Childhood adversity, caregiver warmth tied to long-term heart health
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Key takeaways:
- Adults who reported abuse or neglect during childhood were less likely to have ideal CV health.
- The findings were not significant for adults with an annual income of $35,000 or less.
Adults who reported experiences of childhood adversity such as abuse or neglect were less likely to have optimal CV health at various points during 20 years of follow-up, underscoring the impact of positive caregiver-child relationships.
The longitudinal study also showed that participants who reported stable caregiver relationships during childhood were more likely to have higher CV health metric during adulthood, though the association was modified by adult income.
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“Our study results offer cutting-edge insight into how policies, practices and programming that support healthy, supportive and consistent caregiver and child relationships, and perhaps more simply, healthy and resourced adults who may be caregivers of children, may offset risk for the No. 1 killer of Americans — CVD — and enhance overall health,” Robin Ortiz, MD, MS, FAAP, DipABLM, assistant professor of pediatric and public health and a core faculty member in the Institute for Excellence in Health Equity at New York University Grossman School of Medicine, told Healio.
Assessing childhood experiences
Ortiz and colleagues analyzed data from 2,074 participants from the CARDIA study, a prospective, epidemiological study initiated in 1985 to explore the development of risk factors and CVD in Black and white adults enrolled at age 18 to 30 years (mean age at baseline, 25 years; 56% women; 61% white). Participants completed the Risky Family Environment questionnaire at 15 years’ follow-up, which retrospectively asks about experiences of abuse, caregiver warmth and family or household challenges before age 18 years. Researchers also scored participants on CV health at baseline, year 7 and year 20 using the American Heart Association’s Life’s Simple 7 scoring metric, which includes smoking, cholesterol, BP, glucose, BMI, physical activity and diet. Researchers calculated the association between risky family exposure and CV health, adjusting for age, sex, race and alcohol use.
The findings were published in Circulation: Cardiovascular Quality and Outcomes.
Researchers found that at baseline, 55% of participants met five or more categories for ideal CV health, falling to 45% by year 7 and declining to 24% by year 20. Less than 1% of participants met ideal CV health metrics across all seven categories at all time points. At baseline, 28.4% of participants had an ideal CV health score of 12 or higher, falling to 16.3% at year 20.
The median Risky Family Environment score was 10.
Longitudinally, for every 1 U greater Risky Family Environment score, the odds of attaining high CV health decreased by 3.6%, for an OR of 0.9645 (95% CI, 0.94-0.98).
Each unit greater child abuse and caregiver warmth score corresponded to 12.8% lower and 11.7% higher odds for ideal CV health, respectively, with ORs of 0.872 (95% CI, 0.77-0.99) and 1.1165 (95% CI, 1.01-1.24), across 20 years of follow-up.
Results persisted in sensitivity analyses stratified by income in adulthood for those in the highest adult income gradient, defined as greater than $74,000 per year; however, results were no longer significant for adults in the lowest income gradient, defined as less than $35,000 per year.
The researchers noted that the income-based analyses suggest that people with low income in adulthood may have faced adversity in both early and later life beyond family relationship experiences, and perhaps also socioeconomic hardships or structural adversity.
“If a child is unable to predict if they will experience a threat to safety or the warmth of a caregiver, a large amount of energy may be expelled on the uncertainty and inability to focus on preservation or growth, hindering any potential survival benefit from either programming mechanism,” Ortiz told Healio. “This is a potential interpretation of our study results. The applications of these findings must consider that we as a society see that it is challenging to be a caregiver and it requires dedicated resources and support. Thus, we must work as researchers, clinicians and health care providers, and as a collective society, to find interventions that can support consistency of warmth and nurturing in caregiver-child relationships, likely through offering resources to adults who are caregivers for their own health and well-being, to impact health for both generations.”
Identify targets for intervention
In a related editorial published in Circulation: Cardiovascular Quality and Outcomes, Shakira Suglia, ScD, associate professor of epidemiology at Emory University Rollins School of Public Health, and Ayana April-Sanders, PhD, of the department of statistics and epidemiology at Rutgers University School of Public Health, wrote that the researchers must identify targets for intervention, such as health and behavioral components of CV health, that are in the causal pathway between adversities and CVD. Current interventions mainly focus on cognitive-behavioral therapy to address mental health outcomes, they wrote.
“Understanding whether interventions that strengthen caregiver-child relations can promote positive CV health across the life course would address a critical gap in our knowledge of how we ameliorate the impact of adversities,” Suglia and April-Sanders wrote. “It is also important to consider that interventions to promote CV health need to consider how these interventions should be delivered to populations impacted by adversities and other social stressors. As noted, populations are differentially impacted by adversities given the relation between adversities and social factors, resulting in a potentially increased risk of exposure and differential impact among minoritized and disadvantaged groups.”
References:
- Childhood relationships, experiences may have good and bad effects on adult heart health. https://newsroom.heart.org/news/childhood-relationships-experiences-may-have-good-and-bad-effects-on-adult-heart-health. Published Jan. 23, 2024. Accessed Jan. 23, 2024.
- Suglia S, et al. Circ Cardiovasc Qual Outcomes. 2024;doi:10.1161/CIRCOUTCOMES.123.010661.
For more information:
Robin Ortiz, MD, MS, FAAP, DipABLM, can be reached at robin.ortiz@nyulangone.org; X (Twitter): @DrRobinOrtiz.
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