BMJ 1996;313:79-84 (13 July)

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Cardiovascular risk factors in British children from towns with widely differing adult cardiovascular mortality

Peter H Whincup, senior lecturer in clinical epidemiology,a Derek G Cook, reader in epidemiology,b Fiona Adshead, lecturer in public health medicine,b Stephanie Taylor, senior registrar in public health medicine,a Olia Papacosta, research statistician,a Mary Walker, honorary lecturer,a Valerie Wilson, research coordinator a

a Department of Primary Care and Population Sciences, Royal Free Hospital School of Medicine, London NW3 2PF, b Department of Public Health Sciences, St George's Hospital Medical School, London SW17 0RE

Correspondence to: Dr Whincup.

Abstract

Objective: To examine whether cardiovascular risk factors differ in children from towns in England and Wales with widely differing adult cardiovascular death rates.
Design: School based survey conducted during 1994 in 10 towns, five with exceptionally high adult cardiovascular mortality (standardised mortality ratio 131-143) and five with exceptionally low adult cardiovascular mortality (64-75). Towns were surveyed in high-low pairs.
Subjects: 3415 white children aged 8-11 years with physical measurements (response rate 75%), including 1287 with blood samples (response rate 64%), of whom 515 had blood samples taken 30 minutes after a glucose load.
Results: Children in towns with high cardiovascular mortality were on average shorter than those in towns with low mortality (mean difference 1.2 cm; 95% confidence interval 0.3 to 2.1 cm; P = 0.02) and had a higher ponderal index (0.34 kg/m3; 0.16 to 0.52 kg/m3; P = 0.006). Mean systolic pressure was higher in high mortality towns, particularly after adjustment for height (2.0 mm Hg; 0.8 to 3.2 mm Hg; P = 0.009). Mean waist:hip ratio, total cholesterol concentration, and 30 minute post-load glucose measurements were similar in high and low mortality towns. The differences in height and blood pressure between high and low mortality towns were unaffected by standardisation for birth weight.
Conclusions: The differences in height, ponderal index, and blood pressure between towns with high and low cardiovascular mortality, if persistent, may have important future public health implications. Their independence of birth weight suggests that the childhood environment rather than the intrauterine environment is involved in their development.

Key messages

  • Development of cardiovascular risk factors in British children living in areas with widely different adult cardiovascular mortality has been little stud- ied

  • Children in areas of high mortality are on average shorter and have higher ponderal indices and higher blood pressures (particularly when height differences are taken into account) than those in areas of low mortality

  • Total cholesterol concentration, waist:hip ratio, and post-load glucose/glucose tolerance are very similar in high and low mortality areas

  • The differences in height, ponderal index, and blood pressure are independent of birth weight, suggesting that childhood rather than intrauterine factors may be important in their development


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