Childhood adversity linked to cardiovascular disease in early adulthood

Children who experience adversity – including serious family illness or death, poverty, neglect, or dysfunctional and stressful family relationships – are at increased risk of developing cardiovascular disease (CVD) in early adulthood, a large Danish study has found .

Compared with young adults who experienced little childhood adversity, peers who experienced high childhood adversity were about 60% more likely to develop cardiovascular disease, the researchers found.

The risk was similar for men and women, and was highest for those who experienced serious illness or death in the family, as well as for those who experienced severe and increasing adversity throughout childhood and adolescence.

“We know far too little about the relationship between early childhood trauma and stress and the risk of cardiovascular disease later in life. That’s why this project is so important as it may reveal one of the explanations for social inequalities in cardiovascular disease. vascular disease disease,” said Gunnar Gíslason, MD, PhD, head of research at the Danish Heart Association, which sponsored the study, in a press release.

Social determinants of CVD

Jessica Bengtsson, PhD, of the University of Copenhagen, Denmark, and colleagues reported their findings online Nov. 15 in European Heart Journal.

Using the DANLIFE course (DANLIFE), they examined the effect of childhood adversity before age 15 on the development of cardiovascular disease between ages 16 and 38 in nearly 1.3 million individuals without congenital heart disease.

DANLIFE contains information on 12 childhood adversities, divided into three dimensions, the authors explain. Material deprivation includes things like family poverty and long-term parental unemployment. Loss or threat of loss includes physical illness or death among participants’ parents or siblings. Family life includes adversities such as foster care, parental and sibling mental illness, parental alcohol and drug abuse, and maternal separation.

A total of 4118 subjects (2195 men and 1923 women) developed cardiovascular disease between the ages of 16 and 38 years; 966 had ischemic heart disease and 3152 had cerebrovascular disease.

In multivariate-adjusted analyses, CVD risk was increased in those who experienced severe physical illness and death in the family, with adjusted hazard ratios (aHRs) of 1.6 for men (95% CI, 1.4 – 1.8) and 1 .4 for women (95) % CI, 1.2 – 1.6), compared with peers who experienced low adversity.

A higher risk of cardiovascular disease was also seen in those with very high adversity during childhood and adolescence, with an aHR of 1.6 for men (95% CI, 1.3 – 2.0) and 1.6 for women (95% CI, 1.3 – 2.0).

The association between childhood adversity and cardiovascular disease in early adulthood may be partially explained by adverse health behaviors, such as heavy drinking, smoking and physical inactivity, in those who experience childhood adversity, the researchers say.

However, investigating the specific mechanisms linking childhood adversity to cardiovascular disease in young adulthood is “a challenge for future research,” they add.

The Danish results are consistent with recent data from the CARDIA (Coronary Artery Risk Development in Young Adults) study, which suggests that there is a 46% higher risk of cardiovascular disease at an average age of 40 years with high exposure to psychosocial difficulties in childhood.

No quick fix

“The incidence of cardiovascular disease is low in early adulthood but increases significantly during this period. This highlights the importance of research into non-genetic risk factors early in life, which could be targeted for early prevention,” Naja Hulvej Rod, PhD, University of the University of Copenhagen, senior author of the current study, said in the press release.

“Targeting the social origins of such adversity and ensuring support structures for families who are, for example, dealing with illness in the family could potentially have a long-term protective effect,” added Rod.

Ali Zaidi, MD, co-director, Mount Sinai Children’s Heart Center, New York, called this study “very interesting” because it suggests that childhood adversity “in and of itself may be a risk factor for cardiovascular disease.”

Zaidi said what he finds most interesting is that children who experience adversity growing up “may be more likely to not think about their health, ie. turn to smoking, drugs, to the social factors that we often talk about.

“This is the part that hasn’t been well studied,” said Zaidi, associate professor of medicine (cardiology) and pediatrics, Icahn School of Medicine at Mount Sinai.

“The larger debate that goes beyond the scope of this paper is how to deal with adversity in childhood. This study opens up the possibility of a debate about the social determinants of health and policy and social intervention. That’s really where the debate needs to go,” said Zaidi | Medscape Cardiology.

The study was supported by the Danish Heart Association. Bengtsson and Zaidi have not disclosed any relevant financial relationships.

Eur Heart J. Published online 15 November 2022. Full text

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