- Laboratory of Integrative Human Physiology, School of Kinesiology, University of Minnesota, Minneapolis, Minnesota, 55455
| | - Justin R. Ryder
- Department of Pediatrics, University of Minnesota Medical School, 2450 Riverside Avenue, Minneapolis, MN 55455, USA
| | - Julia Steinberger
- Department of Pediatrics, University of Minnesota Medical School, 2450 Riverside Avenue, Minneapolis, MN 55455, USA
| | - Alan R. Sinaiko
- Department of Pediatrics, University of Minnesota Medical School, 2450 Riverside Avenue, Minneapolis, MN 55455, USA
| | - David R. Jacobs
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, 1300 South Second St, Minneapolis, MN 55454, USA
| | - Donald R. Dengel
- Laboratory of Integrative Human Physiology, School of Kinesiology, University of Minnesota, Minneapolis, Minnesota, 55455
- Department of Pediatrics, University of Minnesota Medical School, 2450 Riverside Avenue, Minneapolis, MN 55455, USA
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Ketterl TG, Chow EJ, Leisenring WM, Goodman P, Koves IH, Petryk A, Steinberger J, Baker KS. Adipokines, Inflammation, and Adiposity in Hematopoietic Cell Transplantation Survivors. Biol Blood Marrow Transplant 2018; 24:622-626. [PMID: 29197678 PMCID: PMC5831197 DOI: 10.1016/j.bbmt.2017.11.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 11/22/2017] [Indexed: 12/15/2022]
Abstract
Adult survivors of acute leukemia in childhood have a higher-than-expected frequency of obesity and are at increased risk for metabolic syndrome and early mortality from cardiovascular disease (CVD). Adipose tissue has been recognized as an endocrine and paracrine organ that secretes various adipokines involved in metabolic regulation and inflammatory processes. In this study, we examined inflammatory factors (IL-6 and TNF-α) and adipokines (adiponectin, leptin), in addition to body composition and adiposity, in cancer survivors who underwent hematopoietic cell transplantation (HCT) during childhood compared with sibling controls. Over 2-year survivors of HCT for hematologic malignancies during childhood were recruited from 2 institutions along with a control population of siblings. Participants underwent evaluation for body composition, anthropometric measurements, and assessment of CVD risk factors and adipokines. Cases were stratified by radiation exposure in the preparative regimen (total body irradiation [TBI] + central nervous system [CNS] irradiation, TBI only, chemotherapy only) and adjusted least squares means were estimated for each adipokine and adjusted by age, sex, race, Tanner stage, and percent fat mass (PFM) percentiles (0-24, 25-74, 75+). A total of 151 HCT survivors and 92 siblings underwent evaluation. Significant differences in mean adipokine levels were detected between survivors and siblings; leptin was significantly higher and adiponectin significantly lower in HCT survivors who received TBI with or without CNS irradiation compared with siblings. IL-6 was significantly higher in all groups of HCT survivors compared with siblings. Body mass index (BMI) was similar in survivors and controls, although PFM was significantly higher in all groups of HCT survivors and lean body mass (LBM) was lower in survivors who received TBI with or without CNS radiation compared with siblings. HCT survivors showed an unfavorable profile of inflammation, adipokines, and adiposity, despite similar BMI as controls. Higher PFM and lower LBM may contribute to these findings. TBI exposure is correlated with greater severity of these observations. Increasing LBM may represent a tangible target for mitigating the high cardiometabolic risks of HCT survivors.
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Affiliation(s)
- Tyler G Ketterl
- Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Eric J Chow
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Pam Goodman
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ildi H Koves
- Seattle Children's Hospital, Seattle, Washington
| | - Anna Petryk
- University of Minnesota Medical Center, Minneapolis, Minnesota
| | | | - K Scott Baker
- Fred Hutchinson Cancer Research Center, Seattle, Washington
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Gooty VD, Sinaiko AR, Ryder JR, Dengel DR, Jacobs DR, Steinberger J. Association Between Carotid Intima Media Thickness, Age, and Cardiovascular Risk Factors in Children and Adolescents. Metab Syndr Relat Disord 2018; 16:122-126. [PMID: 29412763 DOI: 10.1089/met.2017.0149] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Measures of carotid intima media thickness (cIMT) in adults are correlated with adiposity and the metabolic syndrome (MetS) and predict cardiovascular (CV) events. Relations in children are not as well studied. Our objective was to determine the relations of cIMT with body mass index (BMI) and CV risk score in children. METHODS The study included 291 children (158 M/133 F) 6-18 years of age (140 aged 6-11/151 aged 12-18) with measurements of height, weight, waist circumference; fasting lipids, glucose, insulin, and cIMT. A CV risk cluster score was developed from sum of the z-scores of the five MetS components (waist circumference, blood pressure, serum triglycerides, high-density lipoprotein cholesterol, and insulin). Partial Pearson correlation coefficients were adjusted for age, sex, and race. RESULTS There was no significant age difference in cIMT from 6 to 18 years of age. BMI and CV risk score were significantly correlated (P < 0.0001), and both were correlated with cIMT (r = 0.14, P = 0.02 and r = 0.16, P = 0.006, respectively). Slight age-related differences in associations of cIMT with CV risk score and BMI were explained by unusual values in a few children. CONCLUSIONS These cross-sectional data in normal children show that cIMT was stable from childhood into adolescence. However, both BMI and CV risk score had small, but significant positive correlations with cIMT. Therefore, maintaining normal levels of adiposity and other risk variables may be useful in preventing early changes associated with preclinical atherosclerosis.
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Affiliation(s)
- Vasu D Gooty
- 1 Department of Pediatrics, University of Minnesota Medical School , Minneapolis, Minnesota
| | - Alan R Sinaiko
- 1 Department of Pediatrics, University of Minnesota Medical School , Minneapolis, Minnesota
| | - Justin R Ryder
- 1 Department of Pediatrics, University of Minnesota Medical School , Minneapolis, Minnesota
| | - Donald R Dengel
- 2 Laboratory of Integrative Human Physiology, School of Kinesiology, University of Minnesota , Minneapolis, Minnesota
| | - David R Jacobs
- 3 Division of Epidemiology and Community Health, School of Public Health, University of Minnesota , Minneapolis, Minnesota
| | - Julia Steinberger
- 1 Department of Pediatrics, University of Minnesota Medical School , Minneapolis, Minnesota
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Koskinen J, Juonala M, Dwyer T, Venn A, Thomson R, Bazzano L, Berenson GS, Sabin MA, Burns TL, Viikari JSA, Woo JG, Urbina EM, Prineas R, Hutri-Kähönen N, Sinaiko A, Jacobs D, Steinberger J, Daniels S, Raitakari OT, Magnussen CG. Impact of Lipid Measurements in Youth in Addition to Conventional Clinic-Based Risk Factors on Predicting Preclinical Atherosclerosis in Adulthood: International Childhood Cardiovascular Cohort Consortium. Circulation 2017; 137:1246-1255. [PMID: 29170152 DOI: 10.1161/circulationaha.117.029726] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 11/03/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Data suggest that the prediction of adult cardiovascular disease using a model comprised entirely of adult nonlaboratory-based risk factors is equivalent to an approach that additionally incorporates adult lipid measures. We assessed and compared the utility of a risk model based solely on nonlaboratory risk factors in adolescence versus a lipid model based on nonlaboratory risk factors plus lipids for predicting high-risk carotid intima-media thickness (cIMT) in adulthood. METHODS The study comprised 2893 participants 12 to 18 years of age from 4 longitudinal cohort studies from the United States (Bogalusa Heart Study and the Insulin Study), Australia (Childhood Determinants of Adult Health Study), and Finland (The Cardiovascular Risk in Young Finns Study) and followed into adulthood when cIMT was measured (mean follow-up, 23.4 years). Overweight status was defined according to the Cole classification. Hypertension was defined according to the Fourth Report on High Blood Pressure in Children and Adolescents from the National High Blood Pressure Education Program. High-risk plasma lipid levels were defined according to the National Cholesterol Education Program Expert Panel on Cholesterol Levels in Children. High cIMT was defined as a study-specific value ≥90th percentile. Age and sex were included in each model. RESULTS In univariate models, all risk factors except for borderline high and high triglycerides in adolescence were associated with high cIMT in adulthood. In multivariable models (relative risk [95% confidence interval]), male sex (2.7 [2.0-2.6]), prehypertension (1.4 [1.0-1.9]), hypertension (1.9 [1.3-2.9]), overweight (2.0 [1.4-2.9]), obesity (3.7 [2.0-7.0]), borderline high low-density lipoprotein cholesterol (1.6 [1.2-2.2]), high low-density lipoprotein cholesterol (1.6 [1.1-2.1]), and borderline low high-density lipoprotein cholesterol (1.4 [1.0-1.8]) remained significant predictors of high cIMT (P<0.05). The addition of lipids into the nonlaboratory risk model slightly but significantly improved discrimination in predicting high cIMT compared with nonlaboratory-based risk factors only (C statistics for laboratory-based model 0.717 [95% confidence interval, 0.685-0.748] and for nonlaboratory 0.698 [95% confidence interval, 0.667-0.731]; P=0.02). CONCLUSIONS Nonlaboratory-based risk factors and lipids measured in adolescence independently predicted preclinical atherosclerosis in young adulthood. The addition of lipid measurements to traditional clinic-based risk factor assessment provided a statistically significant but clinically modest improvement on adolescent prediction of high cIMT in adulthood.
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Affiliation(s)
- Juha Koskinen
- Research Center of Applied and Preventive Cardiovascular Medicine (J.K., O.T.R., C.G.M.) .,Heart Center (J.K.)
| | - Markus Juonala
- Department of Medicine (M.J., J.S.A.V.), University of Turku, Finland.,Division of Medicine (M.J., J.S.A.V.)
| | - Terence Dwyer
- George Institute, University of Oxford, United Kingdom (T.D.).,Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (T.D., A.V., C.G.M.)
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (T.D., A.V., C.G.M.)
| | - Russell Thomson
- Centre for Research in Mathematics, School of Computing, Engineering and Mathematics, Western Sydney University, Australia (R.T.)
| | - Lydia Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (L.B., G.S.B.)
| | - Gerald S Berenson
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (L.B., G.S.B.)
| | - Matthew A Sabin
- Murdoch Children's Research Institute, The Royal Children's Hospital and University of Melbourne, Australia (M.A.S.)
| | - Trudy L Burns
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (T.L.B.)
| | - Jorma S A Viikari
- Department of Medicine (M.J., J.S.A.V.), University of Turku, Finland.,Division of Medicine (M.J., J.S.A.V.)
| | - Jessica G Woo
- Department of Pediatrics, Division of Biostatistics and Epidemiology (J.G.W.).,Department of Medicine, University of Cincinnati, OH (J.G.W.)
| | - Elaine M Urbina
- Department of Pediatrics, Division of Cardiology (E.M.U.), Cincinnati Children's Hospital Medical Center and University of Cincinnati, OH
| | - Ronald Prineas
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (R.P.)
| | - Nina Hutri-Kähönen
- Department of Pediatrics, University of Tampere School of Medicine and Tampere University Hospital, Finland (N.H.-K.)
| | | | - David Jacobs
- Division of Epidemiology and Community Health (D.J.), University of Minnesota, Minneapolis
| | | | - Stephen Daniels
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora (S.D.)
| | - Olli T Raitakari
- Research Center of Applied and Preventive Cardiovascular Medicine (J.K., O.T.R., C.G.M.).,Department of Clinical Physiology (O.T.R.), Turku University Hospital, Finland
| | - Costan G Magnussen
- Research Center of Applied and Preventive Cardiovascular Medicine (J.K., O.T.R., C.G.M.).,Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (T.D., A.V., C.G.M.)
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47
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Steinberger J. Alkaline phosphatase and infant cardiopulmonary bypass. J Pediatr 2017; 190:3-4. [PMID: 29144266 DOI: 10.1016/j.jpeds.2017.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Urbina EM, Bazzano L, Burns T, Dwyer T, Jacobs D, Juonala M, Prineas R, Raitakari O, Sinaiko A, Steinberger J, Venn A, Woo J. Abstract 126: Blood Pressure in Childhood Predicts HTN in Adulthood: The International CV Cohorts Consortium. Hypertension 2017. [DOI: 10.1161/hyp.70.suppl_1.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The natural history of blood pressure (BP) tracking from childhood to adulthood is not well defined. Using data from the International Childhood CV Cohorts Consortium, consisting of 7 international longitudinal cohorts, participants (N=5042) were evaluated by self-reported adult hypertension (HTN). Correlation between mean of all measures of BP on a subject during childhood (8-11 years) or adolescence (15-18 years) and adult BP (28-31 years) was evaluated with Spearman correlation coefficients. Differences in mean BP, body mass index (BMI) and laboratory values were evaluated by t-tests. Participants at time of self-report of HTN were mean age 48.5 years (81.7% white, 17.4% black; 39% male). Prevalence of HTN (N=1562) was 31%; 3480 were normotensive (NT). Correlations between child and adolescent SBP and DBP were r=0.43, 0.42, respectively, child and young adult r=0.24, 0.23 and adolescent and young adult r=0.41, 0.27 (all p<0.0001). Participants self-reporting HTN were more likely to be non-white (46.8% black, 30.2% white, 29.7% other, p<0.0001). Males were more likely to report HTN (33% vs 28% females, p<0.0001). They had significantly higher SBP and BMI as children and adolescents and also significantly higher DBP and fasting glucose by adolescence and lower HDL and higher TG by young adulthood (all p<0.01). We conclude that adult HTN begins in childhood with higher BP and BMI which appear to be important clinical markers for progressive increases in metabolic risk factors as these individuals age through adolescence and young adulthood.
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Marlatt KL, Steinberger J, Rudser KD, Dengel DR, Sadak KT, Lee JL, Blaes AH, Duprez DA, Perkins JL, Ross JA, Kelly AS. The Effect of Atorvastatin on Vascular Function and Structure in Young Adult Survivors of Childhood Cancer: A Randomized, Placebo-Controlled Pilot Clinical Trial. J Adolesc Young Adult Oncol 2017; 8:442-450. [PMID: 28853979 DOI: 10.1089/jayao.2017.0075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Purpose: Many adult survivors of childhood cancer are at high-risk of developing cardiovascular disease. Cancer therapy may cause damage to the vascular endothelium, thereby initiating atherosclerosis. Atorvastatin has been shown to improve endothelial function independent of reducing cholesterol, as well as reduce/slow arterial stiffness and thickening, yet has never been studied in childhood cancer survivors (CCS). Methods: Twenty-seven young adult (age 26.8 ± 6.2 years) survivors of childhood acute lymphoblastic leukemia or Non-Hodgkin's lymphoma were randomly assigned (1:1) 40 mg/day of atorvastatin or placebo for 6 months. Brachial artery flow-mediated dilation (FMD), small artery reactive hyperemia index (RHI), arterial stiffness, and carotid artery elasticity/thickness were assessed. Results: Fifteen participants completed the trial. No significant treatment effect for any vascular outcomes was observed at 6 months; however, a significant decrease in peak FMD (-3.0 [95% confidence interval [CI]: -5.3, -0.7]) and a trending significant decrease in RHI (-0.3 [95% CI: -0.62, 0.01]) was observed in the placebo group, resulting in a trend toward a treatment effects (p < 0.10). No effect on arterial stiffness, carotid arterial elasticity, or thickness was observed. Conclusion: Six months of atorvastatin treatment did not improve endothelial function or arterial stiffness in young adult CCS. While a trend toward an improvement in endothelial function was present, findings should be interpreted with caution owing to the small number of evaluable participants and subsequent lack of sufficient power. Further research in a larger sample size is needed to fully elucidate the effects of atorvastatin on vascular function. Trial registered at clinicaltrials.gov as NCT01733953.
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Affiliation(s)
- Kara L Marlatt
- 1Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Julia Steinberger
- 2Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Kyle D Rudser
- 3Division of Biostatistics, School of Public Health, and Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota
| | - Donald R Dengel
- 2Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota.,4Laboratory of Integrative Human Physiology, School of Kinesiology, University of Minnesota, Minneapolis, Minnesota
| | - Karim T Sadak
- 2Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Jill L Lee
- 2Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Anne H Blaes
- 5Cancer and Blood Disorders Program, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota.,6Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Daniel A Duprez
- 6Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Joanna L Perkins
- 5Cancer and Blood Disorders Program, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | - Julie A Ross
- 2Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Aaron S Kelly
- 2Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota.,6Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
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50
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Koskinen J, Magnussen CG, Sinaiko A, Woo J, Urbina E, Jacobs DR, Steinberger J, Prineas R, Sabin MA, Burns T, Berenson G, Bazzano L, Venn A, Viikari JSA, Hutri-Kähönen N, Raitakari O, Dwyer T, Juonala M. Childhood Age and Associations Between Childhood Metabolic Syndrome and Adult Risk for Metabolic Syndrome, Type 2 Diabetes Mellitus and Carotid Intima Media Thickness: The International Childhood Cardiovascular Cohort Consortium. J Am Heart Assoc 2017; 6:JAHA.117.005632. [PMID: 28862940 PMCID: PMC5586423 DOI: 10.1161/jaha.117.005632] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background There is paucity of knowledge concerning the specific age in youth when the associations of metabolic syndrome (MetS) begin to be operative. Thus, we investigated the relation of age to the associations of childhood MetS with adult MetS, type 2 diabetes mellitus and high carotid intima‐media thickness. Methods and Results Five thousand eight‐hundred three participants were analyzed in 4 cohort studies (Cardiovascular Risk in Young Finns, Bogalusa Heart Study, Princeton Lipid Research Study, Insulin Study). International cutoffs and previously used 75th percentile cutoffs were used for children to define MetS and its components. Mean follow‐up period was 22.3 years. Logistic regression was used to calculate risk ratios and 95% confidence intervals. Childhood MetS and overweight were associated with over 2.4‐fold risk for adult MetS from the age of 5 years onward. Risk for type 2 diabetes mellitus was increased from the age of 8 (risk ratio, 2.6–4.1; 95% confidence interval, 1.35–6.76 and 1.12–7.24, respectively) onward for the 2 childhood MetS criteria based on international cut‐off values and for childhood overweight. Risk for high carotid intima‐media thickness was significant at ages 11 to 18 years in relation to childhood MetS or overweight (risk ratio, 2.44–4.22; 95% confidence interval, 1.55–3.55 and 2.55–5.66, respectively). Continuous childhood MetS score was associated with adult MetS from the age of 5, with type 2 diabetes mellitus from the age of 14 and with high carotid intima‐media thickness from the age of 11 years onward. Conclusions Adult MetS was predicted by MetS in childhood beginning at age 5. However, adult type 2 diabetes mellitus and subclinical atherosclerosis were not predicted by childhood data until after age 8. Body mass index measurement alone at the same age points provided similar findings.
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Affiliation(s)
- Juha Koskinen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland .,Heart Center, Turku University Hospital, Turku, Finland
| | - Costan G Magnussen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Alan Sinaiko
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Jessica Woo
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH
| | - Elaine Urbina
- Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Julia Steinberger
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Ronald Prineas
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Matthew A Sabin
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia.,Department of Pediatrics, University of Melbourne, Parkville, Australia
| | - Trudy Burns
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
| | - Gerald Berenson
- Department of Epidemiology, Tulane Center for Cardiovascular Health, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Lydia Bazzano
- Departments of Epidemiology and Biostatistics and Bioinformatics, Tulane University Health Sciences Center, Tulane University, New Orleans, LA
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Jorma S A Viikari
- Department of Medicine, University of Turku, Finland.,Division of Medicine, Turku University Hospital, Turku, Finland
| | - Nina Hutri-Kähönen
- Department of Pediatrics, University of Tampere School of Medicine and Tampere University Hospital, Tampere, Finland
| | - Olli Raitakari
- Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Terence Dwyer
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia.,Department of Pediatrics, University of Melbourne, Parkville, Australia
| | - Markus Juonala
- Department of Medicine, University of Turku, Finland.,Division of Medicine, Turku University Hospital, Turku, Finland
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