Programming the cardiovascular system

Introduction David Barker and colleagues first trained the spotlight on the idea that the prenatal environment shapes the lifelong health of the heart. They reported that the standardised mortality for ischaemic heart disease within a large population of English men and women was much higher in babies born at the 5- pound (2.3 kg) end of the birthweight scale compared to babies at the 9-pound (4.0 kg) end (Barker et al., 1989). Birthweight affected the death rate in men and women similarly across the weight range, with a significant sudden upturn in the heaviest babies studied. The latter group of heavier newborn babies may have included babies that were macrosomic and born to diabetic mothers. In a separate study, Rich-Edwards and coworkers (1997) found a similar relationship among >100, 000 participants in the American Nurses study. In that study, the numbers of individuals who had symptoms for coronary disease and stroke increased with decreasing recalled birthweight. The implications of the epidemiological findings of Barker’s group are enormous. Cardiovascular disease is the most devastating disease on earth and, as a category, kills more men and women than any other disease. In the USA alone, the costs to society for cardiovascular disease currently exceed $350 billion annually. Furthermore, the rates of death due to cardiovascular events around the world are on the increase (American Heart Association 2004, World Health Organization, 2003, 2004a). Over half of all cardiovascular deaths worldwide are of women (World Health Organization 2004b, 2004c).