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The following is a summary of “A Clinical Tool to Relate Youth Risk Factors to Adult Cardiovascular Events and Type 2 Diabetes: The i3C Consortium,” published in the September 2024 issue of Pediatrics by Haley et al.

This study aims to bridge the gap between childhood cardiovascular (CV) risk factors and their implications for adult cardiovascular disease and type 2 diabetes mellitus (T2DM), translating these into clinically actionable values. Conducted as a prospective observational study within the International Childhood Cardiovascular Cohort (i3C) Consortium, it involved 38,589 participants enrolled in the 1970s and 1980s, with follow-up extending over 30 years. The study examined five key childhood CV risk factors—smoking, body mass index (BMI), systolic blood pressure (SBP), triglycerides (TG), and total cholesterol (TC)—about adult cardiovascular events. A secondary analysis in a subset of participants included metrics such as low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), glucose, and insulin levels.

To facilitate clinical interpretation, age- and sex-specific z-scores for each risk factor were computed, and a combined-risk z-score was derived by averaging the z-scores of the five primary risk factors. These z-scores were then back-transformed to natural units, with hazard ratios for adult CV events categorized into risk levels (green: no increased risk; orange: 1.4 to <2.0-fold increased risk; red: at least doubling risk). Similarly, risk levels for adult T2DM were assessed and presented based on BMI, glucose, and insulin. Results indicated that elevated risk for cardiovascular events was associated with childhood risk factors lower than current clinical thresholds, except for TC, where the risk increased significantly at high-normal levels just below the abnormality cut-off. 

The risk for adult T2DM was also evident at BMI and glucose levels, which are currently deemed normal. This study underscores significant cardiovascular and metabolic risks in childhood at levels previously considered within normal ranges, highlighting the need for early intervention and revised clinical thresholds for assessing long-term health risks.

Source: sciencedirect.com/science/article/abs/pii/S0022347624003809