| Objectives To explore the association between the Chinese Great famine exposure in early life from 1959 to 1962 and the risk of cardiovascular disease（CVD）in adulthood and the modification of the association by ideal cardiovascular health metrics（ICVHMs）.Methods A total of 65,105 Kailuan employees who were born between 1949 and 1974 and participated in the Kailuan Study from 2006 to 2007 were enrolled as observation subjects.A total of 1080 participants with a previous history of CVD and 2498 participants with missing information on ICVHMs（including smoking,physical activity,salt intake,height,weight,blood pressure,fasting blood glucose,and total cholesterol）were excluded,and61,527 participants were finally included for statistical analysis.All participants were divided into three groups based on the date of birth:childhood famine exposure group（participants born in 1949-1958）,fetal famine exposure group（participants born in 1959-1962）,and non-famine exposure group（participants born in 1963-1974）.The follow-up period began on the enrollment date until the new-onset CVD events or December 31,2020,whichever came first.Data processing and analysis were performed using SAS 9.4 statistical software.Normally or approximately normally distributed continuous variables were expressed as mean±standard deviation and ANOVA was used to compare differences between multiple groups;skewed continuous variables were expressed as M(P25,P75);Kruskal-Wallis test was used to compare differences between multiple groups.Categorical variables were expressed as cases（%）,and Pearson’s chi-square test was used to compare differences between multiple groups.The Cochran-Armitage trend test was used to analyze the trend of the number of ICVHMs and the cumulative incidence of CVD across different groups.Cox regression model was used to analyze the effect of famine exposure in early life on the risk of CVD incidence in adulthood and the modification of ICVHMs.In addition,some sensitivity analyses were performed to verify the robustness of the results.Results A total of 5460 new-onset CVD events occurred during a median follow-up period of 13.98（13.65,14.16）years.After adjusting for potential confounders,compared with non-famine-exposed group,the hazard ratio（HR）and 95%confidence interval（CI）for the risk of CVD in the fetal famine-exposed and childhood famine-exposed groups were 1.16（1.04to 1.30）and 0.98（0.85 to 1.14）,respectively.After stratification by sex,an association between fetal famine exposure and increased risk of developing CVD in adulthood was only found in the female population（HR=1.62,95%CI:1.18 to 2.24）,but not in males,with a multiplicative interaction P=0.014.After stratification by the number of ICVHMs,compared with the non-famine exposed group,an increased risk of CVD from fetal famine exposure was only found in participants with a small number of ICVHMs（<3）（HR=1.20,95%CI:1.04 to 1.39）,and such association was not found in those with the number of ICVHMs≥3,with a multiplicative interaction P=0.004.After stratification by whether each ICVHMs was ideal or not,compared with the non-famine exposed group,fetal famine exposures in non-ideal blood pressure（HR=1.14,95%CI:1.01 to 1.29）,non-ideal body mass index（HR=1.21,95%CI:1.06 to 1.39）,smoking（HR=1.20,95%CI:1.02 to 1.42）,non-ideal salt intake（HR=1.17,95%CI:1.03 to 1.31）,and non-ideal physical activity（HR=1.15,95%CI:1.02 to 1.30）,were associated with an increased risk of CVD,and such associations were not observed in non-ideal total cholesterol（HR=1.13,95%CI:0.96-1.33）and non-ideal fasting glucose（HR=1.18,95%CI:0.99 to 1.42）.Conclusions Fetal exposure to the Chinese famine was associated with an increased risk of developing CVD in adulthood,and after sex stratification,fetal famine exposure was found to increase the risk of developing CVD in adulthood only in females.However,the number of ICVHMs may attenuate the effect of fetal famine exposure on the risk of developing CVD.Figure 2;Table 30;Reference 130... |
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