Early origin of coronary heart disease (the “Barker hypothesis”)

Hypotheses, no matter how intriguing, need rigorous attempts at refutation

Risk profiles for coronary heart disease are surely among the most valuable products of epidemiology of the past half century. Not only have some important personal determinants of coronary heart disease been uncovered but also methods for their amelioration have been developed, and best of all, in many countries rates of cardiac disease have fallen steadily for 25 years.

Yet for some time now quietude has beset this field of research. The main risk factors—raised body weight, cholesterol concentration, and blood pressure; glucose intolerance; smoking; and lack of physical activity—are old discoveries, and much current research seems merely to be fine tuning these standbys. The precise role of variations in coagulation profiles in the pathogenesis of coronary heart disease remains hazy, and factors such as stress and social support seem no more and no less promising and ambiguous than they were decades ago.

So the excited welcome given to a totally new set of antecedents is unsurprising. The hypothesis of Professor David Barker and colleagues working in Southampton is that “a baby's nourishment before birth and during infancy,” as manifest in patterns of fetal and infant growth, “programmes” the development of risk factors such as raised blood pressure, fibrinogen concentration, and factor VIII concentration and glucose intolerance and hence these are key determinants of coronary heart disease.

Since 1987 the group has elaborated this hypothesis in at least 40 papers (many of them in the BMJ) and two books.1 2 Although some evidence comes from comparisons among populations, the most recent approach has been to seek places where infant anthropometric measures were systematically recorded many years ago (Hertfordshire and Preston). Middle aged and elderly survivors have then been searched out for study. This idea is in line with a body of research of the past 50 years on the …