AHA Statement on Childhood Adversity and Cardiometabolic Outcomes

Marlene Busko

December 21, 2017

ATLANTA, GA — The American Heart Association (AHA) has issued a statement on the association between children and teens who endure adversity ranging from bullying to sexual abuse and later risk for obesity, hypertension, type 2 diabetes, or cardiovascular disease (CVD) in adulthood[1].

The statement, by Dr Shakira F Suglia (Emory University Rollins School of Public Health, Atlanta, GA), and colleagues was published December 18, 2017 in Circulation.

The authors note that childhood adversity is common; about six in 10 US adults reported having at least one adverse childhood experience[2]—including, for example, divorce of a parent, physical abuse, living in a violent neighborhood, or having a parent who was imprisoned.  

Some children and teens are resilient, but research has shown that these events have a negative impact on cardiovascular health in adulthood, especially in those who experienced four or more adverse events.  

Evidence suggests that stressful adversity in childhood and adolescence can lead to unhealthy behavior, such as overeating and smoking, or changes in mental health or biological processes—and these three pathways lead to cardiovascular risk factors, including hypertension, diabetes, and obesity.  

Clinicians need to know that "context matters," Suglia told theheart.org | Medscape Cardiology. "When you're treating an individual, perhaps screening for [adverse experiences in childhood] may be coupled with mental-health screening or substance-abuse screening."

The researchers hope that this document draws attention to an important time in the development of children and teens, when it may be possible to intervene and set them on a path of good health habits, as opposed to trying to correct an unhealthy lifestyle when they are adults.

"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," Dr Eduardo Sanchez, chief medical officer for prevention and chief of the Centers for Health Metrics and Evaluation, AHA, said in a statement.

"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."

The AHA is working to improve the cardiovascular health of all Americans—including the youngest ones, he said—by among other things providing tools, such as Life's Simple 7 for Kids.

Childhood Adverse Events Common

A recent Behavioral Risk Factor Surveillance System report[2] determined that 59% of US adults had experienced at least one adverse event in childhood, but this percentage is probably even higher in racial/ethnic minorities or disadvantaged neighborhoods, Suglia noted.

Many studies, she noted, have defined childhood adversity based on the 10 items identified by Felitti and colleague[3] in 1998 in the Adverse Childhood Experiences study: witnessing a parent being abused, living with a mentally ill person, living with a substance abuser, imprisonment of a household member, emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, or parental separation or divorce.

However, additional research has also identified other adversities, such as bullying, living in an unsafe neighborhood, dating violence, and economic hardship.

Other research has linked these childhood events with poor health outcomes.  

The report writers aimed to summarize existing evidence and identify research gaps in order to guide future work on finding interventions that can mitigate childhood adversity and its associated risk for cardiometabolic disease.

Three pathways—changes in behavior, mental health, and biology—seem to explain the relationship between distress in childhood and poor cardiovascular health in adulthood.

For example, in response to high distress, children are at higher risk of adopting unhealthy coping mechanisms, such as smoking or overeating, and children growing up in a dysfunctional home environment may not be given a healthy diet or encouraged to engage in physical activity.

Children who are exposed to violence or mistreated may develop posttraumatic stress disorder or experience depression or anxiety.

Childhood adversity may disrupt regulatory systems in the body.

Future research is needed to find out why some children are more resilient and to determine whether any interventions that affect the child and his or her family and neighborhood might help.

"There are no national guidelines or recommendations on systematic surveillance for childhood adversity in the healthcare system," the statement authors conclude, "in part because of a limited understanding of how to prevent or mitigate adversity and to build resilience."

More research is needed "to guide and inform effective and timely individual/clinical and population-level preventive interventions," they conclude.

Suglia has disclosed no relevant financial relationships. Disclosures of the coauthors are listed in  the article.

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