Tag: cardiovascular risk

Categories : Cardiovascular DiseaseTags :

Common Drug Class may Increase Cardiovascular Risk

On By ModernMedia
Photo by Stephen Foster on Unsplash

People who use drugs with anticholinergic effects, including certain antidepressants, drugs for urinary incontinence and common antihistamines, are at higher risk of developing cardiovascular disease. This is shown in a new study from Karolinska Institutet published in BMC Medicine.

Anticholinergic drugs reduce the effect of the neurotransmitter acetylcholine and are commonly prescribed to middle-aged and older people. This large group of drugs includes antihistamines used for allergic conditions, anxiety or insomnia, drugs for urinary incontinence, and certain antidepressants, where tricyclic antidepressants have a strong anticholinergic effect, whereas SSRIs have a weaker effect. A high cumulative use of these drugs, referred to as anticholinergic burden (see fact box), has previously been linked to impaired cognitive ability. 

May affect heart regulation 

The new study suggests that the drugs may also affect the parasympathetic nervous system and thereby the regulation of the cardiovascular system. The results show that it may be important to monitor the total drug burden in everyday clinical practice.

The study included more than 500 000 people in Stockholm who were 45 years of age or older and had no prior cardiovascular disease, except for hypertension, at the start of the study. The researchers followed the participants for up to 14 years and analysed how the use of anticholinergic drugs was associated with the development of cardiovascular disease.

“Many of these drugs are used by older people and by people with multiple medical conditions. We wanted to investigate whether the total exposure had any significance for the risk of developing cardiovascular disease over time,” says Nanbo Zhu, postdoctoral researcher at the Department of Neurobiology, Care Sciences and Society, Karolinska Institutet.

71 per cent higher cardiac risk

The study showed that the risk of cardiovascular disease increased in line with how much anticholinergic medication the participants used each year. Those with the highest exposure had a 71% higher risk of a cardiovascular event than people who did not use anticholinergic medication at all. The association was seen for all types of cardiovascular disease but was particularly clear for heart failure and various forms of arrhythmia.

“Our results indicate that the cumulative drug burden can affect heart regulation, not only in the short term but also over the long term. This does not mean that the drugs should always be avoided, but that exposure should be monitored carefully,” says Hong Xu, assistant professor at the Department of Neurobiology, Care Sciences and Society.

The researchers point out that the study is observational, meaning it cannot establish a causal relationship. Other factors, such as underlying diseases, may also influence the associations.

The work was carried out within the Stockholm CREAtinine Measurements project in collaboration between several research groups at Karolinska Institutet and Region Stockholm. The study was funded by the Swedish Research Council, the Center for Innovative Medicine Foundation, and other foundations.

Some researchers report assignments for the pharmaceutical industry, which are disclosed in the scientific publication.

Publication

“Anticholinergic drug burden and incident cardiovascular events: a population-based study”, Nanbo Zhu, Maria Eriksdotter, Bahira Shahim, Kristina Johnell, Sara Garcia-Ptacek, Juan-Jesus Carrero, Hong Xu, BMC Medicine, online 28 February 2026, doi: 10.1186/s12916-026-04751-w.

Facts about the drugs

Anticholinergic drugs in the study were identified based on the Anticholinergic Cognitive Burden (ACB) scale, a tool used in research and clinical contexts. The scale covers a wide range of different drugs that are scored between 1 and 3, depending on how much the drug blocks the neurotransmitter acetylcholine. The consumption of these drugs is added up to estimate a patient’s anticholinergic burden. The drugs included in ACB are listed in table S1 in the study’s supplementary information.

Source: Karolinska Institutet

Categories : Cardiovascular Disease Metabolic DisordersTags :

New Study Explains How Long-term Diabetes Causes Vascular Damage

On By ModernMedia
Source: CC0

The longer a person has type 2 diabetes, the greater the risk of cardiovascular disease. A new study from Karolinska Institutet, published in the journal Diabetes, shows that changes in red blood cells may be an important explanation, and identifies a specific molecule as a possible biomarker.

People with type 2 diabetes are at increased risk of heart attack and stroke, and the risk increases the longer they have lived with the disease. Previous research has shown that red blood cells can affect blood vessel function in diabetes. Now, a new study shows that the duration of the disease plays a decisive role in when and how these changes occur – and that long-term type 2 diabetes can make red blood cells directly harmful to blood vessels.

The researchers studied both animals and patients with type 2 diabetes. Red blood cells from mice with long-term diabetes and patients who had had the disease for over seven years had a harmful effect on blood vessel function. No such effect was seen in newly diagnosed individuals, but after seven years of follow-up, their blood cells had developed the same harmful properties. When the researchers restored the levels of microRNA-210 in the red blood cells, vascular function improved.

“What really stands out in our study is that it is not only the presence of type 2 diabetes that matters, but how long you have had the disease. It is only after several years that red blood cells develop a harmful effect on blood vessels,” says Zhichao Zhou, associate professor at the Department of Medicine, Solna, Karolinska Institutet, and lead author of the study.

The study points to microRNA-210 in red blood cells as a possible biomarker for early detection of the risk of cardiovascular complications. Researchers are now working to investigate whether this can be used in larger population studies.

“If we can identify which patients are at greatest risk before vascular damage has already occurred, we can also become better at preventing complications,” says Eftychia Kontidou, doctoral student from the same group and the first author of the study.

Source: Karolinska Institutet

Categories : Ageing Cardiovascular DiseaseTags :

Sitting for Long Stretches Raises Heart and Diabetes Risks – Even in Active Older Adults

On By ModernMedia
Photo by JD Mason on Unsplash

Spending too long sitting raises the risk of heart disease and diabetes in people over 60, warns a major global review. Published in the Journal of Physical Activity and Health, the review analysed data from 28 international studies involving 82 000 people aged 60 and older.

It flags strong links between sitting time and worsening markers for chronic disease including high blood sugar, cholesterol, waist size, and blood pressure. And that’s even for people who exercise regularly.

That means — whether watching TV, using a tablet or reading a book — the longer older people sit, the higher their risk of major health problems like heart disease, stroke, and type 2 diabetes.

“This is a link we can’t ignore,” said Dr Daniel Bailey, Reader in Sedentary Behaviour and Health at the Department of Life Sciences, Brunel University of London. “You can meet the weekly exercise target, but if you spend the rest of the day sitting, your health is still at risk.”

In the UK, where more than 12 million people are aged 65 or older, older adults can spend up to 80% of their waking hours sitting down and longer during winter or for people with mobility issues. That means millions may be unknowingly accumulating risks day after day — a concern for families, carers, and health professionals.

One of the most revealing findings was that the harmful effect of sitting for long periods showed up even in otherwise healthy older adults, not just those already diagnosed with illness. Waist measurement, a major predictor of health risk, had the strongest, most consistent link with sitting time.

“We’re seeing these impacts in people who don’t yet feel unwell,” said Dr Bailey. “That means we have a chance to intervene early and protect health before problems start.”

Importantly, the study found limited protective effect from exercise alone. After accounting for how active people were, the damage from long hours of sitting remains.

“The evidence is clear. We urgently need strategies that don’t just encourage exercise, but also help people sit less throughout the day,” said Dr Bailey. “Simple changes make a difference —standing during phone calls, replacing some TV time with gardening or a stroll, or light chores around the house.”

The study by Brunel University of London, the University of Lincoln, Federation University in Australia, and the University of Bedfordshire is the most comprehensive analysis to date linking sedentary behaviour to cardiometabolic risk in later life. As the NHS contends with rising rates of diabetes and heart disease, it spells out to policymakers that keeping moving throughout the day is as vital as structured exercise.

Dr Bailey stressed the shared role of public services, community groups and healthcare professionals to help older people avoid sitting for long stretches: “From GP advice to local councils and charities, there’s a role for everyone in changing the message.”

Source: Brunel University of London

Categories : Cardiovascular DiseaseTags :

The Cardiovascular Disease and Inflammation Link is ‘Clinically Actionable’

On By ModernMedia
Human heart. Credit: Scientific Animations CC4.0

A new ACC Scientific Statement on Inflammation and Cardiovascular Disease (CVD) highlights new groundbreaking research linking inflammation atherosclerotic cardiovascular disease (ASCVD) and provides consensus-based recommendations for evaluation, treatment and prevention reflecting this new era.

“The evidence linking inflammation with ASCVD is no longer exploratory but is compelling and clinically actionable,” write the authors, led by Writing Committee Chair George A. Mensah, MD, FACC. “The time for taking action has now arrived.”

Published in JACC, the Statement includes specific recommendations for screening, evaluation, and CVD risk assessment; inflammatory biomarkers in cardiovascular imaging; inflammation inhibition in behavioural and lifestyle risks; and anti-inflammatory approaches in primary and secondary prevention, as well as in heart failure and other cardiovascular diseases.

Among the key takeaways:

  • High-sensitivity C-reactive protein (hsCRP) is an inexpensive and widely available blood test. While there has been debate within the medical community regarding the utility of hsCRP, this statement details the data confirming its value in clinical decision making in primary and secondary prevention.
  • In patients with known CVD, hsCRP level is at least as predictive of future events as LDL cholesterol levels, even in patients treated with statin therapy.
  • The important role of lifestyle interventions to reduce systemic inflammation is emphasised, including regular exercise (at least 150 minutes/week), Mediterranean or DASH Diet, and intake of omega-3 fatty acids, including two to three meals per week of fatty fish high in EPA and DHA. This advice aligns with lifestyle management recommendations in the 2025 ACC/AHA High Blood Pressure Guideline

The Statement also discusses current challenges and opportunities based on the new evidence, exploring topics like the advancing field of cardioimmunology and areas for further research, such as the interplay between inflammation and key physiological systems, the role of novel special pro-resolving bioactive lipid molecules in promoting the resolution of inflammation and CVD risk reduction, and more.

The authors close with a call for action to “embrace anti-inflammatory interventions in patients with established ASCVD” and for clinical practice guidelines that implement “broad screening of primary and secondary prevention patients for hsCRP, in combination with LDL cholesterol.” Additionally, they note: “The time is also ripe for the development of strategies to promote increased physician awareness of the crucial role of inflammation in CVD and accelerate the adoption of evidence-based, guideline-directed anti-inflammatory therapy through dissemination and implementation research.”

Read the full statement.

Source: American College of Cardiology

Categories : Cardiovascular DiseaseTags :

Low-dose Colchicine May Reduce Risk of Heart Attack and Stroke

On By ModernMedia

Researchers found that low-dose colchicine can be used to reduce heart attacks and strokes in high-risk patients

Photo by Towfiqu Barbhuiya on Unsplash

A widely-used, inexpensive gout drug could reduce heart attacks and strokes in people with cardiovascular disease, according to a new Cochrane review.

The review examined the effects of low doses of colchicine, a drug used to treat gout, and found no increase in serious side effects.

Cardiovascular disease is often driven by chronic low-grade inflammation, which contributes to recurrent cardiovascular events such as heart attacks and strokes. Colchicine has anti-inflammatory properties that make it a promising option for people with heart disease. 

A promising effect on cardiovascular risk

The review included 12 randomised controlled trials involving nearly 23 000 people with a history of heart disease, heart attack or stroke. The studies looked at patients who took colchicine for at least six months, with doses of 0.5mg once or twice a day. Most participants were male (~80%) and the mean age was 57 to 74 years old. Half received colchicine, while the other half received either a placebo or no additional treatment alongside their usual care.

Overall, those taking low-dose colchicine were less likely to experience a heart attack or stroke. For every 1000 people treated, there were 9 fewer heart attacks and 8 fewer strokes compared with those not taking the drug. Whilst there were no serious adverse events identified, patients who took colchicine were more likely to have stomach or digestive side effects, but these were usually mild and didn’t last long.

Among 200 people with cardiovascular disease – where we would normally expect around seven heart attacks and four strokes – using low-dose colchicine could prevent about two of each. Reductions like this can make a real difference for patients who live with ongoing, lifelong cardiovascular risk.

– Dr Ramin Ebrahimi, co-lead author from the University Medicine Greifswald, Germany

A new use for a long-established medicine

As cardiovascular diseases are the leading cause of death globally, colchicine presents a promising inexpensive and accessible option for secondary prevention in high-risk patients.

These results come from publicly funded trials repurposing a very old, low-cost drug for an entirely new use. It shows the power of academic research to reveal treatment opportunities that traditional drug development often overlooks.

 – Lars Hemkens, senior author from the University of Bern, Switzerland

The evidence is less clear when it comes to whether colchicine affects overall death rates or the need for procedures like coronary revascularisation. The studies didn’t provide any information to say whether the drug improves quality of life or reduces hospital stays. The authors stress that further research is needed in these areas.

Source: Cochrane

Categories : Cardiovascular Disease Metabolic DisordersTags :

Waist-to-Height Ratio Better than BMI at Predicting Cardiovascular Risk

On By ModernMedia
Photo by Andres Ayrton on Pexels

The ratio of a person’s waist measurement compared to their height is more reliable than body mass index (BMI) at predicting heart disease risk, according to new research from UPMC and University of Pittsburgh physician-scientists. 

This finding, published out now in The Lancet Regional Health—Americas, could reshape how clinicians and the public assess cardiovascular risk, especially for people who don’t meet the classic definition of obesity. 

The team analysed data from 2721 adults who had participated in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The individuals had no cardiovascular disease at baseline and were followed for more than five years. 

“Higher BMI, waist circumference and waist-to-height ratio at baseline were all associated with higher risk of developing future cardiovascular disease – until we adjusted for other classic risk factors, such as age, sex, smoking, exercise, diabetes, hypertension and cholesterol,” said lead author Thiago Bosco Mendes, clinical instructor of medicine at Pitt and obesity medicine fellow at UPMC. “When we did that, only waist-to-height ratio held as a predictor.” 

Much of that predictive power is concentrated among individuals with a BMI under 30, which is below the classic threshold for obesity, who may not realise they are at risk for cardiovascular disease.  

BMI doesn’t account for fat distribution or distinguish between harmful, visceral fat and protective, subcutaneous fat. By contrast, waist-to-height ratio (WHtR), calculated by dividing waist circumference by height, directly reflects central obesity, which is more closely linked to heart disease. That means that people with a BMI lower than 30, but a WHtR over 0.5, may be at higher risk of future coronary artery calcification, a key marker of cardiovascular disease, even in the absence of other risk factors. 

“Using waist-to-height ratio as a cardiovascular screening tool could lead to earlier identification and intervention for at-risk patients who might otherwise be missed,” said senior author Marcio Bittencourt, associate professor of medicine at Pitt and cardiologist at UPMC. “It’s a simple and powerful way to spot heart disease risk early, even if a patient’s weight, cholesterol and blood pressure all seem normal.” 

Source: University of Pittsburgh School of Medicine

Categories : Ageing ExerciseTags :

Number of Steps Matters More for Older Women’s Health than the Frequency

On By ModernMedia

4000 steps once/twice weekly is associated with 26% lower risk of death rising to 40% if done on 3 days of the week – but it’s daily step count rather than number of days that matters, findings suggest 

Photo by Teona Swift on Unsplash

Clocking up at least 4000 daily steps on just 1 or 2 days per week is linked to a lower risk of death and cardiovascular disease among older women, according to research published online in the British Journal of Sports Medicine.

This large prospective study examined not only how many steps older women take but how often they reach their step targets across the week, addressing a key gap in current physical activity guidelines.

Researchers found that achieving at least 4000 steps per day on 1-2 days per week was associated with a significantly lower risk of death and lower risk of cardiovascular disease (CVD), compared with not reaching this level on any day.

A large body of evidence shows that lifelong physical activity is important for improving the healthspan, say the researchers. But it’s not entirely clear how much physical activity people should do as they age to reap appreciable health benefits, particularly in respect of step counts which are yet to make it into physical activity guideline recommendations, they add.

To explore this further, they set out to look at the associations between daily step counts of between 4000 and 7000 and death from all causes and from cardiovascular disease in older women.

They also wanted to find out if the total number of daily steps might drive any observed associations, rather than the frequency of achieving step count thresholds, with a view to informing future guidelines–in particular the US Physical Activity Guidelines, the next edition of which is planned for 2028.

The study followed 13547 women (average age 71) from the US Women’s Health Study who wore accelerometers (activity trackers) for seven consecutive days between 2011–2015 and were tracked for nearly 11 years. The women were free of cardiovascular disease or cancer at the start of the study.

During the monitoring period of nearly 11 years up to the end of 2024, 1765 women (13%) died and 781 (5%) developed cardiovascular disease.

Clocking up at least 4000 steps/day on 1–2 days of the week was associated with a 26% lower risk of death from all causes and a 27% lower risk of a cardiovascular disease death compared with not reaching this threshold on any day of the week.

For those achieving this step count on at least 3 days of the week, the lower risk of death from any cause increased to 40%, but remained at 27% for the risk of cardiovascular death.

But while higher daily step counts of 5000 to 7000 on 3 or more days of the week were associated with a further fall in all-cause mortality risk (32%) they were associated with a levelling out in cardiovascular disease mortality risk (16%).

When the findings were adjusted to take account of average daily steps, previously observed associations weakened, suggesting that [average] steps is the key driver of the protective effect, suggest the researchers.

This is an observational study, and as such, no firm conclusions can be drawn about cause and effect. The researchers also acknowledge that physical activity was assessed only for 1 week, and therefore couldn’t account for variations in behaviour over longer periods, nor did they have information on dietary patterns.

Nevertheless, they suggest: “The present study….suggests that frequency of meeting daily step thresholds is not critical (even 1–2 days/week of ≥4000 steps/day was related to lower mortality and CVD), and that step volume is more important than the frequency of meeting daily step thresholds in the older population.”

And they go on to explain: “An important translational implication of these findings is that since step volume is the important driver of the inverse associations, there is no ‘better’ or ‘best’ pattern to take steps; individuals can undertake [physical activity] in any preferred pattern (eg, ‘slow and steady’ vs ‘bunched patterns’) for lower mortality and CVD risk, at least among older women.”

They conclude: “These findings provide additional evidence for considering including step metrics in the next [physical activity] guidelines, and that ‘bunching’ steps is a viable option for health.”

Source: BMJ Group

Categories : Metabolic Disorders Surgeries & ProceduresTags :

Study Shows Greater Long-Term Benefits of Bariatric Surgery Compared to GLP-1 RAs

On By ModernMedia
Sleeve gastrectomy. Credit: Scientific Animations CC4.0

A large Cleveland Clinic study has found that people with obesity and type 2 diabetes who undergo weight-loss surgery live longer and face fewer serious health problems compared with those treated with GLP-1 receptor agonist medicines alone.

Patients who had weight-loss surgery (also known as bariatric or metabolic surgery) lost more weight, achieved better blood sugar control, and relied less on diabetes and heart medications over 10 years. The research is published in Nature Medicine.

“Even with today’s best medicines, metabolic surgery offers unique and lasting benefits for people with obesity and diabetes,” said Ali Aminian, MD, director of Cleveland Clinic’s Bariatric & Metabolic Institute and primary investigator of the study. “The benefits we observed went beyond weight loss. Surgery was linked to fewer heart problems, less kidney disease, and even lower rates of diabetes-related eye damage.”

GLP-1 (glucagon-like peptide-1) receptor agonists are a class of medications widely used to treat type 2 diabetes and obesity and to reduce health risks. Both metabolic surgery and GLP-1 medicines improve cardiovascular health and metabolism.

The M6 study (Macrovascular and Microvascular Morbidity and Mortality after Metabolic Surgery versus Medicines) followed 3932 adults with diabetes and obesity who received care at Cleveland Clinic for up to 10 years. Among them, 1657 underwent metabolic surgery (including gastric bypass or sleeve gastrectomy), while 2275 were treated with GLP-1 medicines (including liraglutide, dulaglutide, exenatide, semaglutide, and tirzepatide).

At the end of the study, patients who had metabolic surgery had a:

  • 32% lower risk of death
  • 35% lower risk of major heart problems (such as heart attack, heart failure, or stroke)
  • 47% lower risk of serious kidney disease
  • 54% lower risk of diabetes-related eye damage (retinopathy)

On average, people who had metabolic surgery lost 21.6% of their body weight over 10 years, compared with 6.8% weight loss in people who took GLP-1 medicines. Hemoglobin A1c, a marker of average blood sugar, improved more with surgery (-0.86%) than with GLP-1 medicines (-0.23%). Patients in the surgery group also required fewer prescriptions for diabetes, blood pressure, and cholesterol.

“Even in the era of these powerful new drugs to treat obesity and diabetes, metabolic surgery may provide additional benefits, including a survival advantage,” said Steven Nissen, MD, Chief Academic Officer of the Heart, Vascular & Thoracic Institute at Cleveland Clinic and senior author of the study.

“Our findings indicate that surgery should remain an important treatment option for obesity and diabetes,” said Dr Aminian. “These long-term benefits are harder to achieve with GLP-1 medicines alone, as many patients stop using the medications over time.”

According to the authors, the study has some limitations. It was observational rather than a randomized comparison of drugs and surgery, and it did not focus exclusively on the newest and most effective GLP-1 medicines. The researchers note that future studies should directly compare surgery with newer GLP-1 therapies, such as semaglutide and tirzepatide, to further guide treatment decisions.

Source: Cleveland Clinic

Categories : Ageing Cardiovascular DiseaseTags :

New Research Finds Visceral Fat is Linked to Heart Ageing

On By ModernMedia
Photo by Anna Shvets

Excessive amounts of visceral fat, the hidden fat surrounding organs, is linked with faster ageing of the heart, a new study has found. Ageing is the biggest risk factor for heart disease but why some people age faster than others isn’t fully understood.

The scientists leading the research, which is published in the European Heart Journal, say that visceral body fat could play an important role in accelerating ageing of the heart and blood vessels. This type of fat is known to be harmful to health and this study now links it to faster heart ageing.

Sex differences

The study, led by scientists from the Medical Research Council (MRC) Laboratory of Medical Sciences, also found differences between men and women. They discovered that fat around the hips and thighs could potentially slow heart ageing in women. The scientists analysed data from 21 241 participants in UK Biobank, which includes whole body imaging to map the amount of fat and where it is located in the body. The study was

Determining an individual’s ‘heart age’

The UK Biobank data also includes detailed imaging of the heart and blood vessels. Artificial intelligence (AI) was used to analyse these images to capture signs of organ ageing such as tissues becoming stiff and inflamed. An individual was given a ‘heart age’ which can be compared to their actual age at the time of the scan.

The risks of ‘hidden’ fat

The researchers found that faster heart ageing was linked to having more visceral adipose tissue. Visceral adipose tissue is fat found deep inside the abdomen around organs such as the stomach, intestines, and liver. This type of fat cannot be seen from the outside, and some people can have large amounts of visceral fat despite having a healthy weight.

Premature ageing

The researchers found signs on blood tests that visceral fat is linked to increased inflammation in the body, which is a potential cause of premature ageing. They also found differences between the sexes. Male-type fat distribution, which is fat around the belly and often called ‘apple-shaped’, was particularly predictive of early ageing in men.

The role of hormones

In contrast, a genetic predisposition to female-type fat, primarily fat on the hips and thighs, often called ‘pear-shaped’, was protective against heart ageing in women. The researchers also found a link between higher oestrogen levels in pre-menopausal women and a slowing of heart ageing. They suggested that this could indicate a role for hormones in protecting against heart ageing.

Increasing healthy lifespan

Professor Declan O’Regan, who led the research at the MRC Laboratory of Medical Sciences and Imperial College London, said:

We have known about the apple and pear distinction in body fat, but it hasn’t been clear how it leads to poor health outcomes. Our research shows that ‘bad’ fat, hidden deep around the organs, accelerates ageing of the heart.

But some types of fat could protect against ageing, specifically fat around the hips and thighs in women.

We also showed that body mass index wasn’t a good way of predicting heart age which underscores the importance of knowing where fat is stored in the body and not just total body weight.

The goal of our research is to find ways to increase healthy lifespan. While being active is important, we found that hidden fat could still be harmful even in fit people.

In the future, we plan to investigate how drug therapies, such as GLP-1 inhibitors (for example, Ozempic) could improve not just diabetes and obesity but target the ageing effects of hidden visceral fat.

Source: UK Research Institute

Categories : Cardiovascular Disease PaediatricsTags :

Higher Blood Pressure in Childhood Linked to Earlier Adulthood Heart Disease Mortality

On By ModernMedia
Photo by Ben Wicks on Unsplash

Blood pressure matters at all ages. Children with higher blood pressure at age 7 may be at an increased risk of dying of cardiovascular disease by their mid-50s,  according to preliminary research presented at the American Heart Association’s Hypertension Scientific Sessions 2025. The study is simultaneously published in JAMA.

“We were surprised to find that high blood pressure in childhood was linked to serious health conditions many years later. Specifically, having hypertension or elevated blood pressure as a child may increase the risk of death by 40% to 50% over the next five decades of an individual’s life,” said Alexa Freedman, Ph.D., lead author of the study and an assistant professor in the department of preventive medicine at the Northwestern University’s Feinberg School of Medicine in Chicago. “Our results highlight the importance of screening for blood pressure in childhood and focusing on strategies to promote optimal cardiovascular health beginning in childhood.”

Previous research has shown that childhood blood pressure is associated with an increased risk of cardiovascular disease in adulthood, and a 2022 study found that elevated blood pressure in older children (average age of 12 years) increased the risk of cardiovascular death by middle age (average age of 46 years). The current study is the first to investigate the impact of both systolic (top number) and diastolic (bottom number) blood pressure in childhood on long-term cardiovascular death risk in a diverse group of children. Clinical practice guidelines from the American Academy of Pediatrics recommend checking blood pressure at annual well-child pediatric appointments starting at age 3 years.

“The results of this study support monitoring blood pressure as an important metric of cardiovascular health in childhood,” said Bonita Falkner, MD, FAHA, an American Heart Association volunteer expert. “Moreover, the results of this study and other older child cohort studies with potential follow-up in adulthood will contribute to a more accurate definition of abnormal blood pressure and hypertension in childhood.” Falkner, who was not involved in this study, is emeritus professor of paediatrics and medicine at Thomas Jefferson University.

The researchers used the National Death Index to follow up on the survival or cause of death as of 2016 for approximately 38,000 children who had their blood pressures taken at age 7 years as part of the Collaborative Perinatal Project (CPP), the largest US study to document the influence of pregnancy and post-natal factors on the health of children. Blood pressure measured in the children at age 7 years were converted to age-, sex-, and height-specific percentiles according to the American Academy of Pediatrics clinical practice guidelines. The analysis accounted for demographic factors as well as for childhood body mass index, to ensure that the findings were related to childhood blood pressure itself rather than a reflection of children who were overweight or had obesity.

After follow-up through an average age of 54 years, the analysis found: 

  • Children who had higher blood pressure (age-, sex-, and height-specific systolic or diastolic blood pressure percentile) at age 7 were more likely to die early from cardiovascular disease as adults by their mid-50s. The risk was highest for children whose blood pressure measurements were in the top 10% for their age, sex and height.
  • By 2016, a total of 2,837 participants died, with 504 of those deaths attributed to cardiovascular disease.
  • Both elevated blood pressure (90-94th percentile) and hypertension (≥ 95th percentile) were linked with about a 40% to 50% higher risk of early cardiovascular death in adulthood.
  • Moderate elevations in blood pressure were also important, even among children whose blood pressure was still within the normal range. Children who had blood pressures that were moderately higher than average had a 13% (for systolic) and 18% (for diastolic) higher risk of premature cardiovascular death.
  • Analysis of the 150 clusters of siblings in the CPP found that children with the higher blood pressure at age 7 had similar increases in risk of cardiovascular death when compared to their siblings with the lower blood pressure readings (15% increase for systolic and 19% for diastolic), indicating that their shared family and early childhood environment could not fully explain the impact of blood pressure.

“Even in childhood, blood pressure numbers are important because high blood pressure in children can have serious consequences throughout their lives. It is crucial to be aware of your child’s blood pressure readings,” Freedman said.

The study has several limitations, primarily that the analysis included one, single blood pressure measurement for the children at age seven, which may not capture variability or long-term patterns in childhood blood pressure. In addition, participants in the CPP were primarily Black or white, therefore the study’s findings may not be generalisable to children of other racial or ethnic groups. Also, children today are likely to have different lifestyles and environmental exposures than the children who participated in the CPP in the 1960s and 1970s.

Study details, background and design:  

  • 38 252 children born to mothers enrolled at one of 12 sites across the U.S. as part of the Collaborative Perinatal Project between 1959-1965. 50.7% of participants were male; 49.4% of mothers self-identified as Black, 46.4% reported as white; and 4.2% of participants were Hispanic, Asian or other groups.
  • This analysis reviewed blood pressure taken at age 7, and these measures were converted to age-, sex-, and height-specific percentiles according to the American Academy of Pediatrics Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents.
  • Survival through 2016 and the cause of death for the offspring of CPP participants in adulthood were retrieved through the National Death Index.
  • Survival analysis was used to estimate the association between childhood blood pressure and cardiovascular death, adjusted for childhood body mass index, study site, and mother’s race, education and marital status.
  • In addition, the sample included 150 groups of siblings, and the researchers examined whether the sibling with higher blood pressure was more likely to die of cardiovascular disease than the sibling with lower blood pressure. This sibling analysis allowed researchers to ask how much shared family and early childhood factors might account for the mortality risk related to blood pressure.  

Source: American Heart Association