Available online 20 April 2023

Author links open overlay panel, , , , , , , , , , , , , , , , AbstractPurpose

Many children have non-ideal cardiovascular health (CVH), but little is known about the course of CVH in early childhood. We identified CVH trajectories in children and assess the generalizability of these trajectories in an external sample.

Methods

We used data spanning 2010-2018 from children aged 2-12 years within the Chicago Area Patient-Centered Outcomes Research Network (CAPriCORN) – a electronic health record network. Four clinical systems comprised the derivation sample and a fifth the validation sample. Body mass index, blood pressure, cholesterol, and blood glucose were categorized as ideal, intermediate, and poor using clinical measurements, laboratory readings, and ICD diagnosis codes and summed for an overall CVH score. Group-based trajectory modeling was used to create CVH score trajectories which were assessed for classification accuracy in the validation sample.

Results

Using data from 122,363 children (47% female, 47% non-Hispanic White) three trajectories were identified: 59.5% maintained high levels of clinical CVH, 23.4% had high levels of CVH that declined, and 17.1% had intermediate levels of CVH that further declined with age. Similar classification emerged when the trajectories were fitted in the validation sample.

Conclusion

Stratification of CVH was present by age 2, implicating the need for early life and preconception prevention strategies.

Section snippetsINTRODUCTION

In 2010, the American Heart Association defined an operational construct of cardiovascular health (CVH), including seven lifestyle and clinical cardiovascular disease (CVD) risk factors scored as ideal, intermediate, or poor, that could be summed to create an overall CVH score [1], [2], [3], [4]. Less than half of US children ages 8 and older have ideal CVH [5], [6], and those who do not maintain ideal CVH in childhood and adolescence are subsequently at higher risk of developing CVD in

Derivation Sample

Data were provided from four institutions participating in the CAPriCORN network, but we were blinded as to the specific institutions to protect the confidentiality of the data. More detailed information about CAPriCORN has been published previously, including details about processes used to collect standardized Common Data Model records with population de-duplication [14]. A CAPriCORN-specific Institutional Review Board provided full approval for this study.

Records from 540,382 children aged 0

RESULTS

Among this sample of 122,363 children from a diverse, contemporary urban population, baseline age was similar in both samples (5.6 (standard deviation (SD) 3.2), derivation; 5.9 (SD 3.1) validation), as was number of encounters during follow-up (5.7 (SD 3.2), derivation; 6.2 (SD 3.1), validation). When comparing sociodemographic factors of children with and without complete CVH data, we observed that individuals with complete CVH data were more likely to be older, Hispanic or non-Hispanic

DISCUSSION

We analyzed the clinical CVH metrics of 122,363 children longitudinally from ages 2-12, detecting three distinct trajectories of clinical CVH in early childhood. Within these broad clinical CVH trajectory groups, we observed significant differences as early as age 2 in BMI percentile and blood pressure percentiles that widened over time.

This paper builds upon extant research regarding CVH in childhood. Distinct trajectories of CVH in childhood had already been identified with CVH stratification

Limitations

Although EHRs provide a rich source of data, the data are not collected for research purposes, so potential for misclassification within the clinical CVH metrics is possible [28]. Dietary patterns, physical activity, and tobacco smoke exposure are also not routinely nor accurately collected in clinical practice, precluding use of the full range of CVH metrics. Currently there are no pediatric recommendations for repeated universal screening of lipid and glucose levels in children [29], and thus

Conclusions

In summary, these trajectories add to the growing body of evidence regarding the origins of CVH in very early life and give insight into sociodemographic risk factors and clinical metrics that may identify individual children in need of focused prevention efforts to maintain or restore CVH. We have demonstrated that markers of risk pathways are identifiable well before school age, and thus the translation to prevention must include health promotion in the prenatal, infancy, and early childhood

CRediT authorship contribution statement

Lindsay R. Pool: Conceptualization, Methodology, Writing – Original Draft; Lucia C. Petito: Conceptualization, Methodology, Validation, Formal analysis, Writing – Review & Editing; Xiaoyun Yang: Data Curation, Visualization, Writing – Review & Editing; Amy E. Krefman: Project Administration, Data Curation, Validation, Writing – Review & Editing; Amanda M. Perak: Writing – Review & Editing; Matthew M. Davis: Writing – Review & Editing; Philip Greenland: Writing – Review & Editing; Marc Rosenman:

Declaration of Competing Interest

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Norrina Allen reports financial support was provided by American Heart Association.

Acknowledgements and Funding

This work was supported by the American Heart Association’s Strategically Focused Research Network on Children (17SFRN33700101). The funder/sponsor did not participate in the work.

References (29)A.M. Perak et al.Associations of Late Adolescent or Young Adult Cardiovascular Health With Premature Cardiovascular Disease and Mortality

J Am Coll Cardiol

(2020 Dec 8)

L.R. Pool et al.Childhood Risk Factors and Adulthood Cardiovascular Disease: A Systematic Review

J Pediatr

(May 2021)

A.M. Perak et al.Associations of Late Adolescent or Young Adult Cardiovascular Health With Premature Cardiovascular Disease and Mortality

J Am Coll Cardiol

(Dec 8 2020)

D.M. Lloyd-Jones et al.Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond

Circulation

(Feb 2 2010)

T.S. Polonsky et al.Association of Cardiovascular Health With Subclinical Disease and Incident Events: The Multi-Ethnic Study of Atherosclerosis

J Am Heart Assoc

(Mar 20 2017)

V. Xanthakis et al.Ideal cardiovascular health: associations with biomarkers and subclinical disease and impact on incidence of cardiovascular disease in the Framingham Offspring Study

Circulation

(Nov 4 2014)

H. Ning et al.Status of cardiovascular health in US children up to 11 years of age: the National Health and Nutrition Examination Surveys 2003-2010

Circ Cardiovasc Qual Outcomes

(Mar 2015)

C.M. Shay et al.Status of cardiovascular health in US adolescents: prevalence estimates from the National Health and Nutrition Examination Surveys (NHANES) 2005-2010

Circulation

(Apr 2 2013)

T.T. Laitinen et al.Ideal cardiovascular health in childhood and cardiometabolic outcomes in adulthood: the Cardiovascular Risk in Young Finns Study

Circulation

(Apr 24 2012)

N.B. Allen et al.Cardiovascular Health Trajectories From Childhood Through Middle Age and Their Association With Subclinical Atherosclerosis

JAMA Cardiol

(May 1 2020)

A.E. Krefman et al.Influential Periods in Longitudinal Clinical Cardiovascular Health Scores

Am J Epidemiol

(May 20 2021)

L.R. Pool et al.The Timing and Sequence of Cardiovascular Health Decline

Am J Prev Med

(Jul 5 2021)

A.M. Perak et al.Associations of Maternal Cardiovascular Health in Pregnancy With Offspring Cardiovascular Health in Early Adolescence

Jama

(Feb 16 2021)

A.N. Kho et al.CAPriCORN: Chicago Area Patient-Centered Outcomes Research Network

J Am Med Inform Assoc

(Jul-Aug 2014)

View full text

© 2023 Elsevier Inc. All rights reserved.