"People born preterm are at greater risk of developing heart disease as they reach their 20s and 30s, and we have been working to understand what changes in their heart and blood vessels may be putting them at risk," Dr. Adam Lewandowski of the University of Oxford.
Smaller LV volumes and lower function, as well as greater LV mass compared to their term-born peers, "may explain part of their risk of developing clinical heart disease," he said. "These group differences widened as systolic blood pressure increased, with LV mass increasing more than two-fold greater per 1-mm Hg systolic blood pressure in the preterm- compared to term-born young adults."
"These changes were greatest in those born very and extremely preterm (<32 weeks of gestation), who are known to be at greatest risk of heart disease," he added.
As reported in JAMA Cardiology, the cross-sectional cohort study included 200 adults born preterm (<37 weeks' gestation) and 268 born at term. The mean age was about 26; about half were men and most (>95%) were white.
The main outcome was cardiac magnetic resonance measures of LV structure and function in response to systolic blood pressure elevation.
As Dr. Lewandowski noted, preterm-born adults with and without hypertension had higher LV mass index, reduced LV function, and smaller LV volumes compared with their term-born peers both with and without hypertension.
Regression analyses of systolic blood pressure with LV mass index and LV mass to end-diastolic volume ratio revealed a leftward shift in the slopes in preterm-born compared with term-born adults.
As Dr.Lewandowski also noted, compared with term-born adults, there was a 2.5-fold greater LV mass index per 1-mm Hg elevation in systolic blood pressure in very and extremely preterm-born adults (0.394 g/m2 vs. 0.157 g/m2 per 1 mm Hg) and a 1.6-fold greater LV mass index per 1-mm Hg elevation in moderately preterm-born adults (32 to 36 weeks' gestation; 0.250 g/m2 vs. 0.157 g/m2 per 1 mm Hg).
Notably, the LV mass to end-diastolic volume ratio per 1-mm Hg elevation in systolic blood pressure in the very and extremely preterm-born adults was 3.4-fold greater than those born moderately preterm (3.56 × 10−3 vs. 1.04 × 10−3 g/mL per 1 mmHg) and 3.3-fold greater than those born at term (3.56 × 10−3 vs. 1.08 × 10−3 g/mL per 1 mmHg).
Dr. Lewandowski said, "Recognition of preterm birth as a significant risk factor for heart and vascular disease is important for clinicians, parents, and the individuals who were born preterm. Birth history should be included in best practice guidelines from childhood to adulthood to permit healthy lifestyle counselling and appropriate screening."
Further research is also needed to understand whether other lifestyle behaviors may impact risk, he added, and studies are needed for individuals of different race/ethnicity, since the current cohort was 95% Caucasian.
Dr. Jay Pandit, a cardiologist at Northwestern Medicine Central DuPage Hospital in Winfield, Illinois, commented on the study in an email to Reuters Health. "There is a biological association between preterm birth and systolic blood pressure elevation with disproportionate ventricular remodeling; however, there are many confounding factors that come with preterm birth," such as demographics and socioeconomic status.
Nonetheless, he said, "the underlying message is clinically relevant, that screening and awareness of hypertension in essential in all adults >18 years of age as per USPSTF guidelines. As the primary modifiable risk factor for heart attacks, strokes and chronic kidney disease to mention a few, early diagnosis and management can only improve outcomes."
SOURCE: https://bit.ly/3wu3m23 JAMA Cardiology, online May 12, 2021.
By Marilynn Larkin
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