Childhood height may be a marker for stroke risk later

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Being a short kid is associated with increased risk of having a stroke in adulthood, according to Danish research.

A prospective study examined data on more than 300,000 Danish schoolchildren – born between 1930-1989 who were examined at ages 7, 10 and 13. Researchers noted that boys and girls who were 2 to 3 inches shorter than average for their age were at increased risk of clot-related (ischaemic) stroke in adult men and women and of bleeding stroke in men.

While adult height is genetically determined, it is also influenced by factors such as maternal diet during pregnancy, childhood diet, infection and psychological stress. Several of these factors are modifiable and all are thought to affect the risk of stroke.

Researchers noted that a decline in stroke incidence and mortality rates in most high-income countries, primarily in women, occurred simultaneously with a general increase in attained adult height. Taken together, this suggests the involvement of shared underlying mechanisms for height and stroke development.

Researchers say these results have implications for understanding disease origin rather than for clinical risk prediction and future studies should focus on the mechanisms underlying the relationship between childhood height and later stroke.

“Our study suggests that short height in children is a possible marker of stroke risk and suggests these children should pay extra attention to changing or treating modifiable risk factors for stroke throughout life to reduce the chances of having this disease,” said senior study author Dr Jennifer L Baker, associate professor in the Centre for Clinical Research and Prevention at Bispebjerg and Frederiksberg Hospital and Novo Nordisk Foundation Centre for Basic Metabolic Research, faculty of health and medical sciences, at the University of Copenhagen, in Denmark.

Background and Purpose: Attained height, an indicator of genetic potential and childhood growth environment, is inversely associated with stroke, but the mechanisms are poorly understood. We investigated whether childhood height and growth are associated with ischemic stroke (IS) and intracerebral hemorrhage (ICH).
Methods: In a cohort of Danish schoolchildren born 1930 to 1989, with measured height from 7 to 13 years, we investigated associations of childhood stature and growth with risks of adult IS and ICH. Cox proportional hazards regressions were performed to estimate hazard ratios (HRs) with CIs separately for women and men.
Results: Among 311 009 individuals, 10 412 were diagnosed with IS and 2546 with ICH. Height at 7 years was inversely and significantly associated with IS in both sexes (per z score, equivalent to ≈5.2 cm in women and 5.1 cm in men; women: HR=0.89 [95% CI: 0.87–0.92]; men: HR=0.90 [95% CI: 0.88–0.92]) and with ICH in men (HR=0.89 [95% CI: 0.84–0.94]) but not in women (HR=0.97 [95% CI: 0.91–1.04]). Associations were similar at older childhood ages and were stable throughout the study period. No statistically significant associations for growth from 7 to 13 years were observed for IS or ICH.
Conclusions: Short stature at 7 to 13 years is significantly associated with increased risks of IS in both sexes and with ICH in men. Growth during this period of childhood is not significantly associated with either of these stroke subtypes, suggesting that underlying mechanisms linking height with risks of stroke may exert their influence already by early childhood.

Line Klingen Gjærde, Thomas Clement Truelsen, Jennifer Lyn Baker

American Heart Association material
Stroke abstract

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