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People showed lingering long-term effects of childhood cardiovascular risk factors no matter the changes in adulthood, a population-level cohort study found.

Various childhood risk factors were associated with adult cardiovascular disease (CVD) around 2 decades later, the largest direct effects coming from BMI (RR per standard deviation 1.18, 95% CI 1.05-1.34) and LDL cholesterol (RR 1.16, 95% CI 1.01-1.34), according to Terence Dwyer, MD, of Royal Children's Hospital in Parkville, Australia, and colleagues.

In contrast, factors having indirect associations with adult CVD were childhood total cholesterol, triglycerides, and systolic blood pressure.

Childhood BMI emerged again as an important risk factor upon analysis by life course modeling, which showed that childhood BMI played nearly as important role as adult BMI in adult CVD, the investigators reported in .

"These findings suggest that intervention for childhood risk factors, in particular BMI, is warranted to reduce incidence of adult CVD as it cannot be fully mitigated by risk factor management in adulthood," the authors wrote. "The prevention of CVD through reduction of established risk factors has largely focused on interventions commencing in mid-adulthood. However, the underlying pathology, atherosclerosis, can start in childhood, and its early development depends on the same risk factors."

"Although efforts to reduce risk factors in adulthood remain important, efforts to achieve optimal success in preventing both the direct and indirect effects we observed may need to commence in childhood. The development of public strategy that determines the desirable balance of lifestyle and clinical interventions at each life stage is now a priority," Dwyer's group emphasized.

The investigators defined the childhood period as age 3-19 years; adulthood started at age 20 years.

Dwyer's group had analyzed seven longitudinal cohorts included in the International Childhood Cardiovascular Cohort (i3C) Consortium. The cohorts came from the U.S., Finland, and Australia, and tracked participants starting as early as the 1970s.

The present report supports the main results from i3C showing that traditional markers of cardiovascular health in childhood did have a link to cardiac events and deaths in adulthood -- now with additional analyses accounting for adult risk factors.

Dwyer and colleagues identified 10,634 people who entered the study in childhood (13.3 years of age on average) and had their adult study visits at a mean age of 32.3 years. The cohort was 42.4% men and 9.7% Black.

Adult CVD events of interest included myocardial infarction, stroke, transient ischemic attack, ischemic heart failure, angina, peripheral artery disease, abdominal aortic aneurysm, carotid intervention, and coronary revascularization. Fatal and nonfatal events were combined.

Risk factors besides BMI generally contributed more to CVD in adulthood than childhood.

Another finding was that childhood smoking only affected CVD indirectly via adulthood smoking.

"Even though the effects of smoking were mostly via adulthood, our results highlight the opportunity presented in childhood and adolescence to prevent lifelong smoking, because smoking is a modifiable behavior and the majority of adult smokers start in adolescence," the authors noted.

A major limitation of the study, they suggested, is its generalizability beyond high-income setting with majority-white participants.

"Future studies should prioritize collecting more comprehensive data on social determinants of health than we have been able to (e.g., access to health care and healthy environments) to better inform the design and implementation of effective and targeted interventions," Dwyer's group wrote.

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