Preterm birth, vascular function, and risk factors for atherosclerosis

doi:10.1016/S0140-6736(01)06276-6

The Lancet

Volume 358, Issue 9288, 6 October 2001, Pages 1159-1160

https://doi.org/10.1016/S0140-6736(01)06276-6 Get rights and content

Summary

Low birthweight may predispose to the development of atherosclerosis later in life. We have tested the hypothesis that low birthweight as a result of preterm birth is associated with reduced flow-mediated endothelial-dependent vasodilation (FMD), which is an early stage in the development of atherosclerosis. Mean FMD in adolescents born preterm who had a low birthweight did not differ from that for controls born at term (0.225 mm vs 0.220 mm, SD 0.1 for both means, p=0.78). Our findings indicate that low birthweight attributable to prematurity does not increase the risk of vascular disease later in life.

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Cited by (110)

Myeloperoxidase as cardiovascular risk marker in pre-pubertal preterm children?
2019, Nutrition, Metabolism and Cardiovascular Diseases
Citation Excerpt :
The intrauterine environment and the neonatal period are relevant determinants of the risk of cardiovascular diseases. There is increasing evidence pointing to the negative impact of prematurity on future cardiovascular health in adolescents and adults [41,42]. Concerning lipid metabolism, a meta-analysis showed that preterm birth versus full term in adulthood is associated with higher concentrations of LDL-c without differences for triglycerides and HDL-c [16].
To evaluate the biomarkers related to cardiovascular risk in pre-pubertal preterm children with a birth weight of less than 1,500 g and relate them to current nutritional status, insulin resistance, and inflammation.
This is a cross-sectional, controlled study with pre-pubertal preterm children aged 5–9 years with a birth weight of less than 1500 g (Preterm group, n = 44) compared to full term children of adequate weight for gestational age (Control group, n = 30). Clinical evaluation: anthropometry and pubertal staging. Laboratory tests: total cholesterol and fractions, triglycerides, paraoxonase 1, apolipoproteins A-I and B, myeloperoxidase (MPO), high sensitivity C-reactive protein (hs-CRP), glycemia and insulin (to calculate HOMA-IR). In the preterm group, 19 (43.2%) were male, with mean birth weight and gestational age of 1157 ± 242 g and 30.0 ± 2.3 weeks, respectively. The preterm group showed lower concentrations of HDL-c (60.1 ± 10.1 vs. 69.0 ± 10.0 mg/dL; p < 0.001); higher concentrations of hs-CRP [0.55 mg/dL (0.30; 39.4) vs. 0.30 mg/dL (0.30; 10.80); p = 0.043], of MPO [21.1 ng/mL (5.7; 120.0) vs. 8.1 ng/mL (2.6; 29.6); p < 0.001] and of MPO/HDL-c ratio [0.39 (0.09; 2.07) ng/mg vs. 0.11 (0.05; 0.58)]. The MPO/HDL-c ratio was the variable that showed the best discriminatory power between the groups (AUC = 0.878; 95% CI; 0.795–0.961). MPO concentrations in the preterm group were correlated with those of hs-CRP (r = 0.390; p = 0.009), insulin (r = 0.448; p = 0.002) and HOMA-IR (r = 0.462; p = 0.002).
Prepubertal preterm children show high MPO concentrations and MPO/HDL-c ratio that are associated with inflammation and oxidative stress, which, in turn, may be associated with atherosclerosis.
Preterm Birth as a Risk Factor for Metabolic Syndrome and Cardiovascular Disease in Adult Life: A Systematic Review and Meta-Analysis
2019, Journal of Pediatrics
To determine if preterm birth is associated with components of the metabolic syndrome in adult life.
A structured literature search was performed using PubMed. All comparative studies reported metabolic and cardiovascular outcomes in adults (≥18 years of age) born preterm (<37 weeks of gestation) compared with adults born at term (37-42 weeks of gestation) and published through March 2018 were included. The major outcomes assessed were body mass index, waist circumference, waist-to-hip ratio, fat mass, systolic blood pressure (SBP), diastolic blood pressure (DBP), 24-hour SBP, 24-hour DBP, endothelium-dependent brachial artery flow-mediated dilation, carotid intima-media thickness, pulse wave velocity, fasting glucose and insulin, Homeostasis Model Assessment-Estimated Insulin Resistance Index, and lipid profiles. Quality appraisal was performed using a modified version of the Newcastle-Ottawa scale. A meta-analysis was performed for comparable studies which reported sufficient data.
Forty-three studies were included, including a combined total of 18 295 preterm and 294 063 term-born adults. Prematurity was associated with significantly higher fat mass (P = .03), SBP (P < .0001), DBP (P < .0001), 24-hour SBP (P < .001), and 24-hour DBP (P < .001). Furthermore, preterm-born adults presented higher values of fasting glucose (P = .01), insulin (P = .002), Homeostasis Model Assessment-Estimated Insulin Resistance Index (P = .05), and total cholesterol levels (P = .05) in comparison with adults born at term, in random effect models. No statistically significant difference was found between preterm and term-born adults for the other outcomes studied.
Preterm birth is strongly associated with a number of components of the metabolic syndrome and cardiovascular disease in adult life.
Association of preterm birth and small for gestational age with metabolic outcomes in children and adolescents: A population-based cohort study from Taiwan
2018, Pediatrics and Neonatology
Previous studies have identified preterm birth and/or small for gestational age (SGA) as risk factors for features of the metabolic syndrome, including high blood pressure, insulin sensitivity and atherosclerosis, occurring later in life, with controversial results. We conducted this population-based cohort study to investigate metabolic outcomes in those with former preterm birth and/or SGA status in Taiwan.
Data were obtained from Taiwan's universal National Health Insurance Research Database. From 1996 to 2004, 37,119 preterm infants, 3386 SGA infants, and 162,020 matched controls were included. We investigated the risk of the metabolic disease, including hypertension, diabetes, and hyperlipidemia, which had been recorded by the end of 2008.
The preterm and SGA cohort, combined into one, had a significantly increased risk of developing metabolic disorders when compared with the comparison cohort (HR = 2.46, 95% CI = 2.02–3.01). We observed that children with former preterm and SGA status in Taiwan had a higher risk of developing hypertension (HR = 3.24, 95% CI = 1.58–6.67), Type 1 diabetes mellitus (HR = 1.80, 95% CI = 1.05–3.07), Type 2 diabetes mellitus (HR = 2.49, 95% CI = 1.98–3.14), and hyperlipidemia (HR = 2.14, 95% CI = 1.29–3.52).
Our study revealed the risk of metabolic disease in those with preterm birth and/or SGA. Further studies with a longer duration of follow-up are required to confirm if there is a tendency for the metabolic syndrome to develop in this study cohort.
Long-Term Impact of Preterm Birth: Neurodevelopmental and Physical Health Outcomes
2017, Clinics in Perinatology
Citation Excerpt :
On the contrary, augmentation index, which measures arterial pressure wave reflections, is higher in preterm children born at less than 26 weeks’ gestational age or who are small for gestational age, suggesting increased peripheral vascular resistance.30,31 Similarly, although there is no difference in endothelial function measured at the level of the brachial artery,24,26,27 impairment is observed in smaller vessels of preterm-born adolescents.32 Few studies have examined long-term cardiac changes after preterm birth.
Elevated blood pressure with reduced left ventricular and aortic dimensions in adolescents born extremely preterm
2016, Journal of Pediatrics
To evaluate the long-term cardiovascular effects of extremely preterm birth in a cohort of adolescents followed prospectively, who were largely free from intrauterine growth restriction.
Central blood pressures, aortic and cardiac dimensions, left ventricle (LV) function, pulse wave velocity, augmentation index, and microvascular reactive hyperemia were measured in 18-year-old subjects born extremely preterm at <28 weeks' gestation (n = 109) and term-born controls (n = 81).
Compared with controls, preterm adolescents had higher systolic (124 ± 13 vs 118 ± 10 mm Hg, P = .002) and diastolic (72 ± 8 vs 67 ± 7 mm Hg, P < .001) blood pressures, but lower ascending aortic z-scores (0.13 ± 0.89 vs 0.42 ± 0.78, P = .02), LV diastolic (48.5 ± 4 vs 50.3 ± 4.5 mm, P = .007) and systolic (30.2 ± 3.5 vs 31.9 ± 4.0 mm, P = .003) diameters, and a reduced LV mass (130 ± 34 vs 145 ± 41 g, P = .01) and mass index (75 ± 14 vs 81 ± 16 g/m², P = .02). However, LV relative wall thickness, LV function, pulse wave velocity, augmentation index, and microvascular reactive hyperemia were similar. Within the ex-preterm group, there were no significant relationships between birthweight z-scores and any cardiovascular measures, once the latter were adjusted for current body size.
Extremely preterm birth had relatively minor cardiovascular effects in late-adolescence, with increased blood pressures, decreased LV, and aortic size, but preserved LV function, macrovascular properties, and microvascular function. In utero growth was not independently related to cardiovascular function within the ex-preterm cohort.
Longitudinal changes in adiponectin multimer levels in preterm infants
2016, Early Human Development
Preterm infants have altered adiponectin levels at term-equivalent age and have a higher risk of developing components of the metabolic syndrome in later life than term infants.
To investigate the longitudinal changes in adiponectin levels in preterm infants and to compare the levels between term and preterm infants.
A cohort study.
The study subjects were 43 term infants and 42 preterm infants born at ≤ 34-week gestation.
Serum levels of total adiponectin (T-Ad) and high-molecular-weight adiponectin (HMW-Ad) were measured in 42 preterm infants at term-, 6 month-, and 12 month-equivalent ages. Moreover, the levels in 43 term infants investigated previously were reviewed.
In preterm infants, T-Ad and HMW-Ad levels at the 12 month-equivalent age were lower than at the term- and 6 month-equivalent ages (all values p < 0.001), which was consistent with previous results in term infants. The difference in ratios of HMW-Ad to T-Ad between term and preterm infants continued at the 6 month-equivalent age but disappeared at the 12 month-equivalent age. Multiple regression analyses revealed that HMW-Ad levels at term-equivalent age were only a significant determinant of the changes in HMW-Ad between the term- and 12 month-equivalent ages in preterm infants (p < 0.001).
The HMW-Ad levels decline till the 12 month-equivalent age in both term and preterm infants. The changes in HMW-Ad level during infancy might be determined at least to a certain degree up to term-equivalent age in preterm infants.

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Research LettersPreterm birth, vascular function, and risk factors for atherosclerosis

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Research Letters
Preterm birth, vascular function, and risk factors for atherosclerosis