• Cardiac risk factors and prevention

Cardiometabolic disorders including diabetes, hypertension, dyslipidaemia and atherosclerotic cardiovascular diseases (ASCVD) are the biggest threat to human health particularly to people in low-income and middle-income countries. An increasing body of evidence has now linked exposure to suboptimal environment in early life (eg, maternal malnutrition during pregnancy) to elevated risks of cardiometabolic disorders later in life. It is not known, however, whether the detrimental effects of suboptimal environmental exposure in early life on health outcomes could be mitigated by improving lifestyle as adults. In other words, can we correct the mistakes made by our parents by improving our lifestyle later in life? In their Heart paper, Meng et al.1 probably gave us some hints to that question. In a large prospective study of 92 284 Chinese men and women aged 39–51 years followed for a median of 10 years, the authors found that, interestingly, the associations between prenatal exposure to the Chinese famine of 1959–1961 and increased risks of developing ASCVD were primarily restricted to urban participants (HR for cerebrovascular disease=1.18, 95% CI 1.09 to 1.28) and participants with lower physical activity (HR for ischaemic heart disease=1.15, 95% CI 1.05 to 1.26; HR for cerebrovascular disease=1.13, 95% CI 1.05 to 1.21). These findings imply that the association of prenatal famine exposure with cardiovascular risk may be modified by adult lifestyle.