HMN 2025: How Family history of cardiometabolic disease is linked to faster heart damage in youth

A new study of more than 1,500 British adolescents is the first in the world to assess the association between familial cardiometabolic diseases and the offspring’s risk of premature heart damage by early adulthood. The study was conducted in collaboration between the Rutgers Robert Wood Johnson Medical School in the U.S., the Universities of Bristol and Exeter in the U.K., and the University of Eastern Finland. The results were published in the European Journal of Preventive Cardiology.

Study design and key findings

In the study, 1,595 adolescents drawn from the University of Bristol’s “Children of the 90s” cohort were followed up from birth and had repeated heart measures from age 17 until 24 years. One in three adolescents had a family history of cardiometabolic diseases, such as hypertension, type 2 diabetes and high cholesterol levels.

In the whole cohort, the prevalence of excessive heart enlargement (left ventricular hypertrophy) increased from 2.4% at age 17 years to 6.5% at age 24 years. Among adolescents with a family history of cardiometabolic diseases, the prevalence was 1.3% at age 17, but increased four-fold by age 24, compared to a two-fold increase among those without a family history.

Previous research among U.S. adults has shown that the risk burden of parents with early-onset myocardial infarction slightly increased the risk of their adult children developing myocardial infarction in their mid-40s, even though the latter were free of risk factors like obesity, smoking, hypertension, hyperglycemia and dyslipidemia.

However, no study in the world has previously examined the association between a parental history of cardiometabolic diseases and heart damage in the offspring already in adolescence. This is due to the scarcity of repeated echocardiography assessments of the heart in a large population of healthy youth.

Implications for prevention and future research

The study is the largest and the longest repeated echocardiography study in a relatively healthy young population in the world. Questions on parents’ cardiometabolic diseases were collected at a follow-up clinic visit of their offspring. The offspring’s fasting blood samples were repeatedly measured for insulin, glucose, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides and high-sensitivity C-reactive protein. Blood pressure, heart rate, socioeconomic status, smoking status, accelerometer measure of sedentary behavior and physical activity as well as dual-energy X-ray absorptiometry measured fat mass and lean mass were accounted for in the analyses.

The study reported that a family history of cardiometabolic diseases was prospectively associated with a 20% increased odds of progressively worsening structural and functional damage. The study also highlighted that if 60 adolescents had a family history of cardiometabolic diseases, it is likely that one of these adolescents may develop left ventricular hypertrophy, an indicator of premature structural heart damage, directly linked to a parent’s history. In addition, increased glucose in offspring partly explained (10% mediation) the long-term adverse relationship between parents’ history of cardiometabolic disease and the offspring’s enlarged heart.

“These findings highlight just how important family history is when it comes to heart disease. We already know that helping children develop healthy habits early, like being active and eating well, can protect their hearts for life. In addition, by managing blood pressure, cholesterol and other risk factors, and by adopting healthier lifestyles, future parents aren’t just improving their own health, they’re giving their children a better chance at a healthy heart,” says the first author of the study, Dr. Douglas Corsi, a resident doctor at the Rutgers Robert Wood Johnson Medical School in the US and a Doctoral Researcher at the University of Eastern Finland.

“The current findings extend our recent results, where we showed that high blood glucose and insulin resistance increase the risk of premature heart damage in youth. Adolescence is a critical window in the evolution of cardiometabolic diseases, and the faster cardiac damage progression among those with a family history of cardiometabolic diseases raises significant concerns, necessitating a special focus.

“There is a critical 20-year window between mid-20s and mid-40s to prevent premature heart attacks in midlife. Health policies could encourage the general population to examine their blood pressure, cholesterol and glucose levels, at least once every five to 10 years starting in late adolescence,” says Andrew Agbaje, physician and associate professor (docent) of Clinical Epidemiology and Child Health at the University of Eastern Finland.

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