Abstract
Background: We previously adapted a methodology from literature on socioeconomic mobility (the “American Dream”) to develop an analogous concept of Cardiovascular (CV) Risk Mobility (CRM: movement across CV risk rankings during aging) in the Bogalusa Heart Study (BHS). We found high mobility, such that childhood CV risk burden tracks into adulthood, but not so strongly that a low CV-risk stratum in adulthood is unreachable. Because geopolitical, ethnic, and healthcare differences may affect mobility in life course CV health, we sought to further test CRM using an international consortium. Methods: We used prospective data from n=20,685 children followed into adulthood (inverse probability weighted, n=6,029 with adult follow-up) from the 1970s-2010s in three of the i3C Consortium cohorts: BHS, the Young Finns Study (YFS), and the Muscatine Study. During childhood (age 5-18 yr), participants were percentile-ranked by their CV risk factor burden using an age- and sex-adjusted sum of z-scores from total cholesterol, systolic blood pressure, BMI, and triglycerides. During adult follow-up (age 40-55 yr), participants were percentile-ranked using the Framingham score. The rank-rank slope (β) from the regression of adult/child percentile rankings forms the measure of CRM. Results: Patterns of CRM were similar to BHS in both YFS [β=.15 (95% CI: .12, .18) at age 10] and Muscatine [β=.14 (95% CI: .09, .19) at age 10]. Pooled results of age/rank interaction were significant ( p =0.005), indicating a pattern of lower CRM (more tracking) earlier in childhood. The pooled β=.15 (95% CI: .14, .16)], meaning that a child ranked 10 percentiles better was only 1.5 percentiles better as an adult. Conclusions: Populations in the developed world track, yet exhibit large mobility in CV risk. Children are readily able to move from both high to low and low to high CV risk strata over the life course. The earlier children develop a high CV risk factor burden relative to their peers, the lower their mobility, or opportunity to “catch up,” into adulthood.
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