Life course trajectories of cardiovascular risk: Impact on atherosclerotic and metabolic indicators

Background and aims: In this analysis, we estimated population-level trajectory groups of life course cardiovascular risk to explore their impact on mid-life atherosclerotic and metabolic outcomes. Methods: This prospective study followed n = 1269 Bogalusa Heart participants, each with at least 4 study visits from childhood in 1973 through adulthood in 2016. We used discrete mixture modeling to determine trajectories of cardiovascular risk percentiles from childhood to adulthood. Outcomes included mid-life subclinical atherosclerotic measures [(carotid intima-media thickness (cIMT), pulse wave velocity (PWV)], metabolic indicators [(diabetes and body mass index (BMI)], and short physical performance battery (SPPB). Results: Between the mean ages of 9.6–48.3 years, we estimated five distinct trajectory groups of life course cardiovascular risk (High-Low, High-High, Mid-Low, Low-Low, and Low-High). Adult metabolic and vascular outcomes were significantly determined by life course cardiovascular risk trajectory groups (all p < 0.01). Those in the High-Low group had lower risks of diabetes (20% vs. 28%, respectively; p =.12) and lower BMIs (32.4 kg/m² vs. 34.6 kg/m²; p =.06) than those who remained at high risk (High-High) throughout life. However, the High-Low group had better cIMT (0.89 mm vs. 1.05 mm; p <.0001) and PWV (7.8 m/s vs. 8.2 m/s; p =.03) than the High-High group. For all outcomes, those in the Low-Low group fared best. Conclusions: We found considerable movement between low- and high-relative cardiovascular risk strata over the life course. Children who improved their relative cardiovascular risk over the life course achieved better mid-life atherosclerotic health despite maintaining relatively poor metabolic health through adulthood.