Growing up in a challenging family environment is associated with higher rates of cardiovascular disease and mortality in middle age, according to a large prospective study. Lasting physiological, psychological, and behavioral changes are likely to play a role.
Traumatic experiences in childhood can disrupt a person’s ability to handle stressful events later in their life. As an adult, they may turn to unhealthful coping strategies, such as smoking and overeating.
Research suggests that people who experienced abuse and neglect in their childhood are more likely to have diabetes, high blood pressure, inflammation, and higher levels of the hormone cortisol in response to stress.
However, few longitudinal studies have followed individuals into middle age to investigate whether childhood adversity might affect the risk of cardiovascular disease (CVD) and mortality.
But now, the largest ever study of this kind suggests that people who experience trauma, neglect, and family dysfunction as children are significantly more likely to have a CVD event, such as a heart attack or stroke, in middle age.
They may also have a higher mortality rate from all causes.
The study, which Jacob B. Pierce at Northwestern University Feinberg School of Medicine in Chicago, IL, led, appears in the Journal of the American Heart Association.
The researchers suspect that extreme adversity in childhood makes people more likely to take risks with their health.
“This population of adults is much more likely to partake in risky behaviors — for example, using food as a coping mechanism, which can lead to problems with weight and obesity,” says Pierce, a fourth-year medical student at the university.
“They also have higher rates of smoking, which has a direct link to cardiovascular disease,” he adds.
The research used data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, which recruited a racially and socioeconomically diverse group of people aged 18–30 years in 1985–1986. CARDIA took place in four cities across the United States: Birmingham, AL, Chicago, IL, Minneapolis, MN, and Oakland, CA.
Over the three decades of the CARDIA study through to 2018, researchers regularly checked the participants’ physical and mental health.
In 2000–2001, more than 3,600 participants filled out a questionnaire to assess their experience in relation to the following seven features in their childhood family environment:
- parental love and support
- verbal abuse
- physical affection
- physical abuse
- presence of an alcohol or drug abuser in the home
- organization and management of the household
- the extent to which their parents or caregivers knew what they were up to
The questionnaire included questions such as, “How often did a parent or other adult in the household make you feel that you were loved, supported, and cared for?” and “How often did a parent or other adult in the household swear at you, insult you, put you down, or act in a way that made you feel threatened?”
The participants’ responses allowed the authors of the new study to separate them into low, moderate, and high childhood adversity groups.
They discovered that, over a 30-year follow-up, people exposed to high levels of childhood adversity were more than 50% more likely to have a CVD event compared with those in the low adversity group.
Pierce says the question that best predicted cardiovascular disease later in life was: “Did your family know what you were up to as a kid?”
Even moderate exposure to childhood adversity was associated with a more than 50% increased risk of mortality from all causes compared with low adversity.
“Early childhood experiences have a lasting effect on adult mental and physical well-being, and a large number of American kids continue to suffer abuse and dysfunction that will leave a toll of health and social functioning issues throughout their lives,” says senior author Prof. Joseph Feinglass, from the Feinberg School of Medicine.
When the scientists used a fully adjusted model of the data to account for other variables, such as smoking, blood pressure, and education levels at the start of the CARDIA study, the relationship between childhood adversity and CVD was no longer statistically significant.
They believe that this suggests that multiple socioeconomic, clinical, demographic, and psychological factors may collectively mediate the link between childhood adversity and CVD in middle age.
In addition to physiological changes, such as higher blood pressure, higher cortisol, and more inflammation, childhood trauma can result in unhealthy ways of dealing with stress.
The authors write:
“Childhood adversity is known to cause behavioral dysregulation related to several known CVD risk factors both in childhood and adulthood. For example, childhood trauma disrupts ability for children to appropriately cope with and respond to emotionally stressful experiences. As a result, individuals often utilize calorie-dense foods as a mechanism to cope with psychosocial stress, which contributes to the development of obesity.”
In principle, early interventions could help. The researchers write that there are programs to help children and young adults develop healthier strategies to cope with stressful experiences, but funding is limited.
“Social and economic support for young children in the U.S., which is low by the standards of other developed countries, has the biggest ‘bang for the buck’ of any social program,” says Prof. Feinglass.
The authors nevertheless acknowledge that their study had some limitations. For instance, the research only involved participants who were alive 15 years after the CARDIA study began, so the results may underestimate the association that adversity in childhood has with CVD and mortality.
In addition, the study relied on the participants accurately remembering what happened in their childhood more than 15 years earlier.