FAMINE EXPOSURE IN EARLY-LIFE AND HIGH CARDIOVASCULAR RISK IN ADULTHOOD: FINDINGS FROM THE CHINA PATIENT-CENTERED EVALUATIVE ASSESSMENT OF CARDIAC EVENTS MILLION PERSONS PROJECT

Abstract

Objective: Previous studies reported that early-life exposure to undernutrition play key roles in the development of metabolic diseases, but the association with high cardiovascular disease (CVD) risk in later life remains unclear. We aimed to investigate whether exposure to famine in early life is associated with high cardiovascular disease (CVD) risk in adulthood. Design and method: This study included 85,473 participants from the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project in southern China who were born around the time of the Chinese Great Famine. They were divided into four famine exposure groups according to the birth year, including nonexposed (1963–1974), fetal exposed (1959–1962), childhood exposed (1949–1958), and adolescent exposed (1941–1948). High CVD risk was defined as having previous heart disease or a predicted 10-year risk of CVD greater than 20% based on the WHO/ISH criteria. Logistic regression models were used to examine the association between famine exposure and high CVD risk. Results: Among the participants included, 4.6% (3893) participants had high risk for CVD, including 2543 (3.0%) participants had a predicted 10-year risk of CVD greater than 20%. Compared with the nonexposed group, childhood-exposed and adolescent exposed but not fetal-exposed participants had increased risk of having high CVD risk in adulthood, with odd ratios (ORs) (95% CIs) of 1.40 (1.15–1.70), 1.43 (1.07–1.90) and 1.14 (0.97–1.33), respectively, after adjusting for age and other covariates. For individuals without previous heart disease, fetal, childhood, and adolescent famine exposure were associated with higher likelihood of predicted 10-year risk of CVD greater than 20%, with multivariable-adjusted ORs (95%CI) of 1.34 (1.08–1.66), 2.17 (1.69–2.78), and 2.84 (1.98–4.07). Sensitivity analysis showed similar results by combining the relatively older and younger age group as the reference, which neutralized the age gap between the nonexposed group and the exposed groups in the main analysis. Conclusions: Early-life exposure to famine is significantly associated with higher risk of developing CVD in later life. These findings have important epidemiological and clinical implications on the understanding and prevention of CVD.