More interventions needed to treat problem before adulthood.
MedPage Today – December 18, 2017
by Molly Walker
Children and adolescents who suffer adversity, including abuse, throughout childhood tend to have poorer cardiometabolic health, according to an American Heart Association committee report.
All forms of abuse, including bullying, neglect, or witnessing violence, are linked to a greater increased risk of cardiovascular disease, said the report, authored by Shakira F. Suglia, ScD, of Columbia University’s Mailman School of Public Health in New York City, and colleagues writing in Circulation.
Other behavioral, mental health, and biological factors may increase these risks.
The existing literature has linked childhood maltreatment to disrupting “normative developmental processes” and added that it “magnifies risks for health consequences later in life.” Suglia and colleagues also noted that cardiometabolic outcomes have been “strongly patterned” by sex, race/ethnicity, socioeconomic status, and place of birth.
“Despite a lack of objective agreement on what subjectively qualifies as exposure to childhood adversity and a dearth of prospective studies, substantial evidence documents an association between childhood adversity and cardiometabolic outcomes across the life course,” they wrote.
Suglia and colleagues outlined the evidence where a link was found between childhood adversity and increased risk of mortality from cardiovascular disease, myocardial infarction, stroke, ischemic heart disease, and coronary heart disease. Other studies have found relationships between childhood adversity and hypertension, as well as obesity and type 2 diabetes.
The researchers noted that around 60% of all adults experience at least one adverse childhood event and hypothesized a “dose-response relationship” between accumulation of these experiences and cardiometabolic risk factors. They acknowledged, though, that other research supported more of a threshold effect, in which at least four risk factors may be necessary to increase the likelihood of adverse outcomes, and more recent research has suggested the development of an “adversity score” to measure the scope of adverse childhood experiences.
When examining modifying factors for adverse childhood experiences and cardiometabolic risk, the authors found “large gaps” in knowledge about sex differences, with studies finding “no consistent pattern of sex-related variations” in the association between adversity and these risk factors.
While the authors agreed that racial and ethnic minority children in lower socioeconomic status households have both a higher prevalence of childhood adversities and a higher prevalence of cardiometabolic health outcomes, they noted that “existing studies have rarely examined the potential modifying effect of race/ethnicity or lower [socioeconomic status] on childhood adversities and cardiometabolic health relation.” Studies have also not addressed immigration as a potential modifying factor, they said.
But when childhood adversity does impact cardiometabolic health, it does so in three ways. The authors found evidence of behavioral factors, such as an increase in overeating and obesity, as well as smoking. They also found mental health factors, such as post-traumatic stress disorder, as well as mood and anxiety disorders, play a role in cardiometabolic risk.
Suglia and colleagues characterized the link between mood and anxiety disorders and cardiometabolic risk as “widely recognized,” as a recent AHA scientific statement found major depressive disorders and bipolar disorders linked with early cardiovascular disease and accelerated atherosclerosis.
Biological factors that may be altered when children are exposed to adversity include altered stress responses, which the authors note “could trigger health problems, including chronic hypertension.” Indeed, other studies found children who experience stress were associated with faster increases in blood pressure in young adulthood, as well as accelerated increases in BMI.
But the authors also noted a number of limitations with the existing research on the association between childhood adversity and cardiometabolic risk. They said that there is a “lack of agreement on definitions,” specifically of what childhood adversity is, as well as the fact that few “truly prospective studies” were conducted on the link between the two. They noted that most research has been cross-sectional and retrospective.
In addition, few studies tested the mechanisms that link childhood adversity and cardiometabolic risk, which “is critical both to inform whether childhood adversity is casual in cardiometabolic disease and to identify targets for intervention,” the authors wrote.
“Future studies that focus on mechanisms, resiliency, and provide vulnerability factors would further strengthen the evidence and provide much-needed information on targets for effective interventions,” they concluded.
Several AHA committees collaborated on the report, including the Council on Epidemiology and Prevention; Council on Cardiovascular Disease in the Young; Council on Functional Genomics and Translational Biology; Council on Cardiovascular and Stroke Nursing; and Council on Quality of Care and Outcomes Research.