Adversities in childhood and young adulthood and incident cardiovascular diseases: a prospective cohort study

Xia Zou; Junfei Zhao; Anping Feng; Kei Hang Katie Chan; Wen-Chih Wu; JoAnn E Manson; Simin Liu; Jie Li

doi:10.1016/j.eclinm.2024.102458

Adversities in childhood and young adulthood and incident cardiovascular diseases: a prospective cohort study

EClinicalMedicine. 2024 Feb 2:69:102458. doi: 10.1016/j.eclinm.2024.102458. eCollection 2024 Mar.

Authors

Xia Zou¹, Junfei Zhao², Anping Feng¹, Kei Hang Katie Chan^{3

4}, Wen-Chih Wu^{3

5}, JoAnn E Manson⁶, Simin Liu^{1

3

7}, Jie Li^{1

8

9

3}

Affiliations

¹ Global Health Research Centre, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.
² Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.
³ Department of Epidemiology and Centre for Global Cardiometabolic Health, School of Public Health, Brown University, Providence, RI, USA.
⁴ Departments of Biomedical Sciences and Electrical Engineering, City University of Hong Kong, Hong Kong SAR, China.
⁵ Division of Cardiology, Department of Medicine, Providence VA Medical Centre & Warren Alpert Medical School of Brown University, Providence, RI, USA.
⁶ Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁷ Departments of Medicine and Surgery, The Warren Alpert Medical School, Brown University, Providence, RI, USA.
⁸ School of Public Health, Southern Medical University, Guangzhou, China.
⁹ School of Medicine, South China University of Technology, Guangzhou, China.

Abstract

Background: Much remains unknown regarding the associations of adversities in childhood and adulthood with incident cardiovascular diseases (CVD). We aimed to examine the independent and cumulative relations of adversities in childhood and adulthood with incident CVD and whether these associations can be mitigated by adopting a healthy lifestyle later in life.

Methods: We included 136,073 men and women [38-72 years at baseline] free of diagnosed CVD at baseline who responded to surveys on adversities in childhood and adulthood in the United Kingdom Biobank prospective cohort. They were recruited between 2006 and 2010 and were followed-up until 28 January 2021. Adversities included physical abuse, emotional abuse, sexual abuse, emotional neglect, and physical neglect. Participants were categorised into four groups according to the exposure periods, which were no adversity, childhood adversity only, adulthood adversity only, and cumulative adversity (both childhood and adulthood). The primary outcomes included incident fatal and non-fatal CVD events. The modifiable lifestyle factors were smoking, physical activity, diet, sleeping, social or leisure activities, and friend or family visits.

Findings: We identified 16,415 (10.71/1000 person-year) incident CVD during a median follow-up of 11.8 years. Compared with participants with no adversity, CVD incidence increased by 11% in those with childhood adversity only (adjusted hazard ratio [HR]: 1.11 [95% CI 1.06-1.17], p < 0.001), 4% in those with adulthood adversity only (1.04 [1.00-1.09], p = 0.05), and 21% in those with cumulative adversity (1.21 [1.16-1.26], p < 0.001). Analysis of interactions showed that adulthood adversity amplified the childhood adversity-CVD association (p for interaction = 0.03). Compared with the participants with one or fewer ideal lifestyle factors, those with more than four ideal factors had a 25%-36% lower risk of CVD across the three adversity groups.

Interpretation: Our findings suggested that childhood adversities were associated with an increased risk of CVD which can be magnified by adulthood adversities and substantially mitigated by adopting a healthy lifestyle later in life.

Funding: The National Natural Science Foundation of China and Guangzhou Foundation for Basic and Applied Basic Research.

Keywords: Adulthood; Adverse experience; Cardiovascular diseases; Childhood; Lifestyle.