Langenberg, C.; (2007) Poor growth, social inequalities and coronary risk. Doctoral thesis , University of London.

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Abstract

Data from 5 epidemiological studies, spanning an age range from childhood to late adult life, are used to investigate associations between components of height, used as markers of growth at different phases, and arterial stiffness, subclinical atherosclerosis and cardiovascular risk. The roles of prenatal growth and life course socioeconomic position are considered. In the 1946 Birth Cohort, shorter leg, but not trunk length, was associated with greater pulse pressure, a measure of arterial stiffness, in adult men and women. Longitudinal analyses suggested that these effects were due to a steeper rise of blood pressure with age, independent of potential confounders and mediators considered. In the Whitehall II Study, shorter leg and trunk length were both associated with adverse levels of several cardiovascular risk factors and also lower distensibility and greater stiffness of the carotid arteries in men. In a cross-sectional examination of Filipino-American women, coronary disease was most strongly associated with leg length, while diabetes prevalence was not associated with measures of growth, but highest in women who were socioeconomically disadvantaged in childhood and adulthood. Higher blood pressure levels were observed in children with shorter leg length, relative to total body height, of a contemporary US birth cohort at age 3 years. The contribution of prenatal growth was considered in all studies where birthweight was available and found to be limited. Finally, results from the first Whitehall Study suggested that associations between stature and cardiovascular mortality may differ by socioeconomic position. These findings lend some support to the hypothesis that factors limiting leg growth are associated with arterial stiffness, subclinical atherosclerosis and cardiovascular risk these associations may originate in childhood and be amplified with age. The specificity of leg length as a marker of early influences on growth that alter cardiovascular risk is questioned.

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