Cardiovascular Risk and the American Dream: Life Course Observations From the BHS (Bogalusa Heart Study)

Benjamin D Pollock, Emily W Harville, Katherine T Mills, Wan Tang, Wei Chen, Lydia A Bazzano, Benjamin D Pollock, Emily W Harville, Katherine T Mills, Wan Tang, Wei Chen, Lydia A Bazzano

Abstract

Background: Economic literature shows that a child's future earnings are predictably influenced by parental income, providing an index of "socioeconomic mobility," or the ability of a person to move towards a higher socioeconomic status from childhood to adulthood. We adapted this economic paradigm to examine cardiovascular risk mobility (CRM), or whether there is life course mobility in relative cardiovascular risk.

Methods and results: Participants from the BHS (Bogalusa Heart Study) with 1 childhood and 1 adult visit from 1973 to 2016 (n=7624) were considered. We defined population-level CRM as the rank-rank slope (β) from the regression of adult cardiovascular disease (CVD) risk percentile ranking onto childhood CVD risk percentile ranking (β=0 represents complete mobility; β=1 represents no mobility). After defining and measuring relative CRM, we assessed its correlation with absolute cardiovascular health using the American Heart Association's Ideal Cardiovascular Health metrics. Overall, there was substantial mobility, with black participants having marginally better CRM than whites (βblack=0.10 [95% confidence interval, 0.05-0.15]; βwhite=0.18 [95% confidence interval, 0.14-0.22]; P=0.01). Having high relative CVD risk at an earlier age significantly reduced CRM (βage×slope=-0.02; 95% confidence interval, -0.03 to -0.01; P<0.001). Relative CRM was strongly correlated with life course changes in Ideal Cardiovascular Health sum (r=0.62; 95% confidence interval, 0.60-0.65).

Conclusions: Results from this novel application of an economic mobility index to cardiovascular epidemiology indicated substantial CRM, supporting the paradigm that life course CVD risk is highly modifiable. High CRM implies that the children with the best relative CVD profiles may only maintain a slim advantage over their peers into adulthood.

Keywords: epidemiology; pediatric; risk; risk factors/global assessment.

© 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Figures

Figure 1
Figure 1
Adjusted rank‐rank slope by race and age. Adjusted for race, sex, rank, age×rank interaction, race×rank interaction, and follow‐up time. CVD indicates cardiovascular disease.
Figure 2
Figure 2
Correlation between relative cardiovascular risk mobility and ideal cardiovascular disease (CVD) health. r=0.710 indicates Pearson's correlation coefficient for the full model; partial correlation for change in cardiovascular risk percentile ranking only was r=0.62 (95% confidence interval [CI], 0.60–0.65). ICH indicates Ideal Cardiovascular Health.

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