Association of preterm birth with lipid disorders in early adulthood:  A Swedish cohort study

Preterm birth has previously been linked with cardiovascular disease (CVD) in adulthood. However, associations with lipid disorders (e.g., high cholesterol or triglycerides), which are major risk factors for CVD, have seldom been examined and are conflicting. Clinicians will increasingly encounter a...

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Veröffentlicht in:PLoS medicine 2019-10, Vol.16 (10), p.e1002947
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description Preterm birth has previously been linked with cardiovascular disease (CVD) in adulthood. However, associations with lipid disorders (e.g., high cholesterol or triglycerides), which are major risk factors for CVD, have seldom been examined and are conflicting. Clinicians will increasingly encounter adult survivors of preterm birth and will need to understand the long-term health sequelae. We conducted the first large population-based study to determine whether preterm birth is associated with an increased risk of lipid disorders. A retrospective national cohort study was conducted of all 2,235,012 persons born as singletons in Sweden during 1973 to 1995 (48.6% women), who were followed up for lipid disorders identified from nationwide inpatient, outpatient, and pharmacy data through 2016 (maximum age 44 years). Cox regression was used to adjust for other perinatal and maternal factors, and co-sibling analyses assessed the potential influence of unmeasured shared familial (genetic and/or environmental) factors. A total of 25,050 (1.1%) persons were identified with lipid disorders in 30.3 million person-years of follow-up. Each additional 5 weeks of gestation were associated with a 14% reduction in risk of lipid disorders (adjusted hazard ratio [HR], 0.86; 95% CI, 0.83-0.89; P < 0.001). Relative to full-term birth (gestational age 39-41 weeks), the adjusted HR associated with preterm birth (
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However, associations with lipid disorders (e.g., high cholesterol or triglycerides), which are major risk factors for CVD, have seldom been examined and are conflicting. Clinicians will increasingly encounter adult survivors of preterm birth and will need to understand the long-term health sequelae. We conducted the first large population-based study to determine whether preterm birth is associated with an increased risk of lipid disorders. A retrospective national cohort study was conducted of all 2,235,012 persons born as singletons in Sweden during 1973 to 1995 (48.6% women), who were followed up for lipid disorders identified from nationwide inpatient, outpatient, and pharmacy data through 2016 (maximum age 44 years). Cox regression was used to adjust for other perinatal and maternal factors, and co-sibling analyses assessed the potential influence of unmeasured shared familial (genetic and/or environmental) factors. A total of 25,050 (1.1%) persons were identified with lipid disorders in 30.3 million person-years of follow-up. Each additional 5 weeks of gestation were associated with a 14% reduction in risk of lipid disorders (adjusted hazard ratio [HR], 0.86; 95% CI, 0.83-0.89; P < 0.001). Relative to full-term birth (gestational age 39-41 weeks), the adjusted HR associated with preterm birth (<37 weeks) was 1.23 (95% CI, 1.16-1.29; P < 0.001), and further stratified was 2.00 (1.41-2.85; P < 0.001) for extremely preterm (22-27 weeks), 1.33 (1.19-1.49; P < 0.001) for very preterm (28-33 weeks), and 1.19 (1.12-1.26; P < 0.001) for late preterm (34-36 weeks). These findings were similar in men and women (e.g., preterm versus full-term, men: HR, 1.22; 95% CI, 1.14-1.31; P < 0.001; women: HR, 1.23; 1.12-1.32; P < 0.001). Co-sibling analyses suggested that they were substantially though not completely explained by shared genetic or environmental factors in families. The main study limitation was the unavailability of laboratory data to assess specific types or severity of lipid disorders. In this large national cohort, preterm birth was associated with an increased risk of lipid disorders in early- to midadulthood. Persons born prematurely may need early preventive evaluation and long-term monitoring for lipid disorders to reduce their future cardiovascular risks.]]></description><identifier>ISSN: 1549-1676</identifier><identifier>ISSN: 1549-1277</identifier><identifier>EISSN: 1549-1676</identifier><identifier>DOI: 10.1371/journal.pmed.1002947</identifier><identifier>PMID: 31626652</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adolescent ; Adult ; Adults ; Age ; Analysis ; Biology and Life Sciences ; Birth ; Cardiovascular diseases ; Cardiovascular Diseases - epidemiology ; Cholesterol ; Cholesterol - blood ; Cohort analysis ; Complications ; Disorders ; Drugstores ; Dyslipidemias - epidemiology ; Environmental factors ; Family medical history ; Female ; Follow-Up Studies ; Funding ; Genetic research ; Gestation ; Gestational Age ; Health ; Health risk assessment ; Health risks ; Hospitals ; Humans ; Lipids ; Male ; Medicine and Health Sciences ; Mortality ; Mutation ; People and places ; Pharmacy ; Population ; Population studies ; Premature birth ; Premature Birth - epidemiology ; Premature infants ; Primary care ; Proportional Hazards Models ; Registries ; Retrospective Studies ; Risk Factors ; Siblings ; Studies ; Sweden - epidemiology ; Triglycerides ; Triglycerides - blood ; Young Adult ; Young adults</subject><ispartof>PLoS medicine, 2019-10, Vol.16 (10), p.e1002947</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Crump et al. 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Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 Crump et al 2019 Crump et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c6797-b36b666d0617ce8ba7ff4b376164494457942c45d7ac1a9007f6c129dd9fce333</citedby><cites>FETCH-LOGICAL-c6797-b36b666d0617ce8ba7ff4b376164494457942c45d7ac1a9007f6c129dd9fce333</cites><orcidid>0000-0002-2990-1166</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6799885/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6799885/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,725,778,782,862,883,2098,2917,23849,27907,27908,53774,53776,79351,79352</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31626652$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Smith, Gordon C.</contributor><creatorcontrib>Crump, Casey</creatorcontrib><creatorcontrib>Sundquist, Jan</creatorcontrib><creatorcontrib>Sundquist, Kristina</creatorcontrib><title>Association of preterm birth with lipid disorders in early adulthood:  A Swedish cohort study</title><title>PLoS medicine</title><addtitle>PLoS Med</addtitle><description><![CDATA[Preterm birth has previously been linked with cardiovascular disease (CVD) in adulthood. However, associations with lipid disorders (e.g., high cholesterol or triglycerides), which are major risk factors for CVD, have seldom been examined and are conflicting. Clinicians will increasingly encounter adult survivors of preterm birth and will need to understand the long-term health sequelae. We conducted the first large population-based study to determine whether preterm birth is associated with an increased risk of lipid disorders. A retrospective national cohort study was conducted of all 2,235,012 persons born as singletons in Sweden during 1973 to 1995 (48.6% women), who were followed up for lipid disorders identified from nationwide inpatient, outpatient, and pharmacy data through 2016 (maximum age 44 years). Cox regression was used to adjust for other perinatal and maternal factors, and co-sibling analyses assessed the potential influence of unmeasured shared familial (genetic and/or environmental) factors. A total of 25,050 (1.1%) persons were identified with lipid disorders in 30.3 million person-years of follow-up. Each additional 5 weeks of gestation were associated with a 14% reduction in risk of lipid disorders (adjusted hazard ratio [HR], 0.86; 95% CI, 0.83-0.89; P < 0.001). Relative to full-term birth (gestational age 39-41 weeks), the adjusted HR associated with preterm birth (<37 weeks) was 1.23 (95% CI, 1.16-1.29; P < 0.001), and further stratified was 2.00 (1.41-2.85; P < 0.001) for extremely preterm (22-27 weeks), 1.33 (1.19-1.49; P < 0.001) for very preterm (28-33 weeks), and 1.19 (1.12-1.26; P < 0.001) for late preterm (34-36 weeks). These findings were similar in men and women (e.g., preterm versus full-term, men: HR, 1.22; 95% CI, 1.14-1.31; P < 0.001; women: HR, 1.23; 1.12-1.32; P < 0.001). Co-sibling analyses suggested that they were substantially though not completely explained by shared genetic or environmental factors in families. The main study limitation was the unavailability of laboratory data to assess specific types or severity of lipid disorders. In this large national cohort, preterm birth was associated with an increased risk of lipid disorders in early- to midadulthood. Persons born prematurely may need early preventive evaluation and long-term monitoring for lipid disorders to reduce their future cardiovascular risks.]]></description><subject>Adolescent</subject><subject>Adult</subject><subject>Adults</subject><subject>Age</subject><subject>Analysis</subject><subject>Biology and Life Sciences</subject><subject>Birth</subject><subject>Cardiovascular diseases</subject><subject>Cardiovascular Diseases - epidemiology</subject><subject>Cholesterol</subject><subject>Cholesterol - blood</subject><subject>Cohort analysis</subject><subject>Complications</subject><subject>Disorders</subject><subject>Drugstores</subject><subject>Dyslipidemias - epidemiology</subject><subject>Environmental factors</subject><subject>Family medical history</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Funding</subject><subject>Genetic research</subject><subject>Gestation</subject><subject>Gestational Age</subject><subject>Health</subject><subject>Health risk assessment</subject><subject>Health risks</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Lipids</subject><subject>Male</subject><subject>Medicine and Health Sciences</subject><subject>Mortality</subject><subject>Mutation</subject><subject>People and places</subject><subject>Pharmacy</subject><subject>Population</subject><subject>Population studies</subject><subject>Premature birth</subject><subject>Premature Birth - epidemiology</subject><subject>Premature infants</subject><subject>Primary care</subject><subject>Proportional Hazards Models</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Siblings</subject><subject>Studies</subject><subject>Sweden - epidemiology</subject><subject>Triglycerides</subject><subject>Triglycerides - blood</subject><subject>Young Adult</subject><subject>Young adults</subject><issn>1549-1676</issn><issn>1549-1277</issn><issn>1549-1676</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>DOA</sourceid><recordid>eNqVk-uK1DAUx4so7kXfQDQgLPhhxqRNk2Y_CMPiZWBxwVU_GtLkdJqh04xJ6zpv47P4ZGZ2ussURlACSUh-53-Sc0mSZwRPScbJ66Xrfaua6XoFZkowTgXlD5JjklMxIYyzh3v7o-QkhOWWwQI_To4ywlLG8vQ4-TYLwWmrOuta5Cq09tCBX6HS-q5GNzZOjV1bg4wNzhvwAdkWgfLNBinTN13tnDlHv3_N0PUNRKhG2tXOdyh0vdk8SR5VqgnwdFhPky_v3n6--DC5vHo_v5hdTjTjgk_KjJWMMYMZ4RqKUvGqomXGGWGUCkpzLmiqaW640kQJjHnFNEmFMaLSkGXZafJip7tuXJBDaIJMM0JziotiS8x3hHFqKdferpTfSKesvD1wfiGV76xuQKaK6xjNguVaUwZUgSiqrMpSUAXQW29vBm99GaOvoe28akai45vW1nLhfsj4WVEUeRR4OQh4972H0P3lyQO1UPFVtq1cFNMrG7ScMcwZ5ThPIzU5QC2ghejZtVDZeDzipwf4OAysrD5o8GpkEJkOfnYL1Ycg59ef_oP9-O_s1dcxe7bH1qBi4QXX9NuyDWOQ7kDtXQgeqvusECy3fXMXabntGzn0TTR7vp_Re6O7Rsn-AGTDEd4</recordid><startdate>20191018</startdate><enddate>20191018</enddate><creator>Crump, Casey</creator><creator>Sundquist, Jan</creator><creator>Sundquist, Kristina</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISN</scope><scope>ISR</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>5PM</scope><scope>DOA</scope><scope>CZK</scope><orcidid>https://orcid.org/0000-0002-2990-1166</orcidid></search><sort><creationdate>20191018</creationdate><title>Association of preterm birth with lipid disorders in early adulthood:  A Swedish cohort study</title><author>Crump, Casey ; Sundquist, Jan ; Sundquist, Kristina</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c6797-b36b666d0617ce8ba7ff4b376164494457942c45d7ac1a9007f6c129dd9fce333</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Adults</topic><topic>Age</topic><topic>Analysis</topic><topic>Biology and Life Sciences</topic><topic>Birth</topic><topic>Cardiovascular diseases</topic><topic>Cardiovascular Diseases - epidemiology</topic><topic>Cholesterol</topic><topic>Cholesterol - blood</topic><topic>Cohort analysis</topic><topic>Complications</topic><topic>Disorders</topic><topic>Drugstores</topic><topic>Dyslipidemias - epidemiology</topic><topic>Environmental factors</topic><topic>Family medical history</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Funding</topic><topic>Genetic research</topic><topic>Gestation</topic><topic>Gestational Age</topic><topic>Health</topic><topic>Health risk assessment</topic><topic>Health risks</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Lipids</topic><topic>Male</topic><topic>Medicine and Health Sciences</topic><topic>Mortality</topic><topic>Mutation</topic><topic>People and places</topic><topic>Pharmacy</topic><topic>Population</topic><topic>Population studies</topic><topic>Premature birth</topic><topic>Premature Birth - epidemiology</topic><topic>Premature infants</topic><topic>Primary care</topic><topic>Proportional Hazards Models</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Siblings</topic><topic>Studies</topic><topic>Sweden - epidemiology</topic><topic>Triglycerides</topic><topic>Triglycerides - blood</topic><topic>Young Adult</topic><topic>Young adults</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Crump, Casey</creatorcontrib><creatorcontrib>Sundquist, Jan</creatorcontrib><creatorcontrib>Sundquist, Kristina</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Canada</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health &amp; 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However, associations with lipid disorders (e.g., high cholesterol or triglycerides), which are major risk factors for CVD, have seldom been examined and are conflicting. Clinicians will increasingly encounter adult survivors of preterm birth and will need to understand the long-term health sequelae. We conducted the first large population-based study to determine whether preterm birth is associated with an increased risk of lipid disorders. A retrospective national cohort study was conducted of all 2,235,012 persons born as singletons in Sweden during 1973 to 1995 (48.6% women), who were followed up for lipid disorders identified from nationwide inpatient, outpatient, and pharmacy data through 2016 (maximum age 44 years). Cox regression was used to adjust for other perinatal and maternal factors, and co-sibling analyses assessed the potential influence of unmeasured shared familial (genetic and/or environmental) factors. A total of 25,050 (1.1%) persons were identified with lipid disorders in 30.3 million person-years of follow-up. Each additional 5 weeks of gestation were associated with a 14% reduction in risk of lipid disorders (adjusted hazard ratio [HR], 0.86; 95% CI, 0.83-0.89; P < 0.001). Relative to full-term birth (gestational age 39-41 weeks), the adjusted HR associated with preterm birth (<37 weeks) was 1.23 (95% CI, 1.16-1.29; P < 0.001), and further stratified was 2.00 (1.41-2.85; P < 0.001) for extremely preterm (22-27 weeks), 1.33 (1.19-1.49; P < 0.001) for very preterm (28-33 weeks), and 1.19 (1.12-1.26; P < 0.001) for late preterm (34-36 weeks). These findings were similar in men and women (e.g., preterm versus full-term, men: HR, 1.22; 95% CI, 1.14-1.31; P < 0.001; women: HR, 1.23; 1.12-1.32; P < 0.001). Co-sibling analyses suggested that they were substantially though not completely explained by shared genetic or environmental factors in families. The main study limitation was the unavailability of laboratory data to assess specific types or severity of lipid disorders. In this large national cohort, preterm birth was associated with an increased risk of lipid disorders in early- to midadulthood. Persons born prematurely may need early preventive evaluation and long-term monitoring for lipid disorders to reduce their future cardiovascular risks.]]></abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>31626652</pmid><doi>10.1371/journal.pmed.1002947</doi><orcidid>https://orcid.org/0000-0002-2990-1166</orcidid><oa>free_for_read</oa></addata></record>
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subjects Adolescent
Adult
Adults
Age
Analysis
Biology and Life Sciences
Birth
Cardiovascular diseases
Cardiovascular Diseases - epidemiology
Cholesterol
Cholesterol - blood
Cohort analysis
Complications
Disorders
Drugstores
Dyslipidemias - epidemiology
Environmental factors
Family medical history
Female
Follow-Up Studies
Funding
Genetic research
Gestation
Gestational Age
Health
Health risk assessment
Health risks
Hospitals
Humans
Lipids
Male
Medicine and Health Sciences
Mortality
Mutation
People and places
Pharmacy
Population
Population studies
Premature birth
Premature Birth - epidemiology
Premature infants
Primary care
Proportional Hazards Models
Registries
Retrospective Studies
Risk Factors
Siblings
Studies
Sweden - epidemiology
Triglycerides
Triglycerides - blood
Young Adult
Young adults
title Association of preterm birth with lipid disorders in early adulthood:  A Swedish cohort study
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