Childhood Risk Factors and Adulthood Cardiovascular Disease: A Systematic Review

Abstract

Objective: To conduct a comprehensive review of the literature on childhood risk factors and their associations with adulthood subclinical and clinical cardiovascular disease (CVD).

Study design: A systematic search was performed using the MEDLINE, EMBASE, PsycINFO, CINAHL, and Web of Science databases to identify English-language articles published through June 2018. Articles were included if they were longitudinal studies in community-based populations, the primary exposure occurred during childhood, and the primary outcome was either a measure of subclinical CVD or a clinical CVD event occurring in adulthood. Two independent reviewers screened determined whether eligibility criteria were met.

Results: There were 210 articles that met the predefined criteria. The greatest number of publications examined associations of clinical risk factors, including childhood adiposity, blood pressure, and cholesterol, with the development of adult CVD. Few studies examined childhood lifestyle factors including diet quality, physical activity, and tobacco exposure. Domains of risk beyond "traditional" cardiovascular risk factors, such as childhood psychosocial adversity, seemed to have strong published associations with the development of CVD.

Conclusions: Although the evidence was fairly consistent in direction and magnitude for exposures such as childhood adiposity, hypertension, and hyperlipidemia, significant gaps remain in the understanding of how childhood health and behaviors translate to the risk of adulthood CVD, particularly in lesser studied exposures like glycemic indicators, physical activity, diet quality, very early life course exposure, and population subgroups.

Keywords: hypertension; life course; obesity; prevention; subclinical.

Figure 1.

The CONSORT diagram illustrates the review search and extraction process, from the initial database search to the studies included in the final qualitative analysis.

Figure 2.

Heat map of identified articles examining childhood exposures and adulthood CVD. Each box lists the number of articles corresponding the exposure and CVD outcome pair. Yellow indicates that only null associations have been observed between the exposure and outcome. Colors deepen from light orange to red with an increasing number of articles indicating the exposure may be associated with higher CVD outcome risk. Colors deepen from light green to dark green with an increasing number of articles indicating the exposure may be associated with lower CVD outcome risk. Gray indicates that no articles examining the exposure and outcome pair were identified in this review. Articles that included multiple subtypes of CVD (eg, CHD and stroke) in the outcome without estimating the association for each subtype of CVD separately were classified as “CVD Mixed Definition”.

Figure 3.

Life course models for CVD development. The 3 hypothesized life course models for the development of CVD: chain of risk, where childhood risk is entirely mediated through adulthood risk; accumulation of risk, where risk factors present at each life stage further increase adulthood risk; and the critical/sensitive period, where exposure at a certain point in the life course confers more risk as compared with other life course stages.