Population-based study sparks ideas on tackling the elevated risk
Babies born prematurely were at increased risk for ischemic heart disease in adulthood, a population-based study in Sweden found.
Early-term birth (gestational age 37-38 weeks) and preterm birth (<37 weeks) were linked, respectively, to a 19% and 53% greater relative risk of ischemic heart disease at ages 30 to 43 years compared with those born at full term, reported Casey Crump, MD, PhD, of the Icahn School of Medicine at Mount Sinai in New York City, and colleagues in JAMA Pediatrics.
Preterm birth held greater relative risk for women than men (adjusted HR 1.93 vs 1.37), although they had lower ischemic heart disease incidence overall (15.16 vs 22.00 per 100,000 person-years).
These findings were not explained by shared environmental or genetic factors among families, the investigators found.
The implication for clinical practice is that patients born prematurely require "long-term follow-up and early preventive actions to reduce the risk of [ischemic heart disease]," the investigators emphasized.
Women should receive regular prenatal and preconception care to promote healthy pregnancy and to reduce risk of preterm birth, Crump told MedPage Today.
"A healthy lifestyle can help prevent heart disease and is even more important in people with other underlying risk factors such as prematurity," he added.
Although there is a greater risk of diabetes and hypertension after preterm birth, guidelines from the American Diabetes Association, the American Heart Association, and their European counterparts have not identified premature birth as an indication for diabetes and hypertension screening, noted Anne Nuyt, MD, of Centre Hospitalier Universitaire Sainte-Justine Research Center in Montréal, and colleagues in an accompanying editorial.
And although pharmacological interventions and lifestyle adjustments have been shown to be effective in treating glucose intolerance and hypertension in the general population, these approaches have not been assessed in the preterm-born adults, Nuyt's group emphasized.
"Given that the pathophysiological pathways may differ in individuals born preterm, interventional clinical trials targeting this population are needed to determine optimal preventive and therapeutic strategies. Moreover, whether screening policies will translate into cardiovascular risk reduction over the long term in individuals born preterm should also be formally assessed," they continued.
Still, physicians managing adult patients should regularly inquire about birth history to identify this at-risk group and to encourage healthy lifestyle and behavioral changes, the editorialists agreed.
Crump's group evaluated more than 2 million singleton live births from the Swedish Birth Registry over 30.9 million person-years of follow-up. Participants were 48.6% female and 0.09% were diagnosed with ischemic heart disease.
Participants were excluded if there was inadequate information regarding gestational age.
A Cox regression was used to evaluate gestational age at birth as it relates to ischemic heart disease in adulthood, while adjusting for other maternal and perinatal factors. Co-sibling analyses examined potential confounding by shared environmental and genetic factors.
Limitations included lack of more detailed clinical information to confirm ischemic heart disease diagnoses and whether the preterm births were medically indicated or spontaneous, along with the single-country focus on Sweden.
The study was supported by the Swedish Heart-Lung Foundation, Region Skåne/Lund University, and the National Heart, Lung, and Blood Institute.
Crump disclosed relationships with the National Heart, Lung, and Blood Institute.
Nuyt and Luu reported no disclosures.
Source Reference: Crump C, et al "Association of preterm birth with risk of ischemic heart disease in adulthood" JAMA Pediatr 2019; DOI: 10.1001/jamapediatrics.2019.1327.
Source Reference: Flahault A, et al "Cardiovascular risk in adults born preterm: time to act" JAMA Pediatr 2019; DOI: 10.1001/jamapediatrics.2019.1324.
Read the original article on Medpage Today: Preemies Face Bigger Ischemic Heart Risk as Adults