Aris Izzuddin M, Rifas-Shiman Sheryl L, Perng Wei, Yi Li, de Ferranti Sarah D, Hivert Marie-France, Oken Emily
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora.
JAMA Cardiol. 2025 May 1;10(5):417-426. doi: 10.1001/jamacardio.2024.4022.
The American Heart Association put forth the Life's Essential 8 construct to assess cardiovascular health (CVH) based on 8 behavioral and health factors. Few studies have characterized the natural history of CVH in early life or identified its sociodemographic determinants.
To characterize CVH trajectories across childhood and adolescence and identify associations with sociodemographic variables.
DESIGN, SETTING, AND PARTICIPANTS: This study used data from the Project Viva prebirth cohort, an ongoing prospective prebirth cohort study conducted in a large multispecialty group practice in eastern Massachusetts among women who were pregnant and enrolled from April 1999 to November 2002. Participant inclusion required 3 or more CVH metrics in early childhood (median [range] age, 3.2 [2.8-6.2] years) or 4 metrics or more in midchildhood (median [range] age, 7.7 [6.6-10.9] years), early adolescence (median [range] age, 13.0 [11.9-16.6] years), or late adolescence (median [range] age, 17.5 [15.4-20.1] years). Of 2218 live births in the original cohort, 1523 were included in the present analysis. Data were analyzed from June to December 2023.
Child sex, race, and ethnicity; maternal education; and household income.
CVH score (0-100 points) from early childhood to late adolescence, calculated as the unweighted average of all available CVH metrics at each life stage.
Among 1523 children, 782 (51.4%) were male; 53 (3.5%) were non-Hispanic Asian, 231 (15.2%) were non-Hispanic Black, 988 (65.0%) were non-Hispanic White, and 175 (11.5%) were non-Hispanic other. The mean (SD) CVH score was 82.6 (8.6) in early childhood, 84.1 (8.3) in midchildhood, 82.0 (9.8) in early adolescence, and 73.8 (11.5) in late adolescence. The estimated mean (SD) age of inflection when CVH score declined was 10.1 (0.7) years for male children and 10.0 (0.6) years for female children; the decline in CVH was associated with health behaviors rather than health factors. Male children (vs female children) had faster CVH score gain before the inflection (β, 0.79 points/year; 95% CI, 0.67 to 0.91) and faster CVH score decline after the inflection (β, -0.33 points/year; 95% CI, -0.44 to -0.22). Non-Hispanic Black children (β, 0.32 years; 95% CI, 0.20 to 0.43) and children of other non-Hispanic races (β, 0.16 years; 95% CI, 0.05 to 0.28) children had later timing of inflection compared with non-Hispanic White children. Children of mothers without (vs with) a college degree or with household income $70 000 per year or less (vs greater than $70 000/year) exhibited lower CVH trajectory throughout childhood. Children of mothers with some college education (vs a college degree) had later timing of inflection (β, 0.16 years; 95% CI, 0.07 to 0.26) and slower CVH score gain before the inflection (β, -0.24 points/year; 95% CI, -0.40 to -0.08).
This study provides insight into the trajectory of CVH early in life, which may contribute to CVH disparities in adulthood, and identified modifiable health behaviors for focused prevention efforts to optimize CVH in early life.
美国心脏协会提出了“生命的基本八项”指标，用于基于8项行为和健康因素评估心血管健康（CVH）。很少有研究描述生命早期CVH的自然史，或确定其社会人口学决定因素。
描述儿童期和青少年期CVH的轨迹，并确定与社会人口学变量的关联。
设计、地点和参与者：本研究使用了来自“生命全程项目”产前队列的数据，这是一项正在进行的前瞻性产前队列研究，在马萨诸塞州东部的一个大型多专科医疗集团中开展，研究对象为1999年4月至2002年11月期间怀孕并登记入组的女性。参与者需在幼儿期（年龄中位数[范围]，3.2[2.8 - 6.2]岁）有3项或更多CVH指标，或在童年中期（年龄中位数[范围]，7.7[6.6 - 10.9]岁）、青春期早期（年龄中位数[范围]，13.0[11.9 - 16.6]岁）或青春期晚期（年龄中位数[范围]，17.5[15.4 - 20.1]岁）有4项或更多指标。在最初队列的2218例活产中，1523例纳入本分析。数据于2023年6月至12月进行分析。
儿童性别、种族和族裔；母亲教育程度；以及家庭收入。
从幼儿期到青春期晚期的CVH评分（0 - 100分），计算方法为每个生命阶段所有可用CVH指标的未加权平均值。
在1523名儿童中，782名（51.4%）为男性；53名（3.5%）为非西班牙裔亚裔，231名（15.2%）为非西班牙裔黑人，988名（65.0%）为非西班牙裔白人，175名（11.5%）为非西班牙裔其他种族。幼儿期CVH评分的平均值（标准差）为82.6（8.6），童年中期为84.1（8.3），青春期早期为82.0（9.8），青春期晚期为73.8（11.5）。CVH评分下降时的估计平均（标准差）拐点年龄男性儿童为10.1（0.7）岁，女性儿童为10.0（0.6）岁；CVH的下降与健康行为而非健康因素相关。男性儿童（与女性儿童相比）在拐点前CVH评分增加更快（β，0.79分/年；95%置信区间，0.67至0.91），在拐点后CVH评分下降更快（β，-0.33分/年；95%置信区间，-0.44至-0.22）。与非西班牙裔白人儿童相比，非西班牙裔黑人儿童（β，0.32岁；95%置信区间，0.20至0.43）和其他非西班牙裔种族儿童（β，0.16岁；95%置信区间，0.05至0.28）的拐点出现时间较晚。母亲没有大学学位（与有大学学位相比）或家庭年收入70000美元及以下（与高于70000美元/年相比）的儿童在整个童年期的CVH轨迹较低。母亲接受过一些大学教育（与大学学位相比）的儿童拐点出现时间较晚（β，0.16岁；95%置信区间，0.07至0.26），且在拐点前CVH评分增加较慢（β，-0.24分/年；95%置信区间，-0.40至-0.08）。
本研究深入了解了生命早期CVH的轨迹，这可能导致成年期CVH的差异，并确定了可改变的健康行为，以便进行有针对性的预防努力，在生命早期优化CVH。
