Novel cardiovascular risk markers: early outcomes and determinants in the National Survey of Health and Development

Diseases of the heart and circulation (together referred to as cardiovascular disease) remain important causes of ill-health and death both in middle-age and in later life. Prevention of these conditions remains an important public health priority. Although several risk factors are well known, novel biological pathways have also been implicated in the development of cardiovascular disease risk. These pathways involve the heart muscle and blood vessel linings, inflammatory processes, fat cells, the function of the kidneys, liver, and pancreas, circulating lipids and nutritional factors (particularly vitamin D). The role of these factors needs to be studied further. The unique 1946 British Birth Cohort (a study of more than 2000 individuals followed in detail from birth to 60-64 years) provides an important opportunity to provide novel insights into the role of these factors. Using this study framework it will be possible to examine the influence of these novel pathway markers on the structure and function of the heart and arteries in middle-age. The investigation will also provide an important opportunity to identify the factors which have the biggest influence on these novel pathway markers. These influences may well operate at different stages of life between conception and middle age, reflecting the fact that at least some of the factors responsible for cardiovascular disease risk operate before adult life. The study will help to determine whether these novel biological pathways mediate the effects of factors operating on cardiovascular disease at different stages during life (for example nutrition in early life) and the effects of socioeconomic factors, which are strongly related to cardiovascular risk. The information provided by the study will improve our understanding of how cardiovascular risk develops through life, and will help to tell us how best to prevent cardiovascular disease at different stages of the life course.

Markers of several novel biological pathways are implicated in the development of cardiovascular disease risk. These include markers of cardiac myocyte and endothelial function, chronic inflammation, adipocyte function, renal function, hepatic function (particularly related to hepatic fat deposition) and pancreatic beta cell function, novel lipid markers and micronutrient status (particularly vitamin D status). However, little is known about the influence of these novel pathway markers on vascular and cardiac structure and function in middle-age, and about the determinants of these novel pathway markers, particularly those operating over the life course. It is also possible that these novel pathways mediate the effects of early life factors on cardiovascular risk, though more evidence is needed. Measurement of novel pathway markers at 60-64 years in 2200 study participants in the unique National Survey of Health and Development (1946 British Birth cohort), in which detailed prospectively collected information on lifetime growth and maturation, nutrition, physical activity and adiposity are already available and in which measurements of vascular and cardiac structure and function are being made at 60-64 years, will provide a novel opportunity to examine the influence of novel pathway markers on cardiovascular risk to study determinants both in adult life and over the life course. The results will help to inform efforts to prevent cardiovascular disease over the life course.