BMJ 2000;320:273-278 ( 29 January )

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Risk of cardiovascular disease measured by carotid intima-media thickness at age 49-51: lifecourse study

Douglas Lamont, senior research associate in epidemiology, a Louise Parker, senior lecturer in epidemiology, a Martin White, senior lecturer in public health, b Nigel Unwin, senior lecturer in epidemiology, bc Stuart M A Bennett, clinical research associate, c Melanie Cohen, research associate, a David Richardson, consultant, d Heather O Dickinson, senior research associate, a Ashley Adamson, lecturer, e K G M M Alberti, professor, c Alan W Craft, professor. a

a Department of Child Health, University of Newcastle, Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, b Department of Epidemiology and Public Health, School of Health Care Sciences, Medical School, University of Newcastle, Newcastle upon Tyne NE1 4HH, c Department of Medicine, Medical School, University of Newcastle, d Department of Radiology, Royal Victoria Infirmary, Newcastle, e Human Nutrition Research Centre, University of Newcastle

Correspondence to: D Lamont d.w.lamont{at}ncl.ac.uk

Objective: To quantify the direct and indirect effects of fetal life, childhood, and adult life on risk of cardiovascular disease at age 49-51 years.
Design: Follow up study of the "Newcastle thousand families" birth cohort established in 1947.
Participants: 154 men and 193 women who completed a health and lifestyle questionnaire and attended for clinical examination between October 1996 and December 1998.
Main outcome measures: Correlations between mean intima-media thickness of the carotid artery (carotid intima-media thickness) and family history, birth weight, and socioeconomic position around birth; socioeconomic position, growth, illness, and adverse life events in childhood; and adult socioeconomic position, lifestyle, and biological risk markers. Proportions of variance in carotid intima-media thickness that were accounted for by each stage of the lifecourse.
Results: Socioeconomic position at birth and birth weight were negatively associated with carotid intima-media thickness, although only social class at birth in women was a statistically significant covariate independent of adult lifestyle. These early life variables accounted directly for 2.2% of total variance in men and 2.0% in women. More variation in carotid intima-media thickness was explained by adult socioeconomic position and lifestyle, which accounted directly and indirectly for 3.4% of variance in men (95% confidence interval 0.5% to 6.2%) and 7.6% in women (2.1% to 13.0%). Biological risk markers measured in adulthood independently accounted for a further 9.5% of variance in men (2.4% to 14.2%) and 4.9% in women (1.6% to 7.4%).
Conclusions: Adult lifestyle and biological risk markers were the most important determinants of the cardiovascular health of the study members of the Newcastle thousand families cohort at age 49-51 years. The limited overall effect of early life factors may reflect the postwar birth year of this cohort.


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Confusion requiring clarification
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