BACKGROUND:Non-invasive methods assessing subclinical atherosclerosis, such as carotid intima-media thickness (IMT) and carotid-femoral pulse wave velocity (cfPWV), are well-described in adults but less so in the paediatric population. Other techniques, such as aortic IMT, may be more appropriate in children. This study aimed to characterise age-related changes to arterial vasculature using best practice methodology for these measures. METHODS:This cross-sectional study involved 97 healthy volunteers aged 2 to 20 (mean age 11.2 years [SD 5.1]). Carotid and aortic IMT were measured using high-resolution ultrasound. A validated semi-automated cuff-based device was used to measure cfPWV. RESULTS:Aortic IMT showed a significant age-related increase of 9 μm per year [95% CI: 6, 12], p < 0.0001) during childhood and adolescence, whilst carotid IMT was significantly associated with male sex (29 μm per year [95% CI: 11, 48], p = 0.002) during this period. cfPWV exhibited an age-related increase from nine years of age onwards (0.11 ms-1 per year [95% CI: 0.06, 0.15], p < 0.001). CONCLUSIONS:Age-related changes in the arterial vasculature vary between sites and methodologies. During childhood, aortic IMT appears to be a more sensitive marker for early structural changes and should be prioritised over carotid IMT and cfPWV. IMPACT:Understanding age-related changes in arterial vasculature via non-invasive measures is poorly described in childhood and adolescence. This study finds that the timing and magnitude of age-related changes vary across arterial beds and between non-invasive measures in the first two decades of life. Aortic intima-media thickness is a more age-appropriate measure of early structural changes in the young than the more widely used carotid intima-media thickness. Furthermore, carotid-femoral pulse wave velocity, a measure of aortic stiffness, is best evaluated in late childhood and adolescence and likely has little relevance in early childhood.

Excessive weight gain (EWG) in childhood may increase cardiovascular disease risk in adulthood, but its relationship to early vascular health remains poorly understood. This study investigated the relationship between EWG and aortic intima-media thickness (aIMT), a non-invasive ultrasound imaging marker of early vascular health, and explored maternal and child factors that may influence growth and aIMT during early childhood. Mother–child pairs from the BABY1000 pilot cohort were followed from early pregnancy to 24 months. Maternal and birth data were collected via questionnaires and medical records. Child anthropometry and aIMT were measured at 6 weeks and 24 months. EWG was defined as a > 0.67 SD increase in weight-for-length/height z-score from birth. Maternal pregnancy diet and child diet at 24-months was assessed with age-specific Australian Eating Survey® food frequency questionnaires. Linear regression was used to examine associations among growth, diet, and aIMT. Of 182 births, 102 infants at 6 weeks and 83 children at 24 months had aIMT data. 26

Dietary macronutrients significantly impact cardiometabolic health, yet research often focuses on individual macronutrient relationships. This study aimed to explore the associations between dietary macronutrient composition and cardiometabolic health. This study included 33,681 US adults (49.7 ± 18.3 years; 52.5

Recent evidence suggests that plant-based diets may reduce the risk of breast cancer (BC). However, the macronutrient composition of plant-based diets and its potential impact on BC risk has not been well explored. This analysis investigated the association of macronutrient composition with BC risk across a spectrum of plant-based diet indexes using a multidimensional approach. This study followed 64,655 participants from the Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l’Education Nationale (E3N) cohort from 1993 to 2014. Diets were evaluated using validated 208-item diet history questionnaires at baseline (1993) and follow-up (2005), to calculate adherence to the overall plant-based diet (PDI), healthful plant-based diet (hPDI), and unhealthful plant-based diet (uPDI). The association of macronutrient composition with BC risk was assessed via generalized additive time-dependent Cox models across different levels of these indexes. Response surfaces were generated to visualize compositional associations at the 25th, 50th, and 75th percentile of each index (low, moderate, and high). A total of 3,932 incident BC cases were identified during the 21-year follow-up. There was a significant association between macronutrient composition and BC risk for hPDI, uPDI, and PDI (all P < 0.001). Akaike information criterion favored the hPDI model for characterizing the association between macronutrients and BC. BC risk was highest for individuals with a lower hPDI score who also consumed a diet containing lower protein (10

The role of dietary macronutrients and energy intake in the aging process has been well-established. However, previous research has mainly focused on the association between leukocyte telomere length (LTL) and individual macronutrients, while the effects of macronutrient composition on LTL remain unclear. This cross-sectional analysis involved 4130 US adults (44.8 ± 17.0 years; 51% female) from the National Health and Nutrition Examination Survey during 1999-2002. A single 24-h dietary recall is used to collect dietary data. The relationship between dietary macronutrient composition and LTL is examined using three-dimensional generalized additive models. After adjustment for age, sex, ethnicity, education, physical activity, BMI, and dietary quality, a three-dimensional association of macronutrient composition with LTL (P = 0.02) is revealed. Diets lower in protein (5-10%), higher in carbohydrates (75%), and lower in fat (15-20%) are associated with the longest LTL corresponding to 7.7 years of slower biological aging. Diets lowest in protein (5%) and carbohydrate (40%), while highest in dietary fat (55%) are associated with the shortest LTL, corresponding to accelerated biological aging of 4.4 years. The associations appeared magnified with higher energy intake. These findings support a complex relationship between dietary macronutrients and biological aging independent of diet quality.

Carotid intima-media thickness (IMT), measured using high-resolution B-mode ultrasonography, is a widely utilized surrogate marker of subclinical atherosclerosis, the pathophysiological process underlying most clinical cardiovascular disease events. Atherosclerosis is a gradual disease that originates early in life, thus, there has been increased interest in measuring carotid IMT in childhood and adolescence to assess structural change in the arterial vasculature in response to adverse exposures. However, the timing of atherosclerosis varies across the vascular tree. Primordial atherosclerotic lesions are present in the abdominal aorta as early as infancy, compared to mid-adolescence for the common carotid. Measurement of IMT at either site is susceptible to several technical challenges that need to be considered, especially in younger children. In this paper, we provide a detailed stepwise method for high-quality assessment of IMT of the abdominal aorta and common carotid artery in the young. We also provide insight into the appropriateness of either site when exploring the associations between early-life exposures and later-life cardiovascular disease.

Abstract Continuous positive airway pressure (CPAP) therapy and oral appliance therapy (OAT) are recommended therapies for obstructive sleep apnoea (OSA). Recent clinical trials, limited by suboptimal implementation of OSA therapy, have demonstrated neutral cardiovascular benefit. It remains unclear if optimised OSA therapy will improve cardiovascular health. Thus, we have designed a pilot interventional study to inform a future RCT with the aim to evaluate the effectiveness of optimised and personalised OSA therapy in patients with acute coronary syndrome(ACS). Patients diagnosed with ACS and OSA (ODI4≥10 events/h) were randomised to personalised OSA treatment (CPAP and/or OAT) versus usual medical care (UC). Patients receiving OSA therapy were allowed to acclimatise to therapy for 1-2 months, with the aim of optimising therapy. Patients were followed up monthly for 6 months to assess treatment effectiveness. Polysomnography and cardiovascular measures were conducted at baseline and 6 months post-therapy or usual care. To date, 9 patients (CPAP=4, OAT=1, UC=4) have completed the study. OSA severity reduced in both treatment groups (CPAP: 53±14 vs. 17±18events/h, OAT: 22.4 vs. 14.7events/h). CPAP compliance was 6.8±0.9hours/day, 90±6%days >4h. OAT subjective compliance was 7 hours/day daily. At completion, 3 patients on CPAP therapy reported they were ‘extremely-comfortable’ using CPAP for OSA treatment. The patient on OAT reported OAT was ‘very effective in reducing OSA symptoms’ and will continue therapy. This preliminary data suggests that it is feasible to personalise and optimise OSA therapy in patients with ACS. Whether this positively impacts on cardiovascular risk remains to be determined.

Background and Aims: There is evidence that central blood pressure (cBP) may improve risk profiling and that risk factors for cBP may be distinct from those for peripheral brachial blood pressure (pBP). Blood pressure tracks strongly from childhood into adulthood, but there is limited evidence regarding risk factors for cBP in children and adolescents. Accordingly, we sought to compare the association between early life anthropometric risk factors with cBP and pBP in children and adolescents. Methods: 97 healthy children and adolescents aged 2 to 20 years were prospectively recruited (mean age 11.2 years [SD 5.1]; stratified into five sex-balanced age groups). Hemodynamic measures were obtained using an appropriately-sized brachial cuff and cBP was measured at the carotid artery using applanation tonometry (SphygmoCor XCEL, AtCor Medical, Australia). Results: In univariate analysis, systolic cBP and pBP increased significantly with age (P < 0.0001) but there was no association with sex. In multivariable analysis, BMI z-score was associated with both higher cBP (3.5 mmHg per 1 kg/m2 [95% CI: 1.0, 5.9], P = 0.005) and pBP (2.4 mmHg per 1 kg/m2 [95% CI: 0.1, 4.7], P = 0.04), adjusted for age and sex. There was weak evidence that these associations were stronger in older children (cBP older: 5.2 mm Hg per 1 kg/m2 [95% CI 1.6, 8.7]; cBP younger: 1.1 mm Hg per 1 kg/m2 [95% CI -2.3, 4.5]; PHETEROGENEITY= 0.09). These associations were independent of height z-score. Conclusions: BMI is independently associated with systolic cBP in childhood and adolescence. This association may become stronger with age during childhood.

Abstract Obstructive sleep apnoea(OSA) is associated with cardiovascular diseases including acute coronary syndrome(ACS). Current estimates suggest some 70% of patients with ACS have OSA. OSA in this population remains under-recognised. This high prevalence calls for effective OSA screening tools for this high-risk population. We aimed to assess the diagnostic accuracy of the Epworth Sleepiness Scale (ESS), Berlin and STOP-BANG questionnaire in screening for OSA in patients with ACS. 70 patients with ACS (age IQR: 58[52,63] years, BMI: 27[24,30]kg/m2) were recruited from the cardiology department following an admission for ACS. Patients were administered with the ESS, Berlin and STOP-BANG questionnaires within 6 months of ACS admission. A level 2 polysomnogram was conducted to confirm the presence and severity of OSA (AHI≥5). The diagnostic accuracy of ESS>10, Berlin questionnaire (high-risk category), STOP-BANG score ≥3 (intermediate-high risk) and STOP-BANG score ≥5 (high-risk) was compared to a level 2 polysomnogram for different OSA severity. OSA (AHI≥5 events/h) was diagnosed in 94% of patients with ACS. 67% of patients had moderate-severe OSA (AHI≥15 events/h). ESS, Berlin and STOP-BANG questionnaires have poor diagnostic accuracy across all severity of OSA (ESS>10, AUC:0.60 (95%CI: 0.42-0.79); Berlin, high risk, AUC:0.54 (95%CI: 0.39-0.68); STOP-BANG ≥3, AUC:0.69 (95%CI: 0.56-0.82); STOP-BANG ≥5, AUC: 0.66 (95%CI: 0.53-0.79)). This study confirms a very high prevalence of OSA in patients with ACS. The Berlin and STOP-BANG questionnaires alone are inadequate to identify OSA in this high-risk cohort. Simplified objective measures to screen for OSA may be better suited for this patient population.

BackgroundThe association between common carotid artery intima-media thickness (CCA-IMT) and incident carotid plaque has not been characterized fully. We therefore aimed to precisely quantify the relationship between CCA-IMT and carotid plaque development. Methods and ResultsWe undertook an individual participant data meta-analysis of 20 prospective studies from the Proof-ATHERO (Prospective Studies of Atherosclerosis) consortium that recorded baseline CCA-IMT and incident carotid plaque involving 21 494 individuals without a history of cardiovascular disease and without preexisting carotid plaque at baseline. Mean baseline age was 56 years (SD, 9 years), 55% were women, and mean baseline CCA-IMT was 0.71 mm (SD, 0.17 mm). Over a median follow-up of 5.9 years (5th-95th percentile, 1.9-19.0 years), 8278 individuals developed first-ever carotid plaque. We combined study-specific odds ratios (ORs) for incident carotid plaque using random-effects meta-analysis. Baseline CCA-IMT was approximately log-linearly associated with the odds of developing carotid plaque. The age-, sex-, and trial arm-adjusted OR for carotid plaque per SD higher baseline CCA-IMT was 1.40 (95% CI, 1.31-1.50; I-2=63.9%). The corresponding OR that was further adjusted for ethnicity, smoking, diabetes, body mass index, systolic blood pressure, low- and high-density lipoprotein cholesterol, and lipid-lowering and antihypertensive medication was 1.34 (95% CI, 1.24-1.45; I-2=59.4%; 14 studies; 16 297 participants; 6381 incident plaques). We observed no significant effect modification across clinically relevant subgroups. Sensitivity analysis restricted to studies defining plaque as focal thickening yielded a comparable OR (1.38 [95% CI, 1.29-1.47]; I-2=57.1%; 14 studies; 17 352 participants; 6991 incident plaques). ConclusionsOur large-scale individual participant data meta-analysis demonstrated that CCA-IMT is associated with the long-term risk of developing first-ever carotid plaque, independent of traditional cardiovascular risk factors.

Macronutrients are a major component of the human diet. However, few studies have assessed their collective association with mortality. We sought to evaluate the associations of macronutrient intake with all-cause, cardiovascular, and cancer mortality in US adults using a multi-nutrient approach. This prospective cohort analysis used data from the National Health and Nutrition Examination Survey from the years 1999 to 2014. The participants included 33,681 US adults aged 20–85 years (52.5% female). The maximum follow-up time was 16.8 years, with a total of 4398 total deaths, including 772 cardiovascular deaths and 952 cancer deaths. The associations between mortality and dietary macronutrients were explored using three-dimensional generalized additive models, allowing for visual and statistical inference of complex nonlinear associations. Absolute macronutrient intake demonstrated a three-way interactive association with all-cause mortality (p < 0.001), cardiovascular mortality (p = 0.02), and cancer mortality (p = 0.05), adjusted for age, sex, ethnicity, socioeconomic status, dietary quality, and lifestyle. Compositionally, a high caloric diet composed of moderately high protein (20%), moderate fat (30%), and moderate carbohydrate (50%) levels was associated with the highest mortality risk. Across the total energy intake levels, lower mortality risk was observed in two separate regions consisting of higher protein (30%), higher carbohydrate (60%), and lower fat levels (10%) or lower protein (10%), moderate carbohydrate (45%), and higher fat levels (45%). These findings highlight a complex nonlinear and interactive association between macronutrients and all-cause mortality such that several distinct dietary compositions are associated with similarly high or low risk. Future research is needed to explore the drivers of these associations and whether they differ across varying dietary patterns and populations.

Background: Dietary and nutritional biomarkers are objective dietary assessment tools that will enable a more accurate and precise determination of diet-disease relations. However, the lack of established biomarker panels for dietary patterns is concerning, as dietary patterns continue to be the focus of dietary guidelines. Objectives: We aimed to develop and validate a panel of objective biomarkers that reflects the Healthy Eating Index (HEI) by applying machine learning approaches to the National Health and Nutrition Examination Survey data. Methods: Cross-sectional population-based data (eligible criteria: age >= 20 y, not pregnant, no reported supplement use of dedicated vitamin A, D, E, or fish oils; n = 3481) from the 2003 to 2004 cycle of the NHANES were used to develop 2 multibiomarker panels of the HEI, 1 with (primary panel) and 1 without (secondary panel) plasma FAs. Up to 46 blood-based dietary and nutritional biomarkers (24 FAs, 11 carotenoids, and 11 vitamins) were included for variable selection using the least absolute shrinkage and selection operator controlling for age, sex, ethnicity, and education. The explanatory impact of selected biomarker panels was assessed by comparing the regression models with and without the selected biomarkers. In addition, 5 comparative machine learning models were constructed to validate the biomarker selection. Results: The primary multibiomarker panel (8 FAs, 5 carotenoids, and 5 vitamins) significantly improved the explained variability of the HEI (adjusted R-2 increased from 0.056 to 0.245). The secondary multibiomarker panel (8 vitamins and 10 carotenoids) had lesser predictive capabilities (adjusted R2 increased from 0.048 to 0.189). Conclusions: Two multibiomarker panels were developed and validated to reflect a healthy dietary pattern consistent with the HEI. Future research should seek to test these multibiomarker panels in randomly assigned trials and identify whether they have broad application in healthy dietary pattern assessment.

The gut microbiome has been shown to play a role in the relationship between diet and cardiometabolic health. We sought to examine the degree to which key microbial lignan metabolites are involved in the relationship between diet quality and cardiometabolic health using a multidimensional framework. This analysis was undertaken using cross-sectional data from 4685 US adults (age 43.6 ± 16.5 years; 50.4% female) participating in the National Health and Nutrition Examination Survey for 1999–2010. Dietary data were collected from one to two separate 24-hour dietary recalls and diet quality was characterized using the 2015 Healthy Eating Index. Cardiometabolic health markers included blood lipid profile, glycemic control, adiposity, and blood pressure. Microbial lignan metabolites considered were urinary concentrations of enterolignans, including enterolactone and enterodiol, with higher levels indicating a healthier gut microbial environment. Models were visually examined using a multidimensional approach and statistically analyzed using three-dimensional generalized additive models. There was a significant interactive association between diet quality and microbial lignan metabolites for triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, insulin, oral glucose tolerance, adiposity, systolic blood pressure, and diastolic blood pressure (all p < 0.05). Each of these cardiometabolic health markers displayed an association such that optimal cardiometabolic health was only observed in individuals with both high diet quality and elevated urinary enterolignans. When comparing effect sizes on the multidimensional response surfaces and model selection criteria, the strongest support for a potential moderating relationship of the gut microbiome was observed for fasting triglycerides and oral glucose tolerance. In this study, we revealed interactive associations of diet quality and microbial lignan metabolites with cardiometabolic health markers. These findings suggest that the overall association of diet quality on cardiometabolic health may be affected by the gut microbiome.

Purpose The health of parents prior to conception, a woman's health during pregnancy and the infant's environment across their first months and years collectively have profound effects on the child's health across the lifespan. Since there are very few cohort studies in early pregnancy, gaps remain in our understanding of the mechanisms underpinning these relationships, and how health may be optimised. 'BABY1000', a pilot prospective longitudinal birth cohort study, aims to (1) identify factors before and during pregnancy and early life that impact longer-term health and (2) assess the feasibility and acceptability of study design to inform future research. Participants Participants were based in Sydney, Australia. Women were recruited at preconception or 12 weeks' gestation, and data were collected from them throughout pregnancy and postpartum, their children until the age of 2 years, and dietary information from a partner (if able) at the last study visit. The pilot aimed to recruit 250 women. However, recruitment ceased earlier than planned secondary to limitations from the COVID-19 pandemic and the final number of subjects was 225. Findings to date Biosamples, clinical measurements and sociodemographic/psychosocial measures were collected using validated tools and questionnaires. Data analysis and 24-month follow-up assessments for children are ongoing. Key early findings presented include participant demographics and dietary adequacy during pregnancy. The COVID-19 pandemic and associated public health and research restrictions affected recruitment of participants, follow-up assessments and data completeness. Future plans The BABY1000 study will provide further insight into the developmental origins of health and disease and inform design and implementation of future cohort and intervention studies in the field. Since the BABY1000 pilot was conducted across the COVID-19 pandemic, it also provides unique insight into the early impacts of the pandemic on families, which may have effects on health across the lifespan.

Aims Current guidelines recommend measuring carotid intima-media thickness (IMT) at the far wall of the common carotid artery (CCA). We aimed to precisely quantify associations of near vs. far wall CCA-IMT with the risk for atherosclerotic cardiovascular disease (CVD, defined as coronary heart disease or stroke) and their added predictive values. Methods and results We analysed individual records of 41 941 participants from 16 prospective studies in the Proof-ATHERO consortium {mean age 61 years [standard deviation (SD) = 11]; 53% female; 16% prior CVD}. Mean baseline values of near and far wall CCA-IMT were 0.83 (SD = 0.28) and 0.82 (SD = 0.27) mm, differed by a mean of 0.02 mm (95% limits of agreement: -0.40 to 0.43), and were moderately correlated [r = 0.44; 95% confidence interval (CI): 0.39-0.49). Over a median follow-up of 9.3 years, we recorded 10 423 CVD events. We pooled study-specific hazard ratios for CVD using random-effects meta-analysis. Near and far wall CCA-IMT values were approximately linearly associated with CVD risk. The respective hazard ratios per SD higher value were 1.18 (95% CI: 1.14-1.22; I-2 = 30.7%) and 1.20 (1.18-1.23; I-2 = 5.3%) when adjusted for age, sex, and prior CVD and 1.09 (1.07-1.12; I-2 = 8.4%) and 1.14 (1.12-1.16; I-2=1.3%) upon multivariable adjustment (all P < 0.001). Assessing CCA-IMT at both walls provided a greater C-index improvement than assessing CCA-IMT at one wall only [+0.0046 vs. +0.0023 for near (P < 0.001), +0.0037 for far wall (P = 0.006)]. Conclusions The associations of near and far wall CCA-IMT with incident CVD were positive, approximately linear, and similarly strong. Improvement in risk discrimination was highest when CCA-IMT was measured at both walls. [GRAPHICS]

Abstract Obstructive sleep apnoea (OSA) is a risk factor for cardiovascular disease. CPAP therapy is the primary treatment for OSA and is known to improve long term cardiovascular health outcomes. Recent neutral findings of randomised clinical trials have created uncertainty about whether effective CPAP therapy can improve cardiovascular health in patients with OSA. We conducted a cross-sectional observational study in patients with acute coronary syndrome (ACS) diagnosed with OSA. We aimed to characterise key surrogate markers of cardiovascular health in this cohort to inform a future intervention study of personalised OSA therapy. 70 patients with ACS (age (IQR):58[52,63]years, BMI:27[24,30]kg/m2) were recruited. A level 2 sleep study was conducted to confirm OSA diagnosis within 6 months after discharge. Carotid femoral pulse wave velocity(cfPWV), pulse wave analysis, endothelial function, heart rate variability, and baroreflex sensitivity were measured. Patients were categorised as no-mild OSA(AHI<15events/h) and moderate-severe OSA(AHI≥15events/h) for analysis. 67% of patients were found to have moderate-severe OSA(AHI≥15events/h) and 40% of patients had severe (AHI≥30events/h). cfPWV was elevated in moderate-severe OSA compared to no-mild OSA (7.4[6.6,8.5] vs. 6.1[4.7,7.1]m/s, p=0.003). This was no longer significant after adjusting for age (p=0.296) and BMI (p=0.053). cfPWV correlated with AHI (rs = 0.35, P=0.0069). Measures of pulse wave analysis, flow mediated dilatation, heart rate variability, and baroreflex sensitivity did not differ between patient groups (data not shown). OSA is highly prevalent in patients with ACS. Arterial stiffness measured by cfPWV appears to show best promise as an outcome measure for a future intervention trial of personalised OSA therapy.

Quantitative rankings of multiple dietary patterns for their effects on non-communicable disease (NCD) biomarkers is lacking and would inform primary prevention strategies. Accordingly, a network meta-analysis (NMA) was conducted to compare and rank the effects of different dietary patterns on NCD biomarkers, and associations of dietary patterns’ underlying macronutrient composition with NCD biomarkers were determined by a nutritional geometry approach. Randomised controlled trials (RCTs) were eligible for inclusion if they enrolled healthy participants, employed food-based dietary pattern interventions without energy restriction, and reported NCD biomarker outcomes. NCD biomarkers were included as an outcome if ≥10 trials were available. A systematic search of five electronic databases identified 4008 records. Sixty-eight articles from 59 RCTs reporting lipids, glycemic, and inflammatory biomarkers were included for quantitative syntheses. Risk-of-bias was predominantly categorized as low or having some concerns, and confidence-of-evidence low. Relative to western habitual diet, the Mediterranean, Dietary Approaches to Stop Hypertension (DASH), dietary guidelines-based, plant-based, and low-fat diets reduced low-density lipoprotein cholesterol (mean difference range: −0.29 to −0.17 mmol/L), total cholesterol (−0.36 to −0.24 mmol/L), and apolipoprotein B (−0.11 to −0.07 g/L) (all p < 0.05); the Paleo, plant-based and dietary guidelines-based diets reduced homeostasis model assessment of insulin resistance (−0.95 to −0.35, all p < 0.05). No dietary pattern ranked consistently highest. The Paleo diet received the highest all-outcomes-combined average Surface Under the Cumulative Ranking Curve value (67%), followed by DASH (62%) and Mediterranean diets (57%), whereas western habitual diet was lowest (36%). Our findings were independent of macronutrient composition, highlighting the significance of dietary pattern-level analysis.

AbstractAdults who were born preterm are at increased risk of hypertension and cardiovascular disease in later life. Infants born late preterm are the majority of preterm births; however, the effect of late preterm on risk of cardiovascular disease is unclear. The objective of this study was to assess whether vascular health and cardiac autonomic control differ in a group of late preterm newborn infants compared to a group of term-born infants.A total of 35 healthy late preterm newborn infants, with normal growth (34–36 completed weeks’ gestation) and 139 term-born infants (37–42 weeks’ gestation) were compared in this study. Aortic wall thickening, assessed as aortic intima–media thickness (IMT) by high-resolution ultrasound, and cardiac autonomic control, assessed by heart rate variability, were measured during the first week of life. Postnatal age of full-term and late preterm infants at the time of the study was 5 days (standard deviation [SD] 5) and 4 days (SD 3), respectively.Infants born late preterm show reduced aortic IMT (574 μm [SD 51] vs. 612 μm [SD 73]) and reduced heart rate variability [log total power 622.3 (606.5) ms2 vs. 1180. 6 (1114.3) ms2], compared to term infants. These associations remained even after adjustment for sex and birth weight.Infants born late preterm show selective differences in markers of cardiovascular risk, with potentially beneficial differences in aortic wall thickness in contrast to potentially detrimental differences in autonomic control, when compared with term-born control infants. These findings provide pathophysiologic evidence to support an increased risk of hypertension and sudden cardiac death in individuals born late preterm.