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Martínez-Gómez J, de Cos-Gandoy A, Fernández-Alvira JM, Bodega P, de Miguel M, Tresserra-Rimbau A, Laveriano-Santos EP, Ramirez-Garza SL, Orrit X, Carvajal I, Estruch R, Lamuela-Raventós RM, Santos-Beneit G, Fuster V, Fernández-Jiménez R. Cardiovascular Health Trajectories in Adolescence and Their Association With Sociodemographic and Cardiometabolic Outcomes in Spain. J Adolesc Health 2024; 74:1039-1048. [PMID: 38323971 DOI: 10.1016/j.jadohealth.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/24/2023] [Accepted: 12/13/2023] [Indexed: 02/08/2024]
Abstract
PURPOSE To determine cardiovascular health (CVH) trajectories and their association with sociodemographic and cardiometabolic outcomes in adolescence. METHODS One thousand eighty adolescents attending 24 secondary schools enrolled in the SI! Program for Secondary Schools trial in Spain were assessed at approximately 12, 14, and 16 years of age. CVH was assessed according to American Heart Association criteria based on seven metrics (smoking status, body mass index, physical activity, diet, blood pressure, total cholesterol, and blood glucose), and CVH trajectories were identified by latent class trajectory modeling. Associations between CVH trajectories, sociodemographic characteristics, and cardiometabolic outcomes were analyzed using generalized linear and Poisson models. RESULTS Five CVH trajectory groups were identified: poor-stable (27 adolescents [2.5%]), intermediate-substantial rise (79 [7.3%]), intermediate-substantial decline (63 [5.8%]), intermediate-mild decline (403 [37.3%]), and intermediate-mild rise (508 [47.1%]). Boys and adolescents from families with low-average income, low-intermediate educational attainment, and a migrant background more frequently belonged to groups with lower baseline CVH and poor or declining trajectories. The intermediate-substantial decline group had the highest prevalence ratio for overweight/obesity (3.84; 95% confidence interval: 2.86-5.16) and metabolic syndrome (4.93; 95% confidence interval: 1.21-20.04) at age 16, whereas prevalence was lowest in the intermediate-mild rise group. DISCUSSION Adolescent CVH trajectories differ according to socioeconomic characteristics and are associated with cardiometabolic outcomes. Primordial prevention interventions should be implemented early in life, taking into account CVH trajectories and with a particular focus on vulnerable populations.
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Affiliation(s)
| | - Amaya de Cos-Gandoy
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | | | - Patricia Bodega
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Mercedes de Miguel
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Anna Tresserra-Rimbau
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, XIA, INSA, University of Barcelona, Barcelona, Spain
| | - Emily P Laveriano-Santos
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, XIA, INSA, University of Barcelona, Barcelona, Spain
| | - Sonia L Ramirez-Garza
- Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, XIA, INSA, University of Barcelona, Barcelona, Spain
| | - Xavier Orrit
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Isabel Carvajal
- Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Ramón Estruch
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; Department of Internal Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Rosa María Lamuela-Raventós
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain; Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, XIA, INSA, University of Barcelona, Barcelona, Spain
| | - Gloria Santos-Beneit
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Foundation for Science, Health and Education (SHE), Barcelona, Spain
| | - Valentín Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York
| | - Rodrigo Fernández-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Department of Cardiology, Hospital Universitario Clinico San Carlos, Madrid, Spain; Centro de Investigación Biomédica En Red en enfermedades CardioVasculares (CIBERCV), Madrid, Spain.
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Martinez-Gomez J, De Cos-Gandoy A, Santos-Beneit G, Tresserra-Rimbau A, Bodega P, De Miguel M, Laveriano-Santos EP, Ramirez-Garza SL, Fernandez-Alvira JM, Orrit X, Carvajal I, Estruch R, Lamuela-Raventos RM, Fuster V, Fernandez-Jimenez R. Cardiovascular health trajectories among adolescents enrolled in the SI Program in Spain: a longitudinal study. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): 1. Fondo de Investigación Sanitaria- Instituto de Salud Carlos III2. SHE Foundation and “la Caixa” Foundation.
Background
There is a paucity of data on adolescents’ cardiovascular health (CVH) profiles and longitudinal trajectories.
Purpose
To identify CVH trajectories in a large cohort of Spanish adolescents aged 12 to 16 years and their relationship with sociodemographic variables.
Methods
This study collected data at approximately 12, 14 and 16 years of age from 1078 adolescents attending 24 secondary schools enrolled in the SI! Program for Secondary Schools trial in Spain [1]. The status (non-ideal = 0 points; ideal = 1 point) of each CVH individual metric (smoking status, body mass index, physical activity, dietary habits, blood pressure, total cholesterol, and blood glucose) was determined following the criteria established by the American Heart Association [2]. An overall CVH score was constructed summing the number of ideal CVH metrics (ranged thus from 0 to 7 points), and poor, intermediate, or ideal overall CVH score was defined as ≤3, 4-5, or 6-7 ideal metrics, respectively [3]. CVH trajectories were identified using latent class trajectory modeling with the Stata command traj [4]. Next, individuals were assigned to the trajectory group they were most likely to belong based on the posterior predictive probabilities of group membership.
Results
Among 1078 adolescents with a baseline mean (SD) age of 12.5 (0.4) years, 48.5% girls, four distinct CVH trajectory groups were identified: low-stable (56 adolescents [5.0%]), low-rise (232 [21.3%]), intermediate-decline (136 [18.2%]) and intermediate-stable (654 [55.5%]) (Figure 1). Adolescents belonging to the intermediate-stable and the low-stable trajectories showed the highest and lowest overall CVH mean (SD) scores at baseline [4.8 (0.8) and 2.6 (0.9), respectively] (Figure 2). Similar differences were observed for the analysis of overall CVH score as a categorical variable (poor, intermediate, ideal). Sociodemographic differences between CVH trajectories were identified, with the highest proportion of girls, high-income and non-migrant families within the intermediate-stable trajectory.
Conclusions
In a large cohort of adolescents, ~55% of adolescents showed an intermediate CVH score at baseline and did not decline over time. The characterization of distinct CVH trajectories and sociodemographic differences between them may help tailoring health promotion programs for adolescents.
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Affiliation(s)
- J Martinez-Gomez
- Spanish National Centre for Cardiovascular Research, Cardiovascular and Health Imaging Lab, Madrid, Spain
| | | | | | - A Tresserra-Rimbau
- University of Barcelona, Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, Barcelona, Spain
| | - P Bodega
- SHE Foundation, Barcelona, Spain
| | | | - EP Laveriano-Santos
- University of Barcelona, Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, Barcelona, Spain
| | - SL Ramirez-Garza
- University of Barcelona, Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, Barcelona, Spain
| | - JM Fernandez-Alvira
- Spanish National Centre for Cardiovascular Research, Cardiovascular Imaging and Population Studies, Madrid, Spain
| | - X Orrit
- SHE Foundation, Barcelona, Spain
| | | | - R Estruch
- Barcelona Hospital Clinic, Department of Internal Medicine, Barcelona, Spain
| | - RM Lamuela-Raventos
- University of Barcelona, Department of Nutrition, Food Science and Gastronomy, School of Pharmacy and Food Sciences, Barcelona, Spain
| | - V Fuster
- Spanish National Centre for Cardiovascular Research, Cardiovascular Imaging and Population Studies, Madrid, Spain
| | - R Fernandez-Jimenez
- Spanish National Centre for Cardiovascular Research, Cardiovascular and Health Imaging Lab, Madrid, Spain
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