From the Journals

AHA: Childhood adversity strongly linked to poorer health outcomes



Research suggests an association between adverse childhood events and poorer cardiometabolic health across the lifespan, a new scientific statement from the American Heart Association declares, although it acknowledges various limitations in understanding the connection.

Dr. Shakira F. Suglia, an associate professor at Emory University, Atlanta

Dr. Shakira F. Suglia

“The statement was meant to provide a summary of what we know, what the limitations are with this work, and how to move forward with research that will elucidate mechanisms and inform intervention and prevention efforts,” said Shakira F. Suglia, ScD, lead author of the statement and chair of an AHA team representing several association councils, in an interview.

For the new statement, which appears in Circulation, researchers reviewed recent systematic reviews into the links between childhood adversity – including events like violence and abuse – and cardiometabolic outcome.

By one estimate, nearly 60% of adults in the United States experienced at least one adverse childhood event. According to the statement, reviews have linked childhood adversity to higher risks of cardiac death and outcomes like heart attack and stroke. They’ve also linked adversity to risk factors like high blood pressure, obesity, and type 2 diabetes.

Research been especially robust in linking certain forms of childhood adversity – abuse and neglect – to higher cardiometabolic risk, the statement said. However, Dr. Suglia noted that research into mortality is limited.

The level of higher risk varies by study and outcome, and no one knows if there’s a cause-and-effect link. “As you can imagine, child adversity is not an exposure that lends itself to randomized trials,” she said. “On top of that, we are talking about health effects that take many years to manifest so we rely on observational studies.”

However, “while there is a possibility that there is an alternate factor that is responsible for these associations, the evidence is consistent across different populations,” said Dr. Suglia of Emory University in Atlanta. “And in general, studies do consider alternative factors that may be associated with both child adversity and cardiovascular health, further strengthening inferences we can make from the observational studies.”

Why might the association exist? “The mechanisms that drive these associations are still not fully elucidated but we hypothesize three pathways that may mediate these associations: behavioral factors (diet, sleep, physical activity, smoking), biological (hypothalamic-pituitary-adrenal axis dysregulation, epigenetic, chronic inflammation), and mental health (posttraumatic stress disorder and depression),” she said.

The statement notes that research is limited into why some people thrive on the cardiometabolic front despite childhood adversity. “One of the recommendations is that we need to focus more on factors that could inform prevention and intervention efforts so that those that are affected by adversity in childhood are not also affected by adverse cardiovascular events,” Dr. Suglia said.

The statement also notes that there’s been only limited research into modifiers of vulnerability to the effects of childhood adversity, such as gender, race/ethnicity, genetics, and community characteristics. And it says there’s been little study of how early interventions may affect cardiometabolic outcomes: “Additional research, including longitudinal prospective studies, designed to guide and inform effective and timely individual/clinical and population-level preventive interventions is required.”

Dr. Suglia reports a research grant from the National Heart, Lung, and Blood Institute. Most of the other statement coauthors report no disclosures outside of government funding.

SOURCE: Suglia S et al. Circulation. 2017 Dec 18. doi: 10.1161/CIR.0000000000000536

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