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The developmental origins of chronic rheumatic heart disease

The developmental origins of chronic rheumatic heart disease
The developmental origins of chronic rheumatic heart disease
Objectives
Programming is the phenomenon whereby the body's structures and functions are permanently set by nutrition and other influences during early development. There is increasing evidence that programming in utero initiates cardiovascular disease. We hypothesized that susceptibility to developing chronic rheumatic heart disease on exposure to Streptococcus pyogenes is programmed.

Methods
We studied hospital admissions and deaths from chronic rheumatic heart disease in 20,431 people born in Helsinki, Finland, during 1924–1944. One hundred and one people, 56 men, and 45 women, had chronic rheumatic heart disease.

Results
The disease was not associated with body or placental size at birth. It was, however, associated with a long umbilical cord so that the hazard ratio for the disease was 1.23 (95% CI 1.04–1.45, P?=?0.02) for every 10 cm increase in cord length. This association was present in people with mitral valve disease, hazard ratio 1.5 (1.20–1.89, P?<?0.0001), but not in people with aortic valve disease, hazard ratio 1.0 (0.76–1.33, P?=?0.97). Growing up in large households increased the risk of rheumatic heart disease.

Conclusion
Longer umbilical cords have more spirals and a greater density of spirals per unit of length. Increased spiraling will increase the resistance to flow and the pressure load on the fetal heart. This could affect the development of the heart's valves and make them more vulnerable to the autoimmune process initiated by Streptococcus pyogenes. The mitral valve may be more vulnerable than the aortic valve because the valve leaflets are larger and therefore have greater wall stress.
1042-0533
655-658
Eriksson, J.G.
eda300d2-b247-479f-95b9-f12d2c72e92b
Kajantie, E.
d4e32f85-9988-4b83-b353-012210ea0151
Phillips, D.I.
29b73be7-2ff9-4fff-ae42-d59842df4cc6
Osmond, C.
2677bf85-494f-4a78-adf8-580e1b8acb81
Thornburg, K.L.
d4c41e0d-b72a-48aa-b9d7-0eae04385497
Barker, D.J.
cabc3433-b628-43e5-9fd7-e6ff5769bf44
Eriksson, J.G.
eda300d2-b247-479f-95b9-f12d2c72e92b
Kajantie, E.
d4e32f85-9988-4b83-b353-012210ea0151
Phillips, D.I.
29b73be7-2ff9-4fff-ae42-d59842df4cc6
Osmond, C.
2677bf85-494f-4a78-adf8-580e1b8acb81
Thornburg, K.L.
d4c41e0d-b72a-48aa-b9d7-0eae04385497
Barker, D.J.
cabc3433-b628-43e5-9fd7-e6ff5769bf44

Eriksson, J.G., Kajantie, E., Phillips, D.I., Osmond, C., Thornburg, K.L. and Barker, D.J. (2013) The developmental origins of chronic rheumatic heart disease. American Journal of Human Biology, 25 (5), 655-658. (doi:10.1002/ajhb.22425). (PMID:23913477)

Record type: Article

Abstract

Objectives
Programming is the phenomenon whereby the body's structures and functions are permanently set by nutrition and other influences during early development. There is increasing evidence that programming in utero initiates cardiovascular disease. We hypothesized that susceptibility to developing chronic rheumatic heart disease on exposure to Streptococcus pyogenes is programmed.

Methods
We studied hospital admissions and deaths from chronic rheumatic heart disease in 20,431 people born in Helsinki, Finland, during 1924–1944. One hundred and one people, 56 men, and 45 women, had chronic rheumatic heart disease.

Results
The disease was not associated with body or placental size at birth. It was, however, associated with a long umbilical cord so that the hazard ratio for the disease was 1.23 (95% CI 1.04–1.45, P?=?0.02) for every 10 cm increase in cord length. This association was present in people with mitral valve disease, hazard ratio 1.5 (1.20–1.89, P?<?0.0001), but not in people with aortic valve disease, hazard ratio 1.0 (0.76–1.33, P?=?0.97). Growing up in large households increased the risk of rheumatic heart disease.

Conclusion
Longer umbilical cords have more spirals and a greater density of spirals per unit of length. Increased spiraling will increase the resistance to flow and the pressure load on the fetal heart. This could affect the development of the heart's valves and make them more vulnerable to the autoimmune process initiated by Streptococcus pyogenes. The mitral valve may be more vulnerable than the aortic valve because the valve leaflets are larger and therefore have greater wall stress.

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More information

Published date: September 2013
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 359305
URI: http://eprints.soton.ac.uk/id/eprint/359305
ISSN: 1042-0533
PURE UUID: d6a933c8-b3e1-40e0-b332-17dbf6f26f71
ORCID for C. Osmond: ORCID iD orcid.org/0000-0002-9054-4655

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Date deposited: 28 Oct 2013 10:19
Last modified: 18 Feb 2021 16:45

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Contributors

Author: J.G. Eriksson
Author: E. Kajantie
Author: D.I. Phillips
Author: C. Osmond ORCID iD
Author: K.L. Thornburg
Author: D.J. Barker

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