2017 Keynote Speaker: Interpersonal Factors and Risk for Cardiovascular Disease
This article is based on the lecture presented by Karen Matthews, Ph.D. University of Pittsburgh at the July 2017 meeting.
Cardiovascular diseases (CVD) begin in childhood and adolescence. In that regard, the American Heart Association cites the substantial burden of obesity, adverse health behaviors, and environments that often begin in childhood as contributing to the development of CVD (Lloyd-Jones et al. 2010). In this presentation, we review key childhood environments associated with later cardiovascular risk, describe the role of positive resources and dispositions as potentially protective, and end with several issues to address in future research.
A key childhood environmental factor related to later CVD is low family socioeconomic status (SES; Galobardes et al. 2006). Childhood SES is often defined by parental educational attainment, occupational rank, and household income relative to size. However, low family SES measured by any of these indices is a proxy for exposure to disadvantaged environments more generally. In one analysis, six adverse environmental characteristics (e.g. family turmoil, community violence) were evaluated. Those from middle income families were exposed to 0 or 1 of these environmental features, whereas those children from low income families were exposed to 3 to 4 on average.
Adverse childhood environments can be categorized according to (a) abuse or threat, specifically emotional, physical, and sexual abuse, and domestic violence; (b) deprivation, specifically emotional and physical neglect; and (c) family dysfunction, specifically mental illness, incarceration, and substance abuse of family members. Adverse childhood environments are not unusual. According to the CDC 2010 study of approximately 54000 adults, 23.6% reported 1 type of childhood adversity, 13.3% 2 types, and 14.3% 5 or more.
Accumulating evidence suggests that adverse childhood environments are associated with CVD risk factors and morbidity (Appelton et al. 2016). In our work, mid-life women who were from poorer, less educated families in childhood relative to others were more likely to develop the metabolic syndrome, a clustering of high glucose, blood pressure, triglycerides, and waist circumference, and low HDL-cholesterol. Additionally, women who reported more abuse and neglect as a child had a greater risk of subclinical CVD, obesity, and inflammation, compared to those who did not.
Positive interpersonal characteristics and dispositions may form a bank of resources, called reserve capacity, that may mediate or moderate the influence of adverse child environments on later CVD risk (Matthews & Gallo, 2011). We have reported that among healthy adolescents, a combination of high self-esteem, positive affect, optimism about the future, and high subjective social standing was a reliable predictor of metabolic syndrome characteristics, independent of health behaviors, body mass index, age, gender, and race.
Furthermore, Black adolescents high on these same measures were protected from elevated nighttime blood pressure (called nondipping; Burford, Low & Matthews, 2013). In another study, low childhood SES was related to prolonged recovery of systolic blood pressure after exposure to laboratory stressors (Boylan et al. 2016), but only if they had lower psychological resource scores – less positive affect, optimism, purpose in life, self-esteem and self-mastery.
The body of research raises several important questions. The first is how to best measure adverse childhood experiences in the context of CVD risk. By necessity, most available evidence is based on retrospective reporting in adulthood. The concordance between retrospective and prospective measures is modest and related to personality. In the Dunedin study, more adverse childhood experiences were reported retrospectively (self-report) than prospectively (by study staff/records) in adults who were less agreeable and conscientious, and more neurotic; conversely, more adverse childhood experiences were reported prospectively in those who were more agreeable. The retrospective measures tended to be related more to subjective measures of health, whereas prospective measures tended to be related more to objective measures (Reuben et al. 2016), suggesting that adverse childhood environments’ predictive value vary by informant and health outcome. Additional important issues are whether frequency, severity, and timing of adverse experiences should be measured.
A second set of questions concerns the cultural context of the relationships. It is assumed, for example, that positive attributes, including conscientiousness, self-control, and social competence, are beneficial and do no harm. However, an emerging body of work suggests a physiological cost of such positive attributes in subgroups. Among poor Black youth, these more positive characteristics were related to higher cardiometabolic risk factors, although the same characteristics were related to lower risk of mental health problems. The interpretation is that persistent effortful striving (called John Henryism) may be costly for disadvantaged groups (Brody et al. 2018).
In summary, adverse environments and positive attributes early in life appear to have a long-lasting impact on cardiovascular health. It is important to understand the pathways, protective factors, and cultural contexts that may enhance or hinder later cardiovascular health.
References (selected)
Appleton, A. A., Holdsworth, E., Ryan, M., & Tracy, M. (2017). Measuring childhood adversity in life course cardiovascular research: a systematic review. Psychosomatic Medicine, 79, 434-440.
Boylan, J. M., Jennings, J. R., & Matthews, K. A. (2016). Childhood socioeconomic status and cardiovascular reactivity and recovery among Black and White men: Mitigating effects of psychological resources. Health Psychology, 35, 957-966.
Brody, G. H., Yu, T., Miller, G. E., Ehrlich, K. B., & Chen, E. (2018). John Henryism Coping and Metabolic Syndrome Among Young Black Adults. Psychosomatic Medicine, 80, 216-221.
Burford, T. I., Low, C. A., & Matthews, K. A. (2013). Night/day ratios of ambulatory blood pressure among healthy adolescents: roles of race, socioeconomic status, and psychosocial factors. Annals of Behavioral Medicine, 46, 217-226.
Galobardes, B., Smith, G. D., & Lynch, J. W. (2006). Systematic review of the influence of childhood socioeconomic circumstances on risk for cardiovascular disease in adulthood. Annals of Epidemiology, 16, 91-104.
Lloyd-Jones, D. M., Hong, Y., Labarthe, D., Mozaffarian, D., Appel, L. J., Van Horn, L., ... & Arnett, D. K. (2010). Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic Impact Goal through 2020 and beyond. Circulation, 121, 586-613.
Matthews, K. A., & Gallo, L. C. (2011). Psychological perspectives on pathways linking socioeconomic status and physical health. Annual Review of Psychology, 62, 501-530.
Reuben, A., Moffitt, T. E., Caspi, A., Belsky, D. W., Harrington, H., Schroeder, F., ... & Danese, A. (2016). Lest we forget: comparing retrospective and prospective assessments of adverse childhood experiences in the prediction of adult health. Journal of Child Psychology and Psychiatry, 57, 1103-1112.
Cardiovascular diseases (CVD) begin in childhood and adolescence. In that regard, the American Heart Association cites the substantial burden of obesity, adverse health behaviors, and environments that often begin in childhood as contributing to the development of CVD (Lloyd-Jones et al. 2010). In this presentation, we review key childhood environments associated with later cardiovascular risk, describe the role of positive resources and dispositions as potentially protective, and end with several issues to address in future research.
A key childhood environmental factor related to later CVD is low family socioeconomic status (SES; Galobardes et al. 2006). Childhood SES is often defined by parental educational attainment, occupational rank, and household income relative to size. However, low family SES measured by any of these indices is a proxy for exposure to disadvantaged environments more generally. In one analysis, six adverse environmental characteristics (e.g. family turmoil, community violence) were evaluated. Those from middle income families were exposed to 0 or 1 of these environmental features, whereas those children from low income families were exposed to 3 to 4 on average.
Adverse childhood environments can be categorized according to (a) abuse or threat, specifically emotional, physical, and sexual abuse, and domestic violence; (b) deprivation, specifically emotional and physical neglect; and (c) family dysfunction, specifically mental illness, incarceration, and substance abuse of family members. Adverse childhood environments are not unusual. According to the CDC 2010 study of approximately 54000 adults, 23.6% reported 1 type of childhood adversity, 13.3% 2 types, and 14.3% 5 or more.
Accumulating evidence suggests that adverse childhood environments are associated with CVD risk factors and morbidity (Appelton et al. 2016). In our work, mid-life women who were from poorer, less educated families in childhood relative to others were more likely to develop the metabolic syndrome, a clustering of high glucose, blood pressure, triglycerides, and waist circumference, and low HDL-cholesterol. Additionally, women who reported more abuse and neglect as a child had a greater risk of subclinical CVD, obesity, and inflammation, compared to those who did not.
Positive interpersonal characteristics and dispositions may form a bank of resources, called reserve capacity, that may mediate or moderate the influence of adverse child environments on later CVD risk (Matthews & Gallo, 2011). We have reported that among healthy adolescents, a combination of high self-esteem, positive affect, optimism about the future, and high subjective social standing was a reliable predictor of metabolic syndrome characteristics, independent of health behaviors, body mass index, age, gender, and race.
Furthermore, Black adolescents high on these same measures were protected from elevated nighttime blood pressure (called nondipping; Burford, Low & Matthews, 2013). In another study, low childhood SES was related to prolonged recovery of systolic blood pressure after exposure to laboratory stressors (Boylan et al. 2016), but only if they had lower psychological resource scores – less positive affect, optimism, purpose in life, self-esteem and self-mastery.
The body of research raises several important questions. The first is how to best measure adverse childhood experiences in the context of CVD risk. By necessity, most available evidence is based on retrospective reporting in adulthood. The concordance between retrospective and prospective measures is modest and related to personality. In the Dunedin study, more adverse childhood experiences were reported retrospectively (self-report) than prospectively (by study staff/records) in adults who were less agreeable and conscientious, and more neurotic; conversely, more adverse childhood experiences were reported prospectively in those who were more agreeable. The retrospective measures tended to be related more to subjective measures of health, whereas prospective measures tended to be related more to objective measures (Reuben et al. 2016), suggesting that adverse childhood environments’ predictive value vary by informant and health outcome. Additional important issues are whether frequency, severity, and timing of adverse experiences should be measured.
A second set of questions concerns the cultural context of the relationships. It is assumed, for example, that positive attributes, including conscientiousness, self-control, and social competence, are beneficial and do no harm. However, an emerging body of work suggests a physiological cost of such positive attributes in subgroups. Among poor Black youth, these more positive characteristics were related to higher cardiometabolic risk factors, although the same characteristics were related to lower risk of mental health problems. The interpretation is that persistent effortful striving (called John Henryism) may be costly for disadvantaged groups (Brody et al. 2018).
In summary, adverse environments and positive attributes early in life appear to have a long-lasting impact on cardiovascular health. It is important to understand the pathways, protective factors, and cultural contexts that may enhance or hinder later cardiovascular health.
References (selected)
Appleton, A. A., Holdsworth, E., Ryan, M., & Tracy, M. (2017). Measuring childhood adversity in life course cardiovascular research: a systematic review. Psychosomatic Medicine, 79, 434-440.
Boylan, J. M., Jennings, J. R., & Matthews, K. A. (2016). Childhood socioeconomic status and cardiovascular reactivity and recovery among Black and White men: Mitigating effects of psychological resources. Health Psychology, 35, 957-966.
Brody, G. H., Yu, T., Miller, G. E., Ehrlich, K. B., & Chen, E. (2018). John Henryism Coping and Metabolic Syndrome Among Young Black Adults. Psychosomatic Medicine, 80, 216-221.
Burford, T. I., Low, C. A., & Matthews, K. A. (2013). Night/day ratios of ambulatory blood pressure among healthy adolescents: roles of race, socioeconomic status, and psychosocial factors. Annals of Behavioral Medicine, 46, 217-226.
Galobardes, B., Smith, G. D., & Lynch, J. W. (2006). Systematic review of the influence of childhood socioeconomic circumstances on risk for cardiovascular disease in adulthood. Annals of Epidemiology, 16, 91-104.
Lloyd-Jones, D. M., Hong, Y., Labarthe, D., Mozaffarian, D., Appel, L. J., Van Horn, L., ... & Arnett, D. K. (2010). Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic Impact Goal through 2020 and beyond. Circulation, 121, 586-613.
Matthews, K. A., & Gallo, L. C. (2011). Psychological perspectives on pathways linking socioeconomic status and physical health. Annual Review of Psychology, 62, 501-530.
Reuben, A., Moffitt, T. E., Caspi, A., Belsky, D. W., Harrington, H., Schroeder, F., ... & Danese, A. (2016). Lest we forget: comparing retrospective and prospective assessments of adverse childhood experiences in the prediction of adult health. Journal of Child Psychology and Psychiatry, 57, 1103-1112.