Adversity In Childhood and Adolescence Sets Stage for Cardiometabolic Outcomes

Eduardo SanchezEduardo Sanchez, M.D., M.P.H., Chief Medical Officer for Prevention and Chief of the Centers for Health Metrics and Evaluation, American Heart Association

The phrase, “So, tell me about your childhood,” may sound cliché, but it might help us better understand cardiometabolic diseases in adults. Adverse experiences in childhood and adolescence are emotionally difficult, but to make matters worse, they are also linked to negative health consequences that reverberate into adulthood. Threats to a young person’s bodily integrity, family, or social structures are associated with negative cardiometabolic outcomes over the life course, according to a scientific statement published today in the American Heart Association journal Circulation.

These adults who endured adverse childhood experiences (ACEs) may face a higher risk of high blood pressure, type 2 diabetes, obesity, heart disease and stroke — diseases that exact a personal toll and an enormous public health and economic burden.

Fifty-nine percent of the U.S. population reports at least one adverse childhood experience, with physical, emotional or sexual abuse most common. Witnessing a parent being abused, living with a substance abuser or a mentally ill person, imprisonment of a household member, parental separation or divorce, neglect and bullying are other examples.

How early-life experiences up risk of chronic health conditions later in life
Behavioral, mental health and biological are three pathways that suggest how childhood adversity may increase the risk of cardiometabolic and other diseases.

Stressful events can worsen diet quality, decrease physical activity, disrupt sleep, and increase smoking; moreover, household dysfunction can trigger or intensify mental health issues. Adversity can disrupt many of the body’s regulatory processes that affect biology. These three pathways, in addition to factors such as sex, race/ethnicity and genetics, can greatly influence cardiovascular risk factors, and ultimately, affect morbidity and mortality of cardiometabolic diseases.

Substantial evidence links childhood adversity with cardiometabolic outcomes — and tells us that it’s important to tackle those issues before they lead to preventable CVD risk factors. We already know that the internal physical signs of heart disease can appear in childhood. Furthermore, establishing healthy behaviors early in life is expected to translate into ideal cardiovascular health in young adulthood and middle age.

Up for the challenge
The broad scope of adverse childhood experiences calls for multi-sector, multi-level efforts to identify and mitigate these experiences earlier, and to prevent them when possible. National guidelines or recommendations for systematic surveillance of childhood adversity in the healthcare system and strategies to prevent adversity and build resilience are key.

The American Heart Association is taking an “equity first” approach to its work, paying special attention to those affected by social factors (such as low socioeconomic status, low educational attainment, lack of social support, and certain residential environments) that are linked with heart disease and its risk factors. Racial and ethnic minority children and those living in lower SES households have a higher prevalence of childhood adversities; as adults, they experience a higher prevalence of cardiovascular and cardiometabolic diseases, which can lead to premature death.

With our research, educational programs, community intervention efforts, and advocacy, and with tools such as Life’s Simple 7 for Kids, the AHA is working to improve the cardiovascular health of all Americans — including the youngest ones.

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