Elsevier

Preventive Medicine

Volume 36, Issue 2, February 2003, Pages 217-228
Preventive Medicine

Regular article
Cardiovascular risk factor profiles and their social gradient from adolescence to age 74 in a Swiss region

https://doi.org/10.1016/S0091-7435(02)00016-6Get rights and content

Abstract

Background

Few European studies have investigated how cardiovascular risk factors (CRF) in adults relate to those observed in younger generations.

Objective

To explore this issue in a Swiss region using two population health surveys of 3636 adolescents ages 9–19 years and 3299 adults ages 25–74 years.

Methods

Age patterns of continuous CRF were estimated by robust locally weighted regression and those of high-risk groups were calculated using adult criteria with appropriate adjustment for children.

Results

Gender differences in height, weight, blood pressure, and HDL cholesterol observed in adults were found to emerge in adolescents. Overweight, affecting 10–12% of adolescents, was increasing steeply in young adults (three times among males and twice among females) in parallel with inactivity. Median age at smoking initiation was decreasing rapidly from 18 to 20 years in young adults to 15 in adolescents. A statistically significant social gradient in disfavor of the lower education level was observed for overweight in all age groups of women above 16 (odds ratios (ORs) 2.4 to 3.3, P < 0.01), for inactivity in adult males (ORs 1.6 to 2.0, P < 0.05), and for regular smoking in older adolescents (OR 1.9 for males, 2.7 for females, P < 0.005), but not for elevated blood pressure.

Conclusion

Discontinuities in the cross-sectional age patterns of CRF indicated the emergence of a social gradient and the need for preventive actions against the early adoption of persistent unhealthy behaviors, to which low-educated girls and women are particularly exposed.

Introduction

In developed countries, cardiovascular diseases (CVDs) are the leading cause of mortality among adults, especially the elderly, and generate a major burden of morbidity throughout life [1]. Besides the genetic components of CVD, many of the risk factors have been identified as early as in fetal life and early childhood [2], [3], [4], [5], [6]. Prospective and retrospective studies have shown that risk factor levels found in childhood and adolescence correlated with those observed later [7], [8], [9]. In addition, it has been demonstrated that the lifestyles and behaviors (such as diet, exercise, and smoking) that greatly determine the risk of CVD are often learned and adopted early in life [10]. The interest of measuring the level of risk factors in childhood and adolescence lies in the assessment of the immediate prevention potential in a given region, and in the subsequent possibility to modify the natural course of disease by helping adolescents to make healthier choices [11], [12], [13].

Ideally, studies with mixed cross-sectional and longitudinal designs would best investigate the rapid changes in CVD risk factor profiles occurring in youths, and how they relate to adult profiles. However, such studies are expensive, and the need persists for population-based data from different ethnic, cultural, and economic settings that document these changes. A large spectrum in the adult distribution of the risk factors has been observed in Europe, with a North–South gradient [14]. The causes and consequences of this disparity remain unestablished, in particular with regard to the early development of risk factors.

Our study region, located in the middle of Europe at the crossroads of Nordic and Mediterranean cultures, may provide an interesting insight in this respect. In Europe, health surveys similar to the National Health And Nutrition Examination Survey (NHANES) in the United States have been carried out extensively within the framework of the international MONICA project (MONItoring trends and determinants in CArdiovascular diseases), but were restricted to the middle adult-age range (35 to 64 years) [15]. In the MONICA Swiss region of Vaud-Fribourg (800,000 residents), the age range was extended from 25 to 75 years. At about the same time, a similar survey was conducted on a large sample of children and adolescents, offering the opportunity to link the two data sets.

Adults from a low socioeconomic background (and children through their parents) have been shown to adopt an adverse lifestyle more often, and therefore display higher levels of CVD risk factors [16], [17]. If it appeared to be true in Switzerland too, this information could be used to target these groups for different types of interventions and to tailor general population preventive strategies to their special needs.

The objectives of this study were (1) to describe the current gender-specific cardiovascular risk factor profiles of the Swiss population over the widest possible age range (9 to 74); (2) to determine the social gradient of these risk factor profiles by considering two education levels: and (3) to assess whether significant social differences in risk factors observed in adulthood are likewise found in the younger age groups (which would give credit to the hypothesis of a social origin of CVD), or whether significant social differences are emerging among children and adolescents that are not currently observed in adulthood.

Section snippets

Health examination survey of children and adolescents

A survey on sport and health in children and adolescents was conducted from September 1996 to March 1997 in the schools of the Canton Vaud, Switzerland. Details of the study design have been given previously [18]. A two-stage cluster sampling procedure was used to select school classes from the 4th, 6th, 8th, 10th, and 11th grades stratified by region and type of school (high school, professional school, etc.). The resulting sample comprised 3,636 subjects drawn from the reference population of

Results

The population profile of the anthropometric measures (height, weight and BMI) and physiological parameters (SBP, DBP and blood lipids) are shown in figures 1 to 6. For the former set of variables, median levels and frequency prevalence rates of overweight and obesity, as well as those of physical inactivity are presented in Table 1 according to gender and age. For the latter set of variables, corresponding figures are given in Table 2 while similar results on smoking habits are displayed in

Discussion

This study provides a direct comparison of the cardiovascular risk factor levels between children/adolescents and adults in Switzerland. Because it is based on cross-sectional surveys, the age pattern of risk factors across consecutive cohorts should not be mistaken for a life span perspective on their natural development. However, as far as anthropometric and physiological parameters are concerned, cross-sectional differences in risk factor levels between age groups are more likely to reflect

Acknowledgements

The adolescent survey was supported by the Vaud Physical Education and Sports Department and the Swiss Federal School of Gymnastics and Sports of Macolin. The Nestlé Research Center (Nestec) carried out the adolescents’ blood sample analyses. The Swiss MONICA Project was funded by the Swiss National Science Foundation (Grants 3.856-0.83, 3.938.0.85, 32-9271.87, 32-30110.90) and the Canton of Vaud.

We acknowledge the contribution of the original surveys’ collaborators: For the adolescent survey,

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