From Neonatal History to Adult Cardiovascular Risk: Preterm Birth as a Lifelong Risk Enhancer

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Background: Preterm birth is increasingly recognized as an early-life exposure with potential cardiovascular consequences across the lifespan. Although improved neonatal care has increased survival among individuals born very and extremely preterm, birth history remains rarely incorporated into cardiovascular risk assessment. Objective: This review synthesizes current evidence linking preterm birth with cardiovascular risk and proposes a practical birth-history-informed framework for preventive cardiology. Methods: A narrative review was conducted to evaluate evidence from population-based cohort studies, sibling-comparison analyses, cardiovascular imaging studies, physiologic exercise studies, Mendelian randomization analyses, mechanistic studies, and selected reviews. The review focused on cardiovascular outcomes, blood pressure trajectories, cardiac remodeling, pulmonary vascular disease, renal and metabolic pathways, autonomic regulation, exercise physiology, and clinical prevention. Results: Preterm birth is most consistently associated with higher blood pressure across life stages and with altered cardiac structure or reserve, particularly among individuals born very or extremely preterm or with complicated neonatal courses. Population-based evidence also links preterm birth with later heart failure, ischemic heart disease, stroke, atrial fibrillation, chronic kidney disease, and diabetes, although absolute risks in young adulthood remain low and associations vary by gestational age, fetal growth, and neonatal complications. Pulmonary vascular, right-heart, and autonomic findings appear most relevant to selected high-risk or symptomatic survivors rather than to all individuals born preterm. Current evidence supports targeted prevention rather than universal advanced testing. Conclusions: Preterm birth should be viewed as an early-life cardiovascular risk enhancer rather than a forgotten neonatal detail. Incorporating gestational age, birth weight, and neonatal complications into cardiovascular history-taking may improve early risk recognition, guide blood pressure and cardiometabolic surveillance, and support individualized prevention across the lifespan.