No abstract

Background-The American Heart Association (AHA) defined a new concept, cardiovascular health, and determined metrics needed to monitor it over time as part of its 2020 Impact Goal definition. Ideal cardiovascular health is defined by the presence of both ideal health behaviors and ideal health factors. The applicability of this concept to a cohort of children and its relationship with cardiometabolic outcomes in adulthood has not been reported. Methods and Results-The

T he American Heart Association (AHA) has defined a new metric of ideal cardiovascular health to accommodate both an expanded emphasis on prevention and greater understanding of the origins of cardiovascular disease as part of its 2020 Impact Goals. The explicit goal of the AHA statement is to improve cardiovascular health of all Americans by 20% by the year 2020 while reducing deaths resulting from cardiovascular diseases and stroke by 20%.1 To monitor progress toward these goals, the AHA has launched a concept of ideal cardiovascular health. This concept is defined by the presence of 7 ideal health factors that describe whether a person has ideal cardiovascular health and indicate where improvement is needed to attain better health.1 Substantial evidence demonstrates that the ideal cardiovascular health index is associated with better vascular health 2 and with reductions in cardiovascular morbidity and mortality. 3,4 Childhood and youth are important stages of life because cardiovascular diseases are rooted in early life 5,6 and socialBackground-The American Heart Association has defined a new metric of ideal cardiovascular health as part of its 2020 Impact Goals. We examined whether psychosocial factors in youth predict ideal cardiovascular health in adulthood. Methods and Results-Participants were 477 men and 612 women from the nationwide Cardiovascular Risk in Young Finns Study. Psychosocial factors were measured from cohorts 3 to 18 years of age at the baseline of the study, and ideal cardiovascular health was examined 27 years later in adulthood. The summary measure of psychosocial factors in youth comprised socioeconomic factors, emotional factors, parental health behaviors, stressful events, self-regulation of the child, and social adjustment of the child. There was a positive association between a higher number of favorable psychosocial factors in youth and greater ideal cardiovascular health index in adulthood (β=0.16; P<0.001) that persisted after adjustment for age, sex, medication use, and cardiovascular risk factors in childhood (β=0.15; P<0.001). The association was monotonic, suggesting that each increment in favorable psychosocial factors was associated with improvement in cardiovascular health. Of the specific psychosocial factors, a favorable socioeconomic environment (β=0.12; P<0.001) and participants' selfregulatory behavior (β=0.07; P=0.004) were the strongest predictors of ideal cardiovascular health in adulthood. Conclusions-The findings suggest a dose-response association between favorable psychosocial factors in youth and cardiovascular health in adulthood, as defined by the American Heart Association metrics. The effect seems to persist throughout the range of cardiovascular health, potentially shifting the population distribution of cardiovascular health rather than simply having effects in a high-risk population. 7 Although the importance of psychosocial factors has been acknowledged, 1,[8][9][10] there remains a lack of knowledge on whether psychosocial factors, emerging already ...

Abstract-Limited and partly controversial data are available regarding the relationship of arterial pulse wave velocity and childhood cardiovascular risk factors. We studied how risk factors identified in childhood and adulthood predict pulse wave velocity assessed in adulthood. The study cohort consisted of 1691 white adults aged 30 to 45 years who had risk factor data available since childhood. Pulse wave velocity was assessed noninvasively by whole-body impedance cardiography. The number of conventional childhood and adulthood risk factors (extreme quintiles for low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, systolic blood pressure, body mass index, and smoking) was directly associated with pulse wave velocity in adulthood (Pϭ0.005 and PϽ0.0001, respectively). In multivariable regression analysis, independent predictors of pulse wave velocity were sex (PϽ0.0001), age (PϽ0.0001), childhood systolic blood pressure (Pϭ0.002) and glucose (Pϭ0.02), and adulthood systolic blood pressure (PϽ0.0001), insulin (Pϭ0.0009), and triglycerides (Pϭ0.003). Reduction in the number of risk factors (PϽ0.0001) and a favorable change in obesity status (Pϭ0.0002) from childhood to adulthood were associated with lower pulse wave velocity in adulthood. Conventional risk factors in childhood and adulthood predict pulse wave velocity in adulthood. Favorable changes in risk factor and obesity status from childhood to adulthood are associated with lower pulse wave velocity in adulthood. These results support efforts for a reduction of conventional risk factors both in childhood and adulthood in the primary prevention of atherosclerosis. (Hypertension. 2010;55:806-811.)Key Words: cardiovascular health Ⅲ risk factors Ⅲ elasticity Ⅲ epidemiology Ⅲ pulse wave velocity I t is well recognized that atherosclerosis has its roots in childhood. Risk factors identified in childhood predict the occurrence of preclinical carotid atherosclerosis in adulthood. 1-3 Risk factors have also been associated with decreased arterial elasticity in cross-sectional studies. 4 -6 We have demonstrated previously a link between youth risk factor exposure and decreased carotid elasticity in adulthood. 7 Arterial pulse wave velocity (PWV) is commonly used as a marker of arterial stiffness. In various patient categories, including patients with hypertension, 8 end-stage renal failure, 9 and diabetes mellitus, 10 PWV is an independent predictor of all-cause and cardiovascular mortality. Furthermore, aortic PWV is associated with higher cardiovascular mortality, coronary heart disease, and stroke among generally healthy older adults. 11 Previous observations concerning the relationship between risk factors identified in childhood/adolescence and arterial PWV in adulthood have been controversial. Li et al 12 (835 participants, aged 24 to 44 years) reported a direct correlation between childhood blood pressure and PWV in adulthood, whereas Oren et al 13 (524 participants, aged 27 to 30 years) did not find an association between adolescent blo...