In a recent study published in Circulation: Cardiovascular Quality and Outcomes, a group of researchers examined the relationship between a risky family (RF) environment in childhood and cardiovascular health (CVH).
Cardiovascular diseases (CVD) are the leading cause of death in the United States, with early signs appearing in childhood. The American Heart Association (AHA) aims to reduce CVD by defining CVH metrics focusing on lifestyle and clinical factors. However, achieving ideal CVH is challenging, especially for Black and Hispanic populations.
Early stress (ELS), including adverse childhood experiences (ACEs), impacts CVH, indicating the need for primary prevention in childhood. Further research is necessary to understand the complex interplay between negative and supportive childhood experiences and their long-term effects on CVH.
About the Study
The CARDIA Study (Coronary Artery Risk Development in Young Adults) analyzed 2074 participants and focused on their responses to the RF Environment Questionnaire during a 15-year follow-up exam. The questionnaire, which assessed negative childhood experiences including emotional and physical abuse and family dynamics, aided in calculating the RF score indicating the degree of adverse childhood environment.
The researchers further analyzed this data, focusing on aspects of child abuse and caregiver warmth to assess early childhood relationship health. The child abuse subscale captured physical and emotional abuse, while the caregiver warmth subscale evaluated the degree of affection and support from adult family members.
The primary outcome of the study was CVH, measured using the AHA 2020 guidelines, encompassing various health metrics such as tobacco use, body metrics, lipid levels, physical activity, diet, blood pressure, and glucose levels. Participants‘ health status was classified as poor, intermediate, or ideal based on a cumulative assessment of these metrics.
The statistical analysis included descriptive evaluations of the cohort and a comparison between low and high RF score groups. The main goal was to examine the effects of the RF environment on CVH over time. The study also explored the combined impact of child abuse and caregiver warmth on CVH.
Secondary analyses investigated how adult income could influence the relationship between childhood environment and CVH. Sensitivity analyses were conducted to account for different CVH assessment methods used in previous studies, ensuring a comprehensive evaluation of the RF-CVH relationship.
In the CARDIA Study with 2074 participants, the average age at study initiation was 25.25 years, with 55% female and 61% white. Initially, 55% of the cohort met at least five ideal CVH categories, especially in fasting glucose levels, but only a minority met ideal diet metrics. By year 7, the proportion meeting ≥5 ideal CVH categories dropped to 45% and decreased further to 24% by year 20. Remarkably, less than 1% of participants consistently met all seven ideal CVH categories throughout the study.
The mean RF environment score was 10, with an interquartile range of 8–14. Participants with a medium or lower RF score were similar in demographic characteristics to those with higher scores, but differed in adult income and education. Those with higher RF scores were more likely to earn less than $25,000 per year and have fewer years of education. Additionally, a smaller percentage of individuals in the high RF group met ≥5 ideal CVH categories at each follow-up time point compared to their low RF counterparts.
At study initiation, participants with high RF scores were more likely to be obese or to smoke, but no further differences in CVH category were observed. Overall, those with high RF consistently had lower CVH scores over the years compared to those with low RF.
Longitudinally, a higher RF score over a 20-year period was significantly associated with a lower CVH score, with a one-unit increase in RF score decreasing the likelihood of achieving ideal CVH by 3.5%. This association remained stable over time and was not influenced by the examination year.
In terms of relationship health, higher child abuse scores were associated with a lower likelihood of achieving ideal CVH, while higher caregiver warmth scores increased these chances. A significant interaction between child abuse and caregiver warmth was observed, indicating that high caregiver warmth combined with low exposure to child abuse led to the highest CVH scores.
Income-stratified analyses revealed that the effects of RF on CVH varied by income level. Higher RF was consistently associated with lower CVH in income brackets of $35,000 to $74,000 and ≥$75,000, but not in lower income groups. There was a significant interaction between caregiver warmth and income, suggesting that the impact of caregiver warmth on CVH varied by income level.
Sensitivity analyses confirmed the consistency of these results across different CVH score thresholds and over all follow-up years. These findings underscore the long-term effects of childhood environment and relationship health on CVH into adulthood.