Cardiovascular disease affects more than 126 million people a year worldwide and continues to be the leading cause of death in the United States. It is well known that risk factors in adults, such as high cholesterol, lead to heart attacks and other cardiovascular illnesses.

A new international study, which includes University of Minnesota researchers, finds for the first time that risk factors present in childhood are also directly related to the onset of heart disease in adults. The study, published in the New England Journal of Medicine, was led by School of Public Health Professor David Jacobs, and Professor Julia Steinberger and Professor Emeritus Alan Sinaiko from the Medical School along with Professor Jessica Woo from the University of Cincinnati College of Medicine.

“Much evidence suggests that the seeds of cardiovascular disease are in childhood, but the specific evidence linking childhood measurements to clinical disease was absent until our study,” said Jacobs. “This study is remarkable in that we now have that evidence and found it by following participants from childhood to adulthood over many decades.”

Data for the study stems from research started 40-50 years ago in Finland, Australia, and five centers in the United States, including the University of Minnesota. These centers formed the International Childhood Cardiovascular Cohorts (i3C) consortium, consisting of close to 40,000 individuals followed from childhood (age 3-19 years) into early adulthood.

Findings from this study show:

• A link between childhood cardiovascular risk factors — such as body mass index (a measure of obesity), blood pressure, blood lipids and cigarette smoking — and the development of cardiovascular events in adults, with 75% of events occurring before age 53.
• Many of the individuals who had adult cardiovascular events were children with cardiovascular risk factors that were measured to be on the high end of the average category.

The findings suggest that even slightly high levels of risk factors at a young age can lead to cardiovascular problems relatively early in life.

“These findings are remarkable in demonstrating that children with only mildly elevated body mass index, blood pressure or lipids, and youth who start smoking, may be at higher risk for adult cardiovascular disease,” said Woo. “However, we also show that when these risk factors are lower in adulthood than in childhood, for example quitting smoking between childhood and adulthood, the risk of suffering from adult cardiovascular disease was lower.”

The study team points out that the risk is real with a majority of U.S. children experiencing declining heart health long before many people become concerned about their chances of having heart attacks and other serious issues.

“Most children are born healthy, but unfortunately much of the benefit of heart health is lost during childhood, and currently less than 5% of U.S. children enjoy ideal cardiovascular health,” said Steinberger. “Hopefully, this study will be a wake-up call that practicing good cardiovascular health behaviors starts when we are young and has to be maintained for life.”

The researchers also emphasized that while modern medicine has many advances for treating heart disease, it’s best to stop it before it starts.

“Despite the great effect medical and surgical care have had on treating heart disease, the major impact on cardiovascular disease will depend on effective preventive strategies beginning in childhood,” said Sinaiko.

The current medical emphasis focusing on reducing the influence of cardiovascular risk factors in adults remains an important component of prevention of premature heart disease in early adulthood. While the present study does not permit the precise identification of children destined to develop heart disease, it strongly suggests the positive value of public health preventive strategies that can lower risk levels during childhood, such as promoting healthy eating and physical activity at home and school. It also points to a need for further research to more precisely identify at-risk children who go on to develop early clinical cardiovascular disease.

“Helping children, families, and schools to follow current health behavior guidelines is an excellent place to start to help protect our children,” said Jacobs.

This research was funded by a grant from the National Heart, Lung and Blood Institute. International partners in the study include Cincinnati Children’s Hospital Medical Center, The University of Cincinnati, Tulane University, University of Iowa, University of Turku and Tampere University in Finland, and Menzies Institute for Medical Research and Murdoch Children’s Research Institute in Australia.