Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 74, Issue 3, Pages 330-341Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2019.03.529
Keywords
blood pressure; cholesterol; coronary heart disease; heart failure; stroke; young adulthood
Categories
Funding
- National Institutes of Health (NIH) [R01 HL130500]
- National Heart, Lung, and Blood Institute (NHLBI), NIH, Department of Health and Human Services [HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I, HHSN268201700005I]
- NHLBI [AG0005, HHSN268201200036C, HHSN268200800007C, HHSN268201800001C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, U01HL080295, U01HL130114, HHSN268201500003I]
- University of Alabama at Birmingham [HHSN268201300025C, HHSN268201300026C]
- Northwestern University [HHSN268201300027C]
- University of Minnesota [HHSN268201300028C]
- Kaiser Foundation Research Institute [HHSN268201300029C]
- Johns Hopkins University School of Medicine [HHSN268200900041C]
- Intramural Research Program of the National Institute on Aging (NIA)
- NIA [AG0005, N01-AG-6-2101, N01-AG-6-2103, N01-AG-6-2106, R01-AG028050, 1RF1AG054443]
- National Institute of Neurological Disorders and Stroke
- National Institute on Aging (NIA) [R01AG023629]
- Boston University [N01-HC-25195, HSN268201500001I]
- National Institute of Nursing Research [R01-NR012459]
- National Center for Advancing Translational Sciences grants [UL1-TR-000040, UL1-TR-001079, UL1-TR-001420, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, N01-HC-95169]
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BACKGROUND Blood pressure (BP) and cholesterol are major modifiable risk factors for cardiovascular disease (CVD), but effects of exposures during young adulthood on later life CVD risk have not been well quantified. OBJECTIVE The authors sought to evaluate the independent associations between young adult exposures to risk factors and later life CVD risk, accounting for later life exposures. METHODS The authors pooled data from 6 U.S. cohorts with observations spanning the life course from young adulthood to later life, and imputed risk factor trajectories for low-density lipoprotein (LDL) and high-density lipoprotein cholesterols, systolic and diastolic BP starting from age 18 years for every participant. Time-weighted average exposures to each risk factor during young (age 18 to 39 years) and later adulthood (age >= 40 years) were calculated and linked to subsequent risks of coronary heart disease (CHD), heart failure (HF), or stroke. RESULTS A total of 36,030 participants were included. During a median follow-up of 17 years, there were 4,570 CHD, 5,119 HF, and 2,862 stroke events. When young and later adult risk factors were considered jointly in the model, young adult LDL >= 100 mg/dl (compared with <100 mg/dl) was associated with a 64% increased risk for CHD, independent of later adult exposures. Similarly, young adult SBP >= 130 mm Hg (compared with < 120 mm Hg) was associated with a 37% increased risk for HF, and young adult DBP >= 80 mm Hg (compared with < 80 mm Hg) was associated with a 21% increased risk. CONCLUSIONS Cumulative young adult exposures to elevated systolic BP, diastolic BP and LDL were associated with increased CVD risks in later life, independent of later adult exposures. (C) 2019 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
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