Kids' "Psychosocial" Risk Markers Predict Their Adult CV Health: Cohort Study

January 14, 2015

HELSINKI, FINLAND — Efforts to improve certain "psychosocial factors" in the life of a child or adolescent—including social adjustment, socioeconomic status, and parental health behaviors—just might pay off in adulthood with a lower likelihood of smoking, obesity, and other CV risk factors, suggests an analysis from a longitudinal cohort study in Finland[1].

The analysis, based on a Cardiovascular Risk in Young Finns Study cohort, found that the more favorable a young person's psychosocial risk profile, the better they scored 27 years later on an index comprising seven CV lifestyle factors and biomarkers, note Dr Laura Pulkki-Råback (University of Helsinki, Finland) and colleagues in their report, published online January 12, 2015 in Circulation. The lifestyle/biomarker metric tracked in the cohort, members of which were aged 3 to 18 years at baseline, was the Ideal Cardiovascular Health Index developed by the American Heart Association (AHA), they write.

The group found that the psychosocial factors were predictive of all levels of cardiovascular health, as reflected in the index in a dose-response fashion. "There was no evidence for any threshold point after which the effect of psychosocial factors would become unimportant."

That "may suggest wider scope for prevention than has previously been considered, because all individuals may benefit from improvements in early-life conditions," they write. "In combination with prior work, this evidence begins to suggest that even improving a single factor would likely result in better future cardiovascular health."

In the current study, the impact of psychosocial factors in the young on cardiovascular health in adulthood "was not trivial," according to Drs Samuel S Gidding and Erica Sood (AI duPont Hospital for Children, Wilmington, DE), in an accompanying editorial[2]. "From the lowest to the highest quintile of psychosocial risk, the median change in cardiovascular health was almost the equivalent of a major risk factor."

They point out that the psychosocial factors with the greatest effects on CV health were socioeconomic ("the better off you are, the more likely you are to have better cardiovascular health") and self-regulatory behavior ("the more you are able to tolerate frustration, get along well with others, and not engage in violent behavior, the likelier you are to have low risk").

"These findings lend credence to the idea that improved education, per se, will lower CV disease rates. Education by itself can improve health judgments, improve social adaptation, and help reduce psychosocial stressors," they write.

The 3577 young members of the cohort at baseline were evaluated for six psychosocial factors, on a form filled out by the parents, which included:

  • Socioeconomic environment, which considered parents' education and occupation and family income.

  • Emotional environment, including parental mental health history, "parental caregiving nurturance," parental life satisfaction, and parental use of alcohol.

  • Parental health "behaviors," which included body-mass index (BMI), smoking status, and physical-activity level.

  • Stressful events, such as changing residences or schools, parental divorce or separation, and serious disease in the family.

  • The child's self-regulatory behavior, such as self-control and aggression control.

  • Social adjustment, using a metric that accounts for parental "worry" over and evaluation of the child's level of social adjustment.

After 27 years, 612 women and 477 men were available for the follow-up evaluation for components of the "ideal-health" index, which encompassed such health "behaviors" as having a BMI <25 kg/m2, engaging inj >150 min/week of moderate physical activity or >75 min/week of vigorous activity, and maintaining an ideal diet composite, including hearty amounts of fruit, vegetables, whole grains, and fish and low intake levels of sodium and sugar-sweetened beverages.

The index also included ideal health "factors," such as having a systolic BP <120 mm Hg and diastolic BP <80 mm Hg, total cholesterol <5.17 mmol/L (<200 mg/dL) and fasting glucose <5.6 mmol/L (<100 mg/dL).

Psychosocial scores of the cohort at baseline showed a significant (P<0.001) dose-response effect on health scores in adulthood even after adjustment for age, sex, medication use, and cardiovascular risk factors at baseline. The most powerful positive psychosocial factors predicting ideal CV health were a favorable socioeconomic environment (P<0.001) and good self-regulatory behavior (P=0.004).

Positive psychosocial factors led most strongly (P<0.001 for all three) to:

  • Lower BMI (odds ratio [OR] 1.14, 95% CI 1.08–1.20).

  • Being a nonsmoker (OR 1.12, 95% CI 1.07–1.19).

  • More favorable glucose level (OR 1.11, 95% CI 1.05–1.17).

"Understanding psychosocial factors that predict cardiovascular health is important insofar as they can be modified to improve outcomes," according to the editorialists. "Certainly, this is no easy feat, particularly for factors related to economic status and family environment, and is not likely to be achieved by pediatricians or medical specialists who are typically charged with the task of improving the health of individual children," they write.

"Instead, population-based, family-focused prevention and intervention efforts are likely to have the highest yield."

Pulkki-Råback and coauthors report they have no relevant financial relationships, as do Gidding and Sood.

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