Cumulative Effect of Psychosocial Factors in Youth on Ideal Cardiovascular Health in Adulthood: The Cardiovascular Risk in Young Finns Study | Journal Scan

Study Questions:

Do psychosocial factors in youth predict ideal cardiovascular health in adulthood?

Methods:

Data from the Cardiovascular Risk in Young Finns Study were used for the present analysis. The participants were randomly selected from the national register of Finland covering the entire country. The baseline survey was conducted in 1980 among participants who were 3-18 years of age. There were 3,577 initially healthy participants in 1980. The adulthood assessment took place 27 years later in 2007, when the participants were 30-45 years old. Participants with missing data were excluded, resulting in an analytic sample of 1,089 participants. A summary measure of psychosocial factors in youth comprised socioeconomic factors, emotional factors, parental health behaviors, stressful events, self-regulation (childhood), and social adjustment (childhood). The ideal cardiovascular health index comprised seven ideal metrics measured in 2007, each contributing 1 point to the ideal cardiovascular health index score. These behaviors included body mass index, physical activity, smoking status, dietary factors, blood pressure, total cholesterol, and fasting glucose. There were only a few participants having an ideal level in 0 factors (n = 18) or all seven factors (n = 11); consequently, the extreme groups were combined, so that the final ideal cardiovascular health index had values of ≤1, 2, 3, 4, 5, or ≥6. Additional assessments during adulthood included whether the participant was using cholesterol-lowering medication, antihypertensive medication, or medication to lower glucose.

Results:

A total of 477 men and 612 women were included in this analysis. The participants were on average 10 years old at the baseline and on average 37 years old at the adulthood measurement. The participants had on average 2.6 points on the ideal cardiovascular health index in adulthood. Inter-correlations between the specific psychosocial factors showed that the socioeconomic factor was associated with healthier behaviors of the parents (r = 0.17, p < 0.001) and greater social adjustment of the child (r = 0.10, p < 0.001). The emotional factor correlated with health behaviors of the parents (r = 0.16, p < 0.001), higher self-regulatory behavior of the child (r = 0.12, p < 0.001), and greater social adjustment of the child (r = 0.10, p = 0.001). The other factors had correlations of <0.10. There was a positive association between a higher number of favorable psychosocial factors in youth and greater ideal cardiovascular health index in adulthood (p < 0.001), which persisted after adjustment for age, sex, medication use, and cardiovascular risk factors in childhood (p < 0.001). The association was monotonic, suggesting that each increment in favorable psychosocial factors was associated with improvement in cardiovascular health. Of the specific psychosocial factors, a favorable socioeconomic environment (p < 0.001) and participants’ self-regulatory behavior (p = 0.004) were the strongest predictors of ideal cardiovascular health in adulthood.

Conclusions:

The investigators concluded that these findings suggest a dose-response association between favorable psychosocial factors in youth and cardiovascular health in adulthood, as defined by the American Heart Association metrics. The effect seems to persist throughout the range of cardiovascular health, potentially shifting the population distribution of cardiovascular health rather than simply having effects in a high-risk population.

Perspective:

These data suggest that the environment in which children grow up is very important for cardiovascular health in adulthood, and extends beyond just physical activity and diet. Successful modification of psychosocial factors, along with healthy behaviors (diet, physical activity, and nonsmoking), may have important public health implications for reducing cardiovascular disease.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Dyslipidemia, Prevention, CHD & Pediatrics and Prevention, CHD & Pediatrics and Quality Improvement, Lipid Metabolism, Nonstatins, Diet, Smoking

Keywords: Adolescent, American Heart Association, Antihypertensive Agents, Blood Pressure, Body Mass Index, Cardiovascular Diseases, Child, Cholesterol, Demography, Fasting, Female, Finland, Food Habits, Glucose, Health Behavior, Healthy Volunteers, Humans, Life Change Events, Male, Motor Activity, Parents, Public Health, Research Personnel, Risk Factors, Smoking, Social Adjustment, Socioeconomic Factors, United States


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