Childhood adversity increases the risk of cardiovascular disease

Childhood adversity increases the risk of cardiovascular disease (CVD), according to a recent study.

CVD is currently the main cause of death worldwide, with rates of CVD in young adults rising over time. Genetic factors have been associated with CVD, but investigators hypothesized that environmental and behavioral factors also impact CVD risk.

Adversity has been linked to CVD in middle-aged and older individuals, but little data has been gathered on the effects of childhood adversity on CVD in young adults. Multiple internal systems develop throughout childhood, including physiological stress response. The development of this system could be affected by frequent exposure to adversity.

Overeating, excessive alcohol consumption, and smoking are all behaviors associated with CVD, and childhood adversity has been linked with a higher risk of these behaviors. However, the effects of childhood adversity on congenital aetiology are still unclear.

To examine the impact of childhood adversity on CVD in individuals aged 16 to 38 years with a focus on ischemic heart disease (IHD) and cerebrovascular disease (CD), investigators conducted a population-based cohort study. Data was gathered from the Danish LIFE course cohort, containing information from multiple registers nationwide.

Information on childhood adversities, morbidity, and mortality of children born from January 1, 1980, to December 31, 2001, was taken for the study. Participants were alive and residing in Denmark until their 16th birthday without a CVD or congenital heart disease diagnosis. The final study population included 1,263,013 individuals.

Adversities were divided into 3 categories: loss or threat of loss in the family, family dynamics, and material deprivation. Family poverty and parental long-term unemployment were cases of material deprivation, while parent and sibling somatic illness and death were loss or threat of loss in the family.

Family dynamics included: parental alcohol and drug abuse, foster care placements, parental and sibling psychiatric illness, and maternal separation.

CVD as cases of IHD or CD was the primary outcome. Covariates included year of birth, paternal age at birth, parental country of origin, and parental cardiometabolic illness. Adjustments were made for the effects of being small for gestational age at birth and parental education at the time of birth.

The mean follow-up period for participants was 10.8 years after their 16th birthday. During this follow-up period, 4118 participants developed CVD, 966 of which developed IHD and 3152 CD. There were 5178 deaths from a cause other than CVD, and 96,812 emigrations from the study prior to the follow-up.

Participants were more likely to face adversity if they were born to teenage mothers, with persistent deprivation risk high among this group. Material deprivation was also common in children born to parents of a non-Western origin.

Parental cardiometabolic illness was seen in 24% of participants with material deprivation, 36% with loss or threat of loss, 39% with high adversity, and 21% with low adversity. Low parental education was seen in 8% of participants in the low adversity group and 54% of the high adversity group, and small for gestational age was seen in 11% of the low adversity group and 22% of the high adversity group.

Individuals with high adversity had an increased risk of developing CVD, with 10 to 18 extra cases per 100,000 people. Men and women in the loss or threat of loss group had 15.6 and 9.7 more CVD cases per 100,000 people respectively. Individuals early in life or having experienced material deprivation were also more likely to develop CVD, but the risk was only modestly higher than average.

As high childhood adversity led to the greatest risk of CVD, investigators recommended that efforts toward providing affected families with support could reduce the rate of long-term cardio-protective effects.

Reference

Bengtsson J, Elsenburg LK, Stig Andersen G, Lytken Larsen M, Rieckmann A, Hulvej Rod N, Childhood adversity and cardiovascular disease in early adulthood: a Danish cohort study. European Heart Journal. 2022. doi:10.1093/eurheartj/ehac607

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