Earn Free CME Credits by reading the latest medical news in your specialty.sign up
Kids with emotionally healthy childhoods had a lower risk of coronary artery calcification as adults, a longitudinal study found.
Childhood psychosocial factors, such as self-regulatory behavior, positive health behaviors among parents, and socioeconomic status, had an inverse relationship with any coronary artery calcification (CAC) in adulthood. For every favorable 1-SD change in the childhood social factors score, the probability of coronary artery calcification in adulthood dropped 15% (0.85, 95% CI 0.76-0.95, P=0.006), reported Markus Juonala, MD, PhD, of the University of Turku in Finland, and colleagues.
This association remained significant even after adjusting for age, sex, and "adulthood risk factors" such as body mass index (BMI), lipids, blood pressure, glucose, smoking, annual income, social support, and depressive symptoms (adjusted probability 0.85, P=0.02), they wrote in JAMA Pediatrics.
Stephen Daniels, MD, of Children's Hospital Colorado in Aurora, characterized this as an "important study." In an email to MedPage Today, he said that clinicians know that a variety of different kinds of factors influence risk of atherosclerotic cardiovascular disease, and they are increasingly aware that issues in childhood are very important.
"The real question will be how to apply this information in a clinical setting," stated Daniels, who was not involved in the research. "Many of these factors have to do with the environment children are living in, and may suggest more of a public policy approach. However, pediatricians should be aware of these factors, and [be] aware that they can have a broad negative impact on health, including cardiovascular health."
The longitudinal cohort of the Cardiovascular Risk in Young Finns Study measured psychosocial data from children, ages 12 to 18, in 1980 and then measured coronary artery calcification in adulthood, 28 years later in 2008. Demographically, 48.2% of participants were men.
When examining individual risk factors, only self-regulatory behavior in childhood had a significant inverse association on coronary artery calcification in adulthood (0.58, P=0.007), even after adjusting for confounders (adjusted probability 0.59, P=0.02).
Overall, 17.7% (55 out of 311 participants) had some coronary artery calcification in adulthood. There were 28 patients with a CAC risk score from 1-10, and 20 patients with a CAC score from 11-100, with seven having a CAC score over 100.
Examining different regions of the coronary artery, childhood psychosocial factors had a significant inverse association with coronary artery calcification on the anterior descending region of the coronary artery (0.83, P=0.006). This association remained significant even after adjusting for childhood risk factors (0.84, P=0.04) and adulthood risk factors (0.79, P=0.03).
The authors noted that this study builds upon their prior research, which found that children with positive psychosocial experiences were more likely to have better cardiovascular health in adulthood (as defined by the American Heart Association (AHA) Ideal Cardiovascular Health Index).
"Early adulthood psychosocial factors have been shown to relate to metabolic functioning and inflammatory process," they wrote. "Adverse psychosocial factors ... may promote deteriorative processes (e.g., inflammation) that increase the risk for cardiac diseases."
Study limitations included the fact that assessments were based on self-report from parents. In addition, the results cannot be generalized to other racial or ethnic groups because the participants were predominantly white. Finally, the definitions of childhood social factors were developed 3 decades ago and may be out of date.
Daniels also questioned the generalizability of the findings, asking if "results from Finland can be applied more broadly. It would be nice to have confirmation of the results from other countries."
Juonala's team cited animal models where psychosocial factors such as stress, aggressiveness, responsiveness to psychological challenge, and stability of social environment have been associated with changes in vasculature. He said his group hopes to conduct more research about the influence of these factors on human biology.
"As a next step, research should attempt to identify the mechanistic pathways whereby early-life psychosocial exposures lead to vascular changes in humans," they wrote.
This study was supported by grants from the Academy of Finland.
Juonala disclosed support from the Social Insurance Institution of Finland, the Turku University Foundation, Paulo Foundation, Paavo Nurmi Foundation, Juho Vainio Foundation, Sigrid Juselius Foundation, Maud Kuistila Foundation, Kuopio, Turku, and Tampere University Hospitals, the Finnish Foundation of Cardiovascular Research, and the Finnish Medical Foundation.
Juonala and co-authors disclosed no relevant relationships with industry.
- Reviewed by F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner