Department of Public Health Sciences, University of Miami, Miami, FL, USA.
Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA.
Int J Epidemiol. 2019 Jun 1;48(3):1004-1013. doi: 10.1093/ije/dyy264.
In designing prevention strategies, it may be useful to understand how early and midlife cardiovascular disease risk factor (CVDRF) exposures affect outcomes that primarily occur in mid to late life. Few single US cohorts have followed participants from early adulthood to late life.
We pooled four prospective cohorts that represent segments of the adult life course, and studied 15 001 White and Black adults aged 18 to 95 years at enrollment. We imputed early and midlife exposure to body mass index (BMI), glucose, lipids and blood pressure (BP). CVDRF trajectories were estimated using linear mixed models. Using the best linear unbiased predictions, we obtained person-specific estimates of CVDRF trajectories beginning at age 20 until each participant's end of follow-up. We then calculated for each CVDRF, summary measures of early and midlife exposure as time-weighted averages (TWAs).
In the pooled cohort, 33.7% were Black and 54.8% were female. CVDRF summary measures worsened in midlife compared with early life and varied by sex and race. In particular, systolic and diastolic BP were consistently higher over the adult life course among men, and BMI was higher among Blacks, particularly Black women. Simulation studies suggested acceptable imputation accuracy, especially for the younger cohorts. Correlations of true and imputed CVDRF summary measures ranged from 0.53 to 0.99, and agreement ranged from 67% to 99%.
These results suggest that imputed CVDRFs may be accurate enough to be useful in assessing the effects of early and midlife exposures on later life outcomes.
在设计预防策略时，了解心血管疾病风险因素（CVDRF）在早期和中年的暴露如何影响主要发生在中年后期的结局，可能会有所帮助。很少有单一的美国队列能够从成年早期跟踪参与者到晚年。
我们汇集了四个代表成人生活轨迹部分的前瞻性队列，并研究了 15001 名年龄在 18 至 95 岁之间的白人和黑人成年人。我们采用线性混合模型估算了早期和中年时期的体重指数（BMI）、血糖、血脂和血压（BP）的暴露情况。采用最佳线性无偏预测值，我们获得了从 20 岁开始到每个参与者随访结束时每个人的 CVDRF 轨迹的个体估计值。然后，我们为每个 CVDRF 计算了早期和中年暴露的综合指标，作为时间加权平均值（TWAs）。
在汇总队列中，33.7%为黑人，54.8%为女性。与生命早期相比，中年 CVDRF 综合指标恶化，且因性别和种族而异。特别是在男性中，收缩压和舒张压在整个成年期一直较高，而 BMI 在黑人中较高，尤其是黑人女性。模拟研究表明，插补的 CVDRF 综合指标具有可接受的准确性，尤其是在年轻队列中。真实和插补的 CVDRF 综合指标的相关性范围从 0.53 到 0.99，一致性范围从 67%到 99%。
这些结果表明，插补的 CVDRF 可能足够准确，可用于评估早期和中年暴露对晚年结局的影响。
