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Original research
Predictors of cardiovascular health in teenagers (aged 13–14 years): a cross-sectional study linked with routine data
  1. Michaela James1,
  2. Danielle Christian2,
  3. Samantha Scott1,
  4. Charlotte Todd1,
  5. Gareth Stratton3,
  6. Joanne Demmler1,
  7. Sarah McCoubrey4,
  8. Julian P Halcox5,
  9. Suzanne Audrey6,
  10. Elizabeth Anne Ellins5 and
  11. Sinead Brophy1
  1. 1Medical School, Swansea University, Swansea, UK
  2. 2Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
  3. 3College of Engineering, Swansea University, Swansea, Swansea, UK
  4. 4Sport Development, City and County of Swansea Council, Swansea, UK
  5. 5Medical School, Institute of Life Science, Swansea University, Swansea, UK
  6. 6Population Health Sciences, University of Bristol, Bristol, UK
  1. Correspondence to Dr Michaela James; m.l.james{at}


Objective To examine the predictors of cardiovascular health in teenagers (aged 13–14 years).

Methods Measures of arterial stiffness (augmentation index (AIx)), blood pressure and cardiovascular fitness were taken from 234 teenage children (n=152 boys) and subsequently linked to routine data (birth and general practice records, education data and hospital admission data). Deprivation at school and at individual level was measured at birth, at 1 year old, at 13 years old and at secondary school using the Welsh Index of Multiple Deprivation. Multivariate regression analysis determined associations between routinely collected data and cardiovascular measures.

Results Teenagers had higher AIx (2.41 (95% CI 1.10 to 3.72)), ran fewer metres (−130.08 m (95% CI −234.35 to −25.78)) in the Cooper Run Test if they attended a more deprived school. However, higher individual level deprivation was associated with greater fitness (199.38 m (95% CI 83.90 to 314.84)). Higher systolic blood pressure was observed in first born children (10.23 mm Hg (95% CI 1.58 to 18.88)) and in those who were never breastfed (4.77 mm Hg (95% CI 1.10 to 8.42)).

Conclusions Improving heart health in deprived areas requires multilevel action across childhood namely, active play and programmes that promote physical activity and fitness and, the promotion of breastfeeding. Recognition of the important early indicators and determinants of cardiovascular health supports further development of the evidence base to encourage policy-makers to implement preventative measures in young people.

  • public health
  • risk factors
  • risk stratification

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  • Contributors MJ wrote the first draft of the paper and all authors provided critical input and revisions for all further drafts, SB wrote analysis and results section and provided critical input and revisions for all further drafts. MJ, CT, SS, JD and SB undertook data collection and data analysis. DC, CT, SB, GS, JH, SA, SM, EE designed the study, aided in interpretation of findings and supervision of study quality. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding This work was supported by the British Heart Foundation and the National Centre for Population Health and Wellbeing Research. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

  • Disclaimer The lead author (MJ) affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The College of Human and Health Science Ethics Committee granted ACTIVE ethical approval (reference: 090516). The study was linked to anonymised routine data and therefore the need for further ethical approval and participant consent was waived by the approving IRB (Institutional Review Board), UK National Health Service Research Ethics Committee. The SAIL independent Information Governance Review Panel (IGRP), which contains members from the UK National Health Service Research Ethics Committee, experts in information governance and members of the public, approved the study.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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