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A new international study published April 4th 2022, in The New England Journal of Medicine finds, for the first time, direct evidence that the recognised risk factors for cardiovascular disease when present in childhood, predict the risk of adult cardiovascular events such as myocardial infarction and stroke.

Five childhood risk factors that predict poor cardiovascular health in adults have been identified after being tracked for up to half a century in the world’s largest international prospective cardiovascular disease study commencing in childhood.

The international study conducted by the International Childhood Cardiovascular Consortium (i3C), found body mass index, blood pressure, cholesterol, triglycerides (a type of fat found in blood) and youth smoking, particularly in combination in early childhood, were clinically linked with cardiovascular events, like stroke and heart attack, or death, from as early as 40 years of age.

Prof Terence Dwyer Emeritus Professor of Epidemiology, Nuffield Department of Women’s & Reproductive Health, University of Oxford and co author of the paper, commented: 


Terry Dwyer

“Despite the effect medical and surgical care have had on treating heart disease, achieving the greatest possible reduction in the heart disease burden will depend on including preventive strategies that commence in childhood.

This study confirms that prevention should begin in childhood. Longitudinal studies like these have been hampered by a lack of inclusion of comprehensive childhood data around body measurements, blood pressure, and blood lipids and a failure to follow-up at ages when cardiovascular disease becomes common.” 

“Studying early life influences on disease has always been put in the too hard basket. But researchers in i3C took up this challenge because we knew the potential benefits to human health at the end could be very substantial.”


The study involved 38,589 participants from Australia, Finland and the US, who were followed from age 3-19 years for a period of 35-50 years. It was conducted by researchers from Cincinnati Children’s, the University of Minnesota, the University of Cincinnati, the University of Colorado, Children’s Hospital Colorado, the University of Turku and Turku University Hospital in Finland, Tampere University in Finland, the University of Tasmania in Australia, Tulane University, the University of Iowa, Wake Forest School of Medicine, Murdoch Children’s Research Institute in Australia, and The University of Oxford.

Prof Dwyer continued “the research found the five risk factors, individually or in combination, present in childhood were predictors of fatal and non-fatal cardiovascular events”.

The results, published in the New England Journal of Medicine showed that increased risk for cardiovascular events was seen in over half the children, with those whose having the highest risk factor levels, at 9 times the risk for an event as for children with below average risk factors.

“While this evidence had not been available previously, the findings were not entirely surprising as it had been known for some time that children as young as five already showed early signs of fatty deposits in arteries. This new evidence justified a greater emphasis on programs to prevent the development of these risk factors in children. Clinicians and public health professionals should now start to focus on how this might best be achieved”.

“While interventions in adulthood like improving diet, quitting smoking, being more active, and taking appropriate medications to reduce risk factors are helpful, it is likely that there is much more that can be done during childhood and adolescence to reduce lifetime risk of cardiovascular disease.”


Read full paper "Childhood Cardiovascular Risk Factors and Adult Cardiovascular Events" here

Read Editorial from New England Journal of Medicine here