The link between preterm birth and long-term cardiovascular risk: mechanisms, evidence, and vulnerable populations: a review

Preterm birth, defined as delivery before 37 weeks of gestation, represents a global health concern linked to substantial cardiovascular risk later in life. Individuals born preterm, especially at earlier gestational ages, exhibit increased rates of hypertension, heart failure, and ischemic heart di...

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Main Authors: Luisiana Stolfi, Marco Fabio Costantino, Francesca Cortese, Gianpaolo D’Addeo, Simona Pesce
Format: Article
Language:English
Published: Open Exploration Publishing Inc. 2025-04-01
Series:Exploration of Cardiology
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Online Access:https://www.explorationpub.com/uploads/Article/A101253/101253.pdf
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author Luisiana Stolfi
Marco Fabio Costantino
Francesca Cortese
Gianpaolo D’Addeo
Simona Pesce
author_facet Luisiana Stolfi
Marco Fabio Costantino
Francesca Cortese
Gianpaolo D’Addeo
Simona Pesce
author_sort Luisiana Stolfi
collection DOAJ
description Preterm birth, defined as delivery before 37 weeks of gestation, represents a global health concern linked to substantial cardiovascular risk later in life. Individuals born preterm, especially at earlier gestational ages, exhibit increased rates of hypertension, heart failure, and ischemic heart disease. The underlying mechanisms include disrupted fetal programming, impaired vascular remodeling, chronic neonatal inflammation, neuroendocrine immaturity, and epigenetic alterations. This review synthesizes current epidemiological evidence from large cohort studies and meta-analyses, integrating mechanistic insights from developmental biology. We discuss distinct prematurity categories—extremely preterm (< 28 weeks), very preterm (28–32 weeks), and moderate to late preterm (33–37 weeks)—highlighting their association with graded cardiovascular risk. Recent findings emphasize the role of non-transmitted parental genes and prenatal environmental toxic metal exposure as additional critical factors influencing fetal cardiovascular programming. A total of 57 articles, identified through a systematic search of PubMed, Embase, and Cochrane databases, were included to address these topics comprehensively. Early identification of preterm-born individuals as a high-risk cardiovascular group is essential for targeted screening, prevention, and interventions from childhood into adulthood. Future studies leveraging multi-omics and epigenetic approaches will further clarify these mechanisms, informing evidence-based guidelines to reduce cardiovascular morbidity associated with preterm birth.
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spelling doaj-art-65904d10212e4ab684939ff74248ee5f2025-08-20T03:50:32ZengOpen Exploration Publishing Inc.Exploration of Cardiology2994-55262025-04-01310125310.37349/ec.2025.101253The link between preterm birth and long-term cardiovascular risk: mechanisms, evidence, and vulnerable populations: a reviewLuisiana Stolfi0https://orcid.org/0009-0001-1445-6979Marco Fabio Costantino1https://orcid.org/0000-0002-6017-020XFrancesca Cortese2https://orcid.org/0000-0002-6899-3366Gianpaolo D’Addeo3Simona Pesce4Cardiovascular Department, “San Carlo” Hospital, 85100 Potenza, ItalyCardiovascular Department, “San Carlo” Hospital, 85100 Potenza, ItalyCardiology Unit, “Madonna delle Grazie” Hospital, 75100 Matera, ItalyCardiovascular Department, “San Carlo” Hospital, 85100 Potenza, ItalyNeonatology and Neonatal Intensive Care Unit, “San Carlo” Hospital, 85100 Potenza, ItalyPreterm birth, defined as delivery before 37 weeks of gestation, represents a global health concern linked to substantial cardiovascular risk later in life. Individuals born preterm, especially at earlier gestational ages, exhibit increased rates of hypertension, heart failure, and ischemic heart disease. The underlying mechanisms include disrupted fetal programming, impaired vascular remodeling, chronic neonatal inflammation, neuroendocrine immaturity, and epigenetic alterations. This review synthesizes current epidemiological evidence from large cohort studies and meta-analyses, integrating mechanistic insights from developmental biology. We discuss distinct prematurity categories—extremely preterm (< 28 weeks), very preterm (28–32 weeks), and moderate to late preterm (33–37 weeks)—highlighting their association with graded cardiovascular risk. Recent findings emphasize the role of non-transmitted parental genes and prenatal environmental toxic metal exposure as additional critical factors influencing fetal cardiovascular programming. A total of 57 articles, identified through a systematic search of PubMed, Embase, and Cochrane databases, were included to address these topics comprehensively. Early identification of preterm-born individuals as a high-risk cardiovascular group is essential for targeted screening, prevention, and interventions from childhood into adulthood. Future studies leveraging multi-omics and epigenetic approaches will further clarify these mechanisms, informing evidence-based guidelines to reduce cardiovascular morbidity associated with preterm birth.https://www.explorationpub.com/uploads/Article/A101253/101253.pdfpreterm birthcardiovascular riskfetal programminghypertensionheart failureinflammationepigeneticsvulnerable populations
spellingShingle Luisiana Stolfi
Marco Fabio Costantino
Francesca Cortese
Gianpaolo D’Addeo
Simona Pesce
The link between preterm birth and long-term cardiovascular risk: mechanisms, evidence, and vulnerable populations: a review
Exploration of Cardiology
preterm birth
cardiovascular risk
fetal programming
hypertension
heart failure
inflammation
epigenetics
vulnerable populations
title The link between preterm birth and long-term cardiovascular risk: mechanisms, evidence, and vulnerable populations: a review
title_full The link between preterm birth and long-term cardiovascular risk: mechanisms, evidence, and vulnerable populations: a review
title_fullStr The link between preterm birth and long-term cardiovascular risk: mechanisms, evidence, and vulnerable populations: a review
title_full_unstemmed The link between preterm birth and long-term cardiovascular risk: mechanisms, evidence, and vulnerable populations: a review
title_short The link between preterm birth and long-term cardiovascular risk: mechanisms, evidence, and vulnerable populations: a review
title_sort link between preterm birth and long term cardiovascular risk mechanisms evidence and vulnerable populations a review
topic preterm birth
cardiovascular risk
fetal programming
hypertension
heart failure
inflammation
epigenetics
vulnerable populations
url https://www.explorationpub.com/uploads/Article/A101253/101253.pdf
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