BACKGROUND:This study aimed to quantify the association between childhood family environment and longitudinal cardiovascular health (CVH) in adult CARDIA (Coronary Artery Risk Development in Young Adults) Study participants. We further investigated whether the association differs by adult income.METHODS:We applied the CVH framework from the American Heart Association including metrics for smoking, cholesterol, blood pressure, glucose, body mass index, physical activity, and diet. CVH scores (range, 0–14) were calculated at years 0, 7, and 20 of the study. Risky Family environment (range, 7–28) was assessed at year 15 retrospectively, for childhood experiences of abuse, caregiver warmth, and family or household challenges. Complete case ordinal logistic regression and mixed models associated risky family (exposure) with CVH (outcome), adjusting for age, sex, race, and alcohol use.RESULTS:The sample (n=2074) had a mean age of 25.3 (±3.5) years and 56% females at baseline. The median risky family was 10 with ideal CVH (≥12) met by 288 individuals at baseline (28.4%) and 165 (16.3%) at year 20. Longitudinally, for every 1-unit greater risky family, the odds of attaining high CVH (≥10) decreased by 3.6% (OR, 0.9645 [95% CI, 0.94–0.98]). Each unit greater child abuse and caregiver warmth score corresponded to 12.8% lower and 11.7% higher odds of ideal CVH (≥10), respectively (OR, 0.872 [95% CI, 0.77–0.99]; OR, 1.1165 [95% CI, 1.01–1.24]), across all 20 years of follow-up. Stratified analyses by income in adulthood demonstrated associations between risky family environment and CVH remained significant for those of the highest adult income (>$74k), but not the lowest (<$35k).CONCLUSIONS:Although risky family environmental factors in childhood increase the odds of poor longitudinal adult CVH, caregiver warmth may increase the odds of CVH, and socioeconomic attainment in adulthood may contextualize the level of risk. Toward a paradigm of primordial prevention of cardiovascular disease, childhood exposures and economic opportunity may play a crucial role in CVH across the life course.

中文翻译：

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不利的童年家庭环境、虐待儿童和看护者的温暖与整个生命周期心血管健康之间关联的证据：年轻人冠状动脉风险发展 (CARDIA) 研究

背景：本研究旨在量化成年 CARDIA（年轻人冠状动脉风险发展）研究参与者的童年家庭环境与纵向心血管健康 (CVH) 之间的关联。我们进一步研究了这种关联是否因成人收入而异。方法：我们应用了美国心脏协会的 CVH 框架，包括吸烟、胆固醇、血压、血糖、体重指数、体力活动和饮食指标。CVH 评分（范围，0-14）在研究的第 0 年、第 7 年和第 20 年计算。风险家庭环境（范围，7-28）在 15 岁时进行回顾性评估，评估儿童时期的虐待经历、照顾者的温暖以及家庭或家庭挑战。完整病例序数逻辑回归和混合模型将风险家庭（暴露）与 CVH（结果）相关联，调整年龄、性别、种族和饮酒情况。结果：样本 (n=2074) 的平均年龄为 25.3 岁 (±3.5 岁) ）年，基线时 56% 为女性。中位风险家庭为 10 个具有理想 CVH (≥12) 的家庭，基线时有 288 人 (28.4%) 达到理想 CVH，第 20 年达到 165 人 (16.3%)。纵向来看，每增加 1 个单位的风险家庭，获得高 CVH 的几率(≥10) 下降 3.6%（OR，0.9645 [95% CI，0.94–0.98]）。每个单位的儿童虐待和照顾者热情评分越高，理想 CVH (≥10) 的几率分别降低 12.8% 和提高 11.7%（OR，0.872 [95% CI，0.77–0.99]；OR，1.1165 [95% CI， 1.01–1.24]），在所有 20 年的随访中。按成年后收入进行的分层分析表明，对于成年收入最高（> 74,000 美元）的人来说，危险的家庭环境与 CVH 之间的关联仍然显着，但对于最低收入（< 35,000 美元）的人来说则不然。结论：尽管童年时期的危险家庭环境因素会增加成年 CVH 的纵向较差的几率、护理人员的热情可能会增加 CVH 的几率、成年期的社会经济成就可能会影响风险水平。为了建立心血管疾病原始预防的范例，儿童时期的暴露和经济机会可能在整个生命过程中的 CVH 中发挥至关重要的作用。