title: The impact of birth weight on cardiovascular disease risk in the Women's Health Initiative.
abstract: OBJECTIVE
  Cardiovascular disease (CVD) is among the leading causes of morbidity and mortality worldwide. Traditional risk factors predict 75-80% of an individual's risk of incident CVD. However, the role of early life experiences in future disease risk is gaining attention. The Barker hypothesis proposes fetal origins of adult disease, with consistent evidence demonstrating the deleterious consequences of birth weight outside the normal range. In this study, we investigate the role of birth weight in CVD risk prediction.
  
  
  RESULTS
  The Women's Health Initiative (WHI) represents a large national cohort of post-menopausal women with 63,815 participants included in this analysis. Univariable proportional hazards regression analyses evaluated the association of 4 self-reported birth weight categories against 3 CVD outcome definitions, which included indicators of coronary heart disease, ischemic stroke, coronary revascularization, carotid artery disease and peripheral arterial disease. The role of birth weight was also evaluated for prediction of CVD events in the presence of traditional risk factors using 3 existing CVD risk prediction equations: one body mass index (BMI)-based and two laboratory-based models. Low birth weight (LBW) (<6 lbs.) was significantly associated with all CVD outcome definitions in univariable analyses (HR = 1.086, p = 0.009). LBW was a significant covariate in the BMI-based model (HR = 1.128, p < 0.0001) but not in the lipid-based models.
  
  
  CONCLUSIONS
  LBW (<6 lbs.) is independently associated with CVD outcomes in the WHI cohort. This finding supports the role of the prenatal and postnatal environment in contributing to the development of adult chronic disease.
authors.affiliation: University of Iowa Department of Epidemiology, College of Public Health, 145 N. Riverside Drive, Iowa City, IA, 52242, USA.
authors.forename: C J
authors.initials: CJ
authors.lastname: Smith
authors.affiliation: University of Iowa Department of Epidemiology, College of Public Health, 145 N. Riverside Drive, Iowa City, IA, 52242, USA.
authors.forename: K K
authors.initials: KK
authors.lastname: Ryckman
authors.affiliation: University at Buffalo, Department of Obstetrics and Gynecology, 219 Bryant Street, Buffalo, NY, 14221, USA.
authors.forename: V M
authors.initials: VM
authors.lastname: Barnabei
authors.affiliation: Medstar Health Research Institute, Hyattsville, MD, USA; Georgetown/Howard Universities Center for Clinical and Translational Research, USA.
authors.forename: B V
authors.initials: BV
authors.lastname: Howard
authors.affiliation: Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY, USA.
authors.forename: C R
authors.initials: CR
authors.lastname: Isasi
authors.affiliation: University of Wisconsin, Department of Obstetrics and Gynecology, Madison, WI, USA.
authors.forename: G E
authors.initials: GE
authors.lastname: Sarto
authors.affiliation: University of Maryland, School of Pharmacy, Baltimore, MD, USA.
authors.forename: S E
authors.initials: SE
authors.lastname: Tom
authors.affiliation: Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: L V
authors.initials: LV
authors.lastname: Van Horn
authors.affiliation: University of Iowa Department of Epidemiology, College of Public Health, 145 N. Riverside Drive, Iowa City, IA, 52242, USA.
authors.forename: R B
authors.initials: RB
authors.lastname: Wallace
authors.affiliation: University of Iowa Department of Epidemiology, College of Public Health, 145 N. Riverside Drive, Iowa City, IA, 52242, USA. Electronic address: jennifer-g-robinson@uiowa.edu.
authors.forename: J G
authors.initials: JG
authors.lastname: Robinson
mesh_terms: D000368:Aged; D001724:Birth Weight; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007230:Infant, Low Birth Weight / Q000378:metabolism*; D008875:Middle Aged; D017698:Postmenopause / Q000378:metabolism; D011247:Pregnancy; D012307:Risk Factors; D057566:Self Report; D016387:Women's Health
keywords: Barker hypothesis; Life course epidemiology; Metabolic syndrome; Proportional hazards model; Risk prediction; Self-reported birth weight