The Unchartered Frontier: Preventive Cardiology Between the Ages of 15 and 35 Years

Gooding, Holly C.; Johnson, Heather M.

doi:10.1007/s12170-016-0509-2

Cited by 10 publications

(8 citation statements)

References 92 publications

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“…Uniformly, our patients felt they had little input on the timing of the transition. This is not inconsistent with previous published studies showing that patients are often not included in either the decision to transition or the timing [12,13]. Not including patients in the timing of transition decision may contradict the notion of the YA evolving development of self-identity and independence.…”

Section: Discussioncontrasting

confidence: 60%

Assessing success in transitioning of young adults from pediatric to adult kidney practice

et al. 2020

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Background: Transfer from a pediatric to an adult medical setting is associated with many barriers. Additionally, there are little data on patients' assessment of the transition process itself. 3 years ago at Lurie Children's Hospital of Chicago, we established a kidney transition program with the help of an adult nephrologist, physician assistant (PA) and social worker (LCSW). After 18 months, we evaluated the patients' perception of the program as part of a continuous quality initiative process. Methods: Patients who had transitioned from pediatric care and were seen at least once in the adult nephrology clinic were anonymized and asked to take an established 5-point Likert scale survey. Survey questions addressed readiness to transition, the transition process itself, and the perception of adult care. Surveys were followed with semi-structured interviews. 3 readers rated each response as either "negative," "neutral," or "positive." Average, standard deviation and reader reliability were calculated. The readers also selected a word that best depicted each response and those mostcommon words were counted by question and overall. Results: 17 out of 42 patients (40%) completed the survey. Average age at transition (mean + SD) was 20 + 2 years; the majority of patients (82%) felt ready to transfer to adult care but only 59% felt they were consulted on the timing. 88% of patients felt having a transition appointment and meeting the adult care providers in the pediatric setting to be valuable. Although 94% of patients ultimately felt comfortable in the adult care environment, 18% experienced noticeable differences in treatment recommendations. 13 semi-structured interviews were conducted. Overall, the patients responded positively (3 + 0, 100% reader reliability) to the transition. But, when asked what could have improved the transition, the word the patients used most was, "earlier." Conclusion: Young adults (YA) transitioning to adult care often feel ready to transition earlier than their transfer of care date. They subjectively benefit from a transition program that outlines the process of transferring their care. Many YA patients would benefit from a transition program that bolsters patient independence during early adult care visits.

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Section: Discussioncontrasting

confidence: 60%

Assessing success in transitioning of young adults from pediatric to adult kidney practice

et al. 2020

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“…Our results add to accumulating evidence that young adulthood is a critical period when exposure to suboptimal BP or cholesterol is particularly harmful, and maintaining optimal levels of BP and LDL throughout young adulthood could yield substantial lifetime CVD prevention benefits (14). However, young adults are difficult to reach by way of traditional, clinic-based preventive programs: they are transitioning between pediatric and adult-centered models of care (36); they often lack health insurance or experience frequent gaps in insurance coverage (37); and their use of ambulatory medical care and adherence to preventive health guidelines are the lowest of any age group (36,38). Data from National Health and Nutrition Examination Surveys showed that young adults lagged behind in awareness, treatment, and control of high BP and LDL compared with middle-aged and older adults (39,40), and were especially unlikely to be aware of borderline levels of BP and cholesterol, which were associated with future risk of CHD and HF in our study (41).…”

Section: Discussionmentioning

confidence: 99%

“…The majority of the young adults with nonoptimal risk factors have low 10-year ASCVD risk and are not likely to receive either pharmacological interventions or advice to pursue lifestyle measures (i.e., weight loss, heart-healthy diet), if they are screened at all (45–47). Pharmacological BP and LDL lowering may benefit selected young adults at high risk for premature ASCVD (36,47,48). The currently ongoing ECAD (Eliminate Coronary Artery Disease) trial is designed to address the question of whether incident ASCVD events can be more effectively prevented by early initiation of statin-based LDL lowering in young and middle-aged adults who are not yet candidates for guideline-based pharmacological LDL lowering due to low 10-year ASCVD risk (47).…”

Section: Discussionmentioning

confidence: 99%

Associations of Blood Pressure and Cholesterol Levels During Young Adulthood With Later Cardiovascular Events

Zhang

Vittinghoff

Pletcher

et al. 2019

Journal of the American College of Cardiology

189

115

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BACKGROUNDBlood pressure (BP) and cholesterol are major modifiable risk factors for cardiovascular disease (CVD), but effects of exposures during young adulthood on later life CVD risk have not been well quantified.OBJECTIVEThe authors sought to evaluate the independent associations between young adult exposures to risk factors and later life CVD risk, accounting for later life exposures.METHODSThe authors pooled data from 6 U.S. cohorts with observations spanning the life course from young adulthood to later life, and imputed risk factor trajectories for low-density lipoprotein (LDL) and high-density lipoprotein cholesterols, systolic and diastolic BP starting from age 18 years for every participant. Time-weighted average exposures to each risk factor during young (age 18 to 39 years) and later adulthood (age ≥40 years) were calculated and linked to subsequent risks of coronary heart disease (CHD), heart failure (HF), or stroke.RESULTSA total of 36,030 participants were included. During a median follow-up of 17 years, there were 4,570 CHD, 5,119 HF, and 2,862 stroke events. When young and later adult risk factors were considered jointly in the model, young adult LDL ≥100 mg/dl (compared with <100 mg/dl) was associated with a 64% increased risk for CHD, independent of later adult exposures. Similarly, young adult SBP ≥130 mm Hg (compared with <120 mm Hg) was associated with a 37% increased risk for HF, and young adult DBP ≥80 mm Hg (compared with <80 mm Hg) was associated with a 21% increased risk.CONCLUSIONSCumulative young adult exposures to elevated systolic BP, diastolic BP and LDL were associated with increased CVD risks in later life, independent of later adult exposures.

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“…79 Nevertheless, a systematic review and meta-analysis of 18 studies, providing cumulative data on 45 249 individuals, demonstrated that in utero exposure to PE is associated with higher systolic (2.39 mm Hg, 95% CI, 1.74-3.05; P < .0001) and diastolic (1.35 mm Hg, 95% CI, 0.90-1.80; P < .00001) blood pressure and increased BMI during childhood and young adulthood. 80 Because the pathological basis of CVD starts in childhood, Goodling and Johnson 81 highlighted recently the importance of primordial prevention of cardiovascular risk factors (ie, before they even occur) during childhood and assessment and primary prevention of CVD during adolescence and early adulthood. By their own admission, identifying, implementing, and disseminating effective interventions in these age groups is challenging.…”

Section: Transgenerational Hypertension and Early-onset Cvdmentioning

confidence: 99%

“…In case of adolescent PE, both the mother and child may benefit from long-term, cardiovascular risk reduction interventions, although such sustained programs are often considered beyond the scope, as well as financial means, of many health-care systems. 81 From a biological perspective, the increased incidence of placental disorders in adolescence, especially very young women, lays bare several aspects of uterine physiology that are virtually unexplored. Concepts such as "uterine immaturity," "decidual resistance," "menstrual preconditioning," and "acute endometrial senescence" are likely also relevant to the pathogenesis of other intransigent reproductive disorders, including endometriosis.…”

Section: Perspectivementioning

confidence: 99%

Adolescent Preeclampsia: Pathological Drivers and Clinical Prevention

et al. 2019

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Preeclampsia is an important cause of maternal and perinatal morbidity, especially in first-time pregnant adolescent women. Although prevention of preeclampsia has been attempted for many decades, effective intervention can only be achieved upon the full elucidation of the risk factors and mechanisms of disease. As the pathogenesis of preeclampsia during adolescence may differ from that in older women, preventive interventions should be tailored accordingly. During adolescence, 4 putative drivers of preeclampsia can be identified. First, uterine immaturity in very young teenagers is likely a major cause of defective deep placentation and adverse reproductive outcome, underscoring the importance of educational programs and public health initiatives focused on teen pregnancy prevention. Second, the association between adolescent obesity and preeclampsia merits further studies on the benefits of weight loss and dietary interventions to improve pregnancy outcome. Third, there is a need for greater awareness of the link between cardiovascular risk factors in young women and early-onset preeclampsia associated with atherosclerosis of the uteroplacental arteries. Finally, infrequent menstruations may prolong uterine immaturity because of lack of "menstrual preconditioning." This risk factor may be amenable to pharmacological/hormonal preconditioning prior to conception.

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The Unchartered Frontier: Preventive Cardiology Between the Ages of 15 and 35 Years

Cited by 10 publications

References 92 publications

Assessing success in transitioning of young adults from pediatric to adult kidney practice

Assessing success in transitioning of young adults from pediatric to adult kidney practice

Associations of Blood Pressure and Cholesterol Levels During Young Adulthood With Later Cardiovascular Events

Adolescent Preeclampsia: Pathological Drivers and Clinical Prevention

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