Longitudinal study of cardiovascular-kidney-metabolic syndrome risk assessment among adolescents and young adults (10–45 years) in Pakistan (LIFECARD): Study design and methodology

Objective LIFECARD is a community-based longitudinal cohort in Pakistan investigating how anthropometric, environmental, and mental health factors (anxiety and depression) and lifestyle behaviors in low middle income country settings influence cardiovascular -kidney-metabolic (CKM) syndrome risk trajectories in individuals aged 10 to 45 years old. Methods and analysis This 10-year longitudinal study will enroll approximately 4000 participants: 2000 adolescents (10–20 years) and 2000 young adults (21–45 years) from Karachi (peri-urban) and Matiari (rural) districts of Sindh. A multistage sampling design will be employed. Clusters of 200 households will be selected first in each area, followed by random selection of 75 households per cluster. One eligible participant per household will be enrolled to minimize clustering. Baseline assessments include sociodemographic data, clinical and family history, obstetric history (married women aged 15–45), tobacco/alcohol consumption, anxiety and depression screening, dietary intake, physical activity, and air quality measurements (personal, indoor, and outdoor). Anthropometric measurements and laboratory investigations (HbA1c, lipid profile) will be performed. These baseline variables will be captured every 2 years. Blood specimens will be bio-banked for future biomarkers and genomic analyses. Carotid intima-media thickness (cIMT) and plaque assessment via ultrasound will be conducted at baseline and every 5 years. Conclusion LIFECARD will be Pakistan's first cohort investigating contextual risk factors for premature CKM from early adolescence (10 years) through adulthood (45 years). These insights will identify critical windows for early interventions to prevent disease initiation and progression.