Life course trajectories of cardiovascular risk: Impact on atherosclerotic and metabolic indicators

Background and aims: In this analysis, we estimated population-level trajectory groups of life course cardiovascular risk to explore their impact on mid-life atherosclerotic and metabolic outcomes. Methods: This prospective study followed n = 1269 Bogalusa Heart participants, each with at least 4 study visits from childhood in 1973 through adulthood in 2016. We used discrete mixture modeling to determine trajectories of cardiovascular risk percentiles from childhood to adulthood. Outcomes included mid-life subclinical atherosclerotic measures [(carotid intima-media thickness (cIMT), pulse wave velocity (PWV)], metabolic indicators [(diabetes and body mass index (BMI)], and short physical performance battery (SPPB). Results: Between the mean ages of 9.6-48.3 years, we estimated five distinct trajectory groups of life course cardiovascular risk (High-Low, High-High, Mid-Low, Low-Low, and Low-High). Adult metabolic and vascular outcomes were significantly determined by life course cardiovascular risk trajectory groups (all p < 0.01). Those in the High-Low group had lower risks of diabetes (20% vs. 28%, respectively; p=.12) and lower BMIs (32.4 kg/m(2) vs. 34.6 kg/m(2); p=.06) than those who remained at high risk (High-High) throughout life. However, the High-Low group had better cIMT (0.89mm vs. 1.05 mm; p<.0001) and PWV (7.8 m/s vs. 8.2 m/s; p=.03) than the High-High group. For all outcomes, those in the Low-Low group fared best. Conclusions: We found considerable movement between low-and high-relative cardiovascular risk strata over the life course. Children who improved their relative cardiovascular risk over the life course achieved better midlife atherosclerotic health despite maintaining relatively poor metabolic health through adulthood.