Author + information
- Victor Waldmann, MD, MPH and
- Bamba Gaye, PhD∗ ()
- ↵∗Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), Cardiology Department, European Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France
We were very interested while reading the work of Rovio et al. (1) in which they sought to investigate the associations between early-life cardiovascular risk factors and midlife cognitive performance in the YFS (Young Finns Study). They observed that the cumulative burden of cardiovascular risk factors (i.e., from childhood or adolescence) was associated with worse midlife cognitive performance independent of adulthood exposure.
The authors examined the effects of exposures to early-life risk factors repeatedly exceeding the recommended guidelines. The reasoning behind this analysis is interesting, and while this approach is very informative, we believe that a better approach would be to examine trajectories of risk factors exceeding the recommended guidelines. The trajectory approach would be more suitable for capturing the effect of risk exposure all throughout childhood, adolescence, and young adulthood (2). By classifying participants into distinct, mutually exclusive trajectory groups, this method would allow for closer scrutiny of the population heterogeneity in the change of cardiovascular risk factor exposures over the life course. This would then allow for the direct comparison of outcomes across these groups.
Furthermore, Rovio et al.’s (1) use of the area under the curve (AUC) to indicate the long-term burden raises some questions. How would the authors deal with 2 participants when the initial value of 1 corresponds to the final value of the other? And vice versa? In fact, an identical AUC could be the result of diametrically opposite evolution: a same total AUC (Figure 1, a+b) and opposite incremental AUC (Figure 1, a). Considering the equal impact of increasing versus decreasing risk factor exposure while aging raises some concerns, especially because the investigators demonstrated that the impact of the burden of risk factors across ages differs.
Please note: Both authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2017 American College of Cardiology Foundation
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