Associations between risk factors in childhood (12-13 years) and adulthood (48-49 years) and subclinical atherosclerosis: the Kaunas Cardiovascular Risk Cohort Study.

BACKGROUND: The data on the childhood determinants of adult cardiovascular disease (CVD) are lacking in populations of Eastern Europe that are characterised by substantially high CVD mortality. From a public health perspective, it is important to identify high-risk individuals as early as possible in order to have the greatest benefit of preventive interventions. The aim of this study was to evaluate the associations of childhood and adulthood traditional risk factors with subclinical atherosclerosis and arterial stiffness in a Lithuanian cohort followed up for 35 years. METHODS: The study cohort consisted of 380 adults aged 48-49 from Kaunas Cardiovascular Risk Cohort study, who were followed up since childhood (12-13 years). The baseline survey (1977) included blood pressure (BP) and anthropometric measurements and sexual maturity scale. In the follow-up survey (2012), BP, anthropometric and lipids measurements, interview about smoking, measurement of carotid intima-media thickness (IMT) and determination of pulse wave velocity (PWV) were performed. Two types of general linear models were applied to test the associations of childhood and adulthood risk factors with IMT and PWV. Model 1 included only childhood variables. In model 2, adulthood variables were added to childhood variables. RESULTS: In linear regression model with childhood variables childhood systolic BP (ß = 0.014; p = 0.016) and BMI (ß = 0.006; p = 0.003) were directly associated with IMT only in women. When adulthood variables were included into regression model, the association between childhood systolic BP and IMT remained significant (ß = 0.013; p = 0.021), while childhood BMI was not associated with IMT (ß = 0.003; p = 0.143). Additionally, association of adult smoking and IMT was found in women (ß = 0.033; p = 0.018). IMT of men was directly related to adult systolic BP (ß = 0.022; p = 0.018) and inversely to HDL cholesterol level (ß = -0.044; p = 0.021). PWV was directly associated only with adult systolic BP in both genders (ß = 0.729 for men and ß = 0.476 for women; p = 0.001). CONCLUSIONS: Sex differences in the associations between childhood and adulthood risk factors and subclinical atherosclerosis were found. The results of the study support efforts to reduce conventional risk factors both in childhood and adulthood for the primary prevention of atherosclerosis.

Anthropometric measurements in childhood and prediction of cardiovascular risk factors in adulthood: Kaunas cardiovascular risk cohort study.

BACKGROUND: This study aimed to examine the associations between anthropometric measurements in childhood and adulthood as well as the effect of childhood body mass index (BMI) and skinfold thickness in the prediction of adult cardiovascular risk factors. METHODS: The Study subjects were participants of the Kaunas Cardiovascular Risk Cohort study. They were 12-13 years old at the time of the baseline survey (1977) and 48-49 years old in the 35-year follow-up survey (2012, n = 506). In childhood, height, weight, subscapular and triceps skinfold thickness measurements were taken. In 2012, health examination involved measurements of blood pressure (BP), BMI, waist circumference, glucose, lipids, and high-sensitivity C-reactive protein (CRP) levels. Logistic regression models were fitted to assess the associations of childhood BMI and skinfold thicknesses as well as BMI gain with cardiovascular risk factors in middle age. All logistic regression models were adjusted for sex, physical activity level, alcohol consumption, smoking and family history of obesity. RESULTS: Over 35 years of follow-up, BMI gain was greater in men than in women. Anthropometric measurements in childhood significantly correlated with values measured in adulthood. The highest correlation coefficients were defined for weight and BMI measurements (in girls r = 0.56 and r = 0.51 respectively; in boys r = 0.45 and r = 0.41 respectively, P < 0.001). Mean values of change in BMI were similar in all quintiles of childhood BMI; however, prevalence of adult obesity increased considerably with increasing quintiles. The risk of adult obesity, metabolic syndrome, hyperglycaemia or type 2 diabetes, and elevated level of high-sensitivity CRP increased with a rise in childhood BMI and skinfold thicknesses, irrespectively of BMI gain from childhood to adulthood. No relationship was found between childhood anthropometric measurements and arterial hypertension, raised level of triglycerides or reduced level of HDL cholesterol. Gain in BMI from childhood to adulthood was associated with increased odds of all above-mentioned risk factors independently of childhood BMI. CONCLUSIONS: Risk of metabolic syndrome, hyperglycaemia and diabetes, and elevated high-sensitivity CRP may be affected by childhood BMI and skinfold thickness, while risk of hypertension, raised triglycerides and reduced HDL cholesterol is associated more strongly with BMI gain from childhood to adulthood.

The effect of tobacco control policy on smoking cessation in relation to gender, age and education in Lithuania, 1994-2010.

BACKGROUND: This study aimed to evaluate the association between tobacco control policies and trends in smoking cessation according to gender, age and educational level in Lithuania in 1994-2010. METHODS: The data were obtained from nine cross-sectional postal surveys conducted biennially within the framework of Finbalt Health Monitor project during 1994-2010. Each survey was based on a nationally representative random sample drawn from the National population register. The sample consisted of 3000 citizens aged 20-64 in 1994-2008 surveys and 4000 in the 2010 survey. In total, 17161 individuals participated in all surveys. The development of tobacco control policy in Lithuania was assessed using the Tobacco Control Scale (TCS). The association of the TCS scores with short-term and long-term quitting according to gender, age and education was examined using logistic regression analysis with control for secular trends. RESULTS: Over the last two decades, a large improvement in the development of tobacco control policy has been achieved in Lithuania. At the same time, this progress was associated with the increase in smoking cessation. A significant increase in both short-term and long-term quit ratios was found among people aged 20-44. An increase by 10 points on the TCS was associated with 17% increase in the odds of short-term quitting and with 15% increase in the odds of long-term quitting. The association between tobacco control policies and long-term quitting was stronger among younger than older people. No differential effect of tobacco control policies on smoking cessation was found in relation to gender and educational level. CONCLUSIONS: The improvement in Lithuanian tobacco control policies was associated with an increase in smoking cessation in long-term perspective. These policies have not only benefitted highly educated groups, but lower educated groups as well. Nonetheless, further development of comprehensive tobacco control policies is needed in order to decrease social inequalities in smoking cessation.