Preterm‐born individuals: a vulnerable population at risk of cardiovascular morbidity and mortality during thermal extremes?

Abstract

New Findings What is the topic of this review?Thermal extremes disproportionately affect populations with cardiovascular conditions. Preterm birth, across all gestational age ranges below 37 weeks, has been identified as a non‐modifiable risk factor for cardiovascular disease. The hypothesis is presented that individuals born preterm are at an increased risk of cardiovascular morbidity and mortality during thermal extremes. What advances does it highlight?Cardiovascular stress tests performed in preterm‐born populations, from infancy through adulthood, highlight a progression of cardiovascular dysfunction accelerating through adolescence and adulthood. This dysfunction has many similarities with populations known to be at risk in thermal extremes. Abstract Preterm‐born individuals are a uniquely vulnerable population. Preterm exposure to the extrauterine environment and the (mal)adaptations that occur during the transitional period can result in alterations to their macro‐ and micro‐physiological state. The physiological adaptations that increase survival in the short term may place those born preterm on a trajectory of lifelong dysfunction and later‐life decompensation. Cardiovascular compensation in children and adolescents, which masks this trajectory of dysfunction, is overcome under stress, such that the functional cardiovascular capacity is reduced and recovery impaired following physiological stress. This has implications for their response to thermal stress. As the Anthropocene introduces greater changes in our environment, thermal extremes will impact vulnerable populations as yet unidentified in the climate change context. Here, we present the hypothesis that individuals born preterm are a vulnerable population at an increased risk of cardiovascular morbidity and mortality during thermal extremes.

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“…Emerging evidence indicates that elevated systemic OXINOS is common among many vulnerable populations (e.g., prematurity, cardiovascular disease, ageing). Recent findings in those born preterm or growth-restricted, as well as to assisted reproductive technologies (accounting for 10% and 2-4% of live births, respectively), indicate that these populations have impaired lifelong cardiovascular function and are potentially at greater physiological risk in the face of climate change (Rimoldi et al, 2015;Sixtus et al, 2023).…”

“…While the elderly are the most commonly studied at‐risk population, we are increasingly aware of populations for whom cardio‐cerebro‐metabolic dysfunction and disease are early life occurrences. These include those born to assisted reproductive technologies or low birth weight (e.g., preterm or growth‐restricted; Crump, 2020 ; Rimoldi et al., 2015 ; Sixtus et al., 2023 ). The Intergovernmental Panel on Climate Change (IPCC) predicts that the main risk for morbidity across the first half of this century will be through climate‐induced exacerbation of health conditions in these vulnerable populations (Smith et al., 2014 ).…”

“…Emerging evidence indicates that elevated systemic OXINOS is common among many vulnerable populations (e.g., prematurity, cardiovascular disease, ageing). Recent findings in those born preterm or growth‐restricted, as well as to assisted reproductive technologies (accounting for 10% and 2–4% of live births, respectively), indicate that these populations have impaired lifelong cardiovascular function and are potentially at greater physiological risk in the face of climate change (Rimoldi et al., 2015 ; Sixtus et al., 2023 ). While not yet linked explicitly to OXINOS, it may contribute, at least in part, to the underlying cardio‐cerebro‐metabolic disease pathophysiology (Bavineni et al., 2019 ; Dammann & Leviton, 2014 ; Dinh et al., 2014 ; Humberg et al., 2020 ; Sutherland et al., 2014 ).…”