A study of 682 school-going adolescents in South Africa has found that body weight, rather than a family history of cardiovascular disease, was the strongest correlate of early cardiac remodelling in young hearts. The findings come from the follow-up phase of the Exercise, Arterial Modulation and Nutrition in Youth South Africa study, known as ExAMIN Youth SA, and were published in BMC Pediatrics.
The research team, led by Chilene Vorster, Wayne Smith and Ruan Kruger, examined how a self-reported family history of cardiovascular disease relates to cardiovascular risk factors and markers of target organ injury in adolescents with a mean age of 11 years. Family history of cardiovascular disease is widely used to flag children who may carry an elevated lifetime risk, but evidence on how it tracks with measurable organ changes in youth has remained limited.
Participants underwent a detailed assessment that included demographics, anthropometric measurements, blood pressure, physical activity and urinary glucose. Cardiovascular ultrasound was used to determine three markers of target organ injury: carotid intima-media thickness, a measure of vessel wall thickening; left ventricular mass index, an index of heart muscle mass; and relative wall thickness, a measure of cardiac geometry.
When the researchers stratified the adolescents by the absence or presence of a family history of cardiovascular disease, cardiovascular risk factors and target organ injury markers turned out to be largely similar between the two groups. The only significant difference was socioeconomic status, which was higher in the family history group. This suggests that, in this cohort, a reported family history alone did not translate into visibly different vascular or cardiac measurements.
The associations that did emerge pointed instead to social and metabolic factors. Carotid intima-media thickness was independently associated with lower socioeconomic status among adolescents without a family history, while in the family history group the odds of carotid intima-media thickness above the 75th percentile were associated with the White population group and lower socioeconomic status. In both groups, relative wall thickness was inversely associated with age, with an additional inverse association with the Black population group in the family history group.
Body mass index z-score emerged as the most consistent correlate of cardiac structure. Left ventricular mass index was positively associated with BMI z-score in both the family history and no-family-history groups, with a coefficient of 0.46 in the family history group versus 0.25 in the no-family-history group, both statistically significant. Relative wall thickness was inversely associated with BMI z-score in both groups, with coefficients of -0.27 and -0.49 respectively.
Higher BMI z-scores were also linked to a threefold increase in the odds of left ventricular hypertrophy above 50 g/m2.16 and of relative wall thickness below 0.32 cm/m2 in both groups. In adolescents without a family history, elevated urinary glucose was associated with a fourfold increase in the odds of left ventricular hypertrophy and lower relative wall thickness, while age was associated with higher odds of relative wall thickness below 0.32 cm/m2 in the family history group.
The authors conclude that target organ injury in these adolescents was associated with a combination of social determinants, family history and modifiable cardiometabolic risk factors. Although a family history of cardiovascular disease identified a subgroup with a greater overall risk burden, BMI z-score stood out as the strongest correlate of cardiac remodelling regardless of family history. The team notes that these findings underscore the importance of early identification and prevention strategies targeting obesity and other modifiable risk factors across all adolescents, not only those with a known family history.
The study was retrospectively registered on ClinicalTrials.gov on 12 August 2019 under identifier NCT04056377. As an observational analysis of a single South African cohort of school-going adolescents, the results describe associations rather than causal effects, and the authors emphasise that modifiable factors such as excess weight may represent the most actionable targets for protecting young hearts.
Subject of Research: Family history of cardiovascular disease and target organ injury in South African adolescents
Article Title: Burden of family history on cardiovascular risk factors and target organ injury in adolescents: the ExAMIN Youth SA study
Article References: Vorster, C., Smith, W., & Kruger, R. (2026). Burden of family history on cardiovascular risk factors and target organ injury in adolescents: the ExAMIN Youth SA study. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07871-7
Image Credits: AI Generated
DOI: 10.1186/s12887-026-07871-7
Keywords: adolescent health, cardiovascular risk, family history, BMI z-score, left ventricular mass, carotid intima-media thickness, target organ injury, hypertension, obesity, ExAMIN Youth SA, South Africa, socioeconomic status
News Source: Frances Kline. (October 28, 2026). Family History of Heart Disease Fails to Explain Early Cardiac Changes in South African Adolescents. Scienmag.
