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Int J Epidemiol. 2018 Dec 7. doi: 10.1093/ije/dyy264. [Epub ahead of print]

Use of a pooled cohort to impute cardiovascular disease risk factors across the adult life course.

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Department of Public Health Sciences, University of Miami, Miami, FL, USA.
Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA.
Division of General Medicine, Columbia University Medical Center, New York, NY, USA.
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
Department of Psychiatry, University of California San Francisco, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
Department of Neurology, University of California San Francisco, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.



In designing prevention strategies, it may be useful to understand how early and midlife cardiovascular disease risk factor (CVDRF) exposures affect outcomes that primarily occur in mid to late life. Few single US cohorts have followed participants from early adulthood to late life.


We pooled four prospective cohorts that represent segments of the adult life course, and studied 15 001 White and Black adults aged 18 to 95 years at enrollment. We imputed early and midlife exposure to body mass index (BMI), glucose, lipids and blood pressure (BP). CVDRF trajectories were estimated using linear mixed models. Using the best linear unbiased predictions, we obtained person-specific estimates of CVDRF trajectories beginning at age 20 until each participant's end of follow-up. We then calculated for each CVDRF, summary measures of early and midlife exposure as time-weighted averages (TWAs).


In the pooled cohort, 33.7% were Black and 54.8% were female. CVDRF summary measures worsened in midlife compared with early life and varied by sex and race. In particular, systolic and diastolic BP were consistently higher over the adult life course among men, and BMI was higher among Blacks, particularly Black women. Simulation studies suggested acceptable imputation accuracy, especially for the younger cohorts. Correlations of true and imputed CVDRF summary measures ranged from 0.53 to 0.99, and agreement ranged from 67% to 99%.


These results suggest that imputed CVDRFs may be accurate enough to be useful in assessing the effects of early and midlife exposures on later life outcomes.


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