What the Long Term Cohort Studies that Began in Childhood Have Taught Us about the Origins of Coronary Heart Disease
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PEDIATRICS (S GIDDING, SECTION EDITOR)
What the Long Term Cohort Studies that Began in Childhood Have Taught Us about the Origins of Coronary Heart Disease Costan G. Magnussen & Kylie J. Smith & Markus Juonala
Published online: 30 January 2014 # Springer Science+Business Media New York 2014
Abstract A limited number of observational studies were commenced in the 1970s and 1980s that have aimed to examine the child and adolescent origin of cardiovascular disease. These studies have provided, and continue to provide, critical evidence that have enhanced our understanding of the disease process, the early-life factors involved, and have informed public health and clinical guideline statements. Using data on preclinical markers of vascular health in adulthood, these studies have recently described the important role for youth lifestyle for later vascular health, provided information on the critical age in youth when risk factor associations with adult vascular health emerge, and have reported on the potential vascular benefits of resolving youth at-risk status in the transition from youth to adulthood. It is these works that we cover in detail in this review. Despite all the achievements from these studies, it is tantalizing that their most important contributions are still to come. That is, once sufficient clinical end points accrue so that analyses linking early life health to hard outcomes can be performed. These studies are a commodity and an invaluable resource that, with minimal re-investment, will provide increasing returns on cardiovascular health into the future.
This article is part of the Topical Collection on Pediatrics C. G. Magnussen (*) : K. J. Smith Menzies Research Institute Tasmania, University of Tasmania, Private Bag 23, TAS 7001 Hobart, Australia e-mail: [email protected] C. G. Magnussen : M. Juonala Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland M. Juonala Department of Medicine, Turku University Hospital, Turku, Finland
Keywords Pediatric . Modifiableriskfactors . Cardiovascular disease . Carotid intima-media thickness . Review
Introduction
“The childhood shows the man, as the morning shows the day” John Milton, Paradise Regained, 1971 A recent historical perspective of the Framingham Heart Study eloquently summarized the role it and other epidemiological studies played in the elucidation and understanding of cardiovascular disease in adult life and its multifactorial origins [1]. These studies helped direct attention toward opportunities for prevention and debunked some prevailing wisdoms of the time. With seminal autopsy studies having already shown that atherosclerotic cardiovascular disease was present at the time of death among apparently healthy young persons [2, 3], it was only a matter of time before a number of groups initiated large prospective observational studies in children and adolescents (herein termed youth) to examine the early-life origin of cardiovascular disease. These studies were predominantly launched in the
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