Risk of cardiovascular disease measured by carotid intima-media thickness at age 49-51: lifecourse study

Objective To quantify the direct and indirect effects of fetal life, childh ood, and adult life on risk of cardiovascular disease at age 49-51 years. Design Follow up study of the "Newcastle thousand families" birth cohort es tablished in 1947. Participants 154 men and 193 women who completed a health and lifestyle que stionnaire and attended for clinical examination between October 1996 and D ecember 1998. Main outcome measures Correlations between mean intima-media thickness of t he carotid artery (carotid intima-media thickness) and family history, birt h weight, and socioeconomic position around birth; socioeconomic position, growth, illness, and adverse Life events in childhood; and adult socioecono mic position, lifestyle, and biological risk markers. Proportions of varian ce in carotid intima-media thickness that were accounted for by each stage of the lifecourse. Results Socioeconomic position at birth and birth weight were negatively as sociated with carotid intima-media thickness, although only social class at birth in women was a statistically significant covariate independent of ad ult lifestyle. These early life variables accounted directly for 2.2% of to tal variance in men and 2.0% in women. More variation in carotid intima-med ia thickness was explained by adult socioeconomic position and lifestyle, w hich accounted directly and indirectly for 3.4% of variance in men (95% con fidence interval 0.5% to 6.2%) and 7.6% in women (2.1% to 13.0%). Biologica l risk markers measured in adulthood independently accounted for a further 9.5% of variance in men (2.4% to 14.2%) and 4.9% in women (1.6% to 7.4%). Conclusions Adult lifestyle and biological risk markers were the most impor tant determinants of the cardiovascular health of the study members of the Newcastle thousand families cohort at age 49-51 years. The limited overall effect of early life factors may reflect the postwar birth year of this coh ort.