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La prevenzione cardiovascolare si inizia fin da piccoli

Negli ultimi trent'anni l'obesità è nettamente in aumento e sta diventando un'emergenza sanitaria.Si stima che nel mondo 500 milioni di adulti sono obesi con un aumento della prevalenza anche nei bambini e negli adolescenti. L'obesità non è solo una patologia per se stessa. Infatti il soggetto obeso può presentare più fattori di rischio cardiovascolare, come il diabete, l'ipertensione, la dislipidemia.
In questo interessante studio 2,3 milioni di adolescenti sono stati seguiti per 40 anni. Il rischio di morte in età adulta per malattia coronarica, ictus e morte improvvisa per cause non note è stato messo in relazione con il loro indice di massa corporea. La conclusione è stata che essere in sovrappeso o obeso da adolescenti è strettamente associato ad un maggiore rischio di malattie cardiovascolari in età adulta e che questo rischio aumenta già in modo graduale per valori di indice di massa corporea al di sopra del 50th percentile.

BODY-MASS INDEX IN 2.3 MILLION ADOLESCENTS AND CARDIOVASCULAR DEATH IN ADULTHOOD

Twig G, Yaniv G, Levine H, Leiba A, Goldberger N, Derazne E, Ben-Ami Shor D, Tzur D, Afek A, Shamiss A, Haklai Z, Kark JD

N Engl J Med 2016;374:2430-40

BACKGROUND: In light of the worldwide increase in childhood obesity, we examined the association between body-mass index (BMI) in late adolescence and death from cardiovascular causes in adulthood.
METHODS: We grouped data on BMI, as measured from 1967 through 2010 in 2.3 million Israeli adolescents (mean age, 17.3±0.4 years), according to age- and sex-specific percentiles from the U.S. Centers for Disease Control and Prevention. Primary outcomes were the number of deaths attributed to coronary heart disease, stroke, sudden death from an unknown cause, or a combination of all three categories (total cardiovascular causes) by mid-2011. Cox proportional-hazards models were used.
RESULTS: During 42,297,007 person-years of follow-up, 2918 of 32,127 deaths (9.1%) were from cardiovascular causes, including 1497 from coronary heart disease, 528 from stroke, and 893 from sudden death. On multivariable analysis, there was a graded increase in the risk of death from cardiovascular causes and all causes that started among participants in the group that was in the 50th to 74th percentiles of BMI (i.e., within the accepted normal range). Hazard ratios in the obese group (=95th percentile for BMI), as compared with the reference group in the 5th to 24th percentiles, were 4.9 (95% confidence interval [CI], 3.9 to 6.1) for death from coronary heart disease, 2.6 (95% CI, 1.7 to 4.1) for death from stroke, 2.1 (95% CI, 1.5 to 2.9) for sudden death, and 3.5 (95% CI, 2.9 to 4.1) for death from total cardiovascular causes, after adjustment for sex, age, birth year, sociodemographic characteristics, and height. Hazard ratios for death from cardiovascular causes in the same percentile groups increased from 2.0 (95% CI, 1.1 to 3.9) during follow-up for 0 to 10 years to 4.1 (95% CI, 3.1 to 5.4) during follow-up for 30 to 40 years; during both periods, hazard ratios were consistently high for death from coronary heart disease. Findings persisted in extensive sensitivity analyses.
CONCLUSIONS: A BMI in the 50th to 74th percentiles, within the accepted normal range, during adolescence was associated with increased cardiovascular and all-cause mortality during 40 years of follow-up. Overweight and obesity were strongly associated with increased cardiovascular mortality in adulthood. (Funded by the Environment and Health Fund.).

N Engl J Med 2016;374:2430-40