Early Childhood Education and Midlife Ideal Cardiovascular Health in a Prospective Urban Cohort.
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ABSTRACT:
SUBMITTER: Reynolds AJ
PROVIDER: S-EPMC10580152 | biostudies-literature | 2023 Oct
REPOSITORIES: biostudies-literature
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Early Childhood Education and Midlife Ideal Cardiovascular Health in a Prospective Urban Cohort.
Reynolds Arthur J AJ Varshney Nishank N Ou Suh-Ruu SR Kritzik Rachel R Loveman-Brown Marley M
JAMA pediatrics 20231201 12
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Project description:ImportanceEducational attainment is an underrecognized factor associated with racial disparities in cardiovascular disease (CVD) risk. Early childhood programs providing comprehensive family services can promote educational and socioeconomic success, but few, if any, studies of large-scale programs have assessed their associations with midlife CVD risk and mediating factors.ObjectiveTo examine the association between an early childhood program providing multisystemic services from ages 3 to 9 years with midlife CVD risk and whether years of education mediate these associations.Design, setting, and participantsUsing a matched-group, quasi-experimental design, a cohort of Black and Hispanic children in the Chicago Longitudinal Study enrolled in an established early childhood program from 1983 to 1989 or the usual services were followed up for 30 years after the end of the intervention. A midlife survey on well-being was administered when the participants were aged 37 years. Analyses were conducted from September 1, 2020, to October 15, 2020.InterventionThe Child-Parent Center (CPC) Education Program provides school-based educational enrichment and comprehensive family services for 6 years, from ages 3 to 9 years (preschool to third grade [P-3]).Main outcomes and measuresGeneral and hard Framingham Risk Scores (FRSs) were calculated from self-reported physical health and behavior profiles in the midlife Chicago Longitudinal Study survey. Years of education completed at age 34 years were measured primarily from administrative records.ResultsThere were 1539 participants in the original sample (1430 Black participants [92.9%]; 108 Hispanic participants [7.0%]; 1 White participant [0.1%]); 1104 of 1401 participants (78.8%) in the tracked sample completed a midlife survey on well-being by age 37 years, and 1060 participants had data available for analysis (mean [SD] age, 34.9 [1.4] years; 565 women [53.3%]), including 523 participants who grew up in high-poverty contexts. After adjusting for 17 baseline attributes and differential attrition via propensity score weighting, CPC preschool was associated with significantly lower general FRS (marginal coefficient, -2.2 percentage points [% hereafter]; 95% CI -0.7% to -3.6%; P = .004) and hard FRS (marginal coefficient, -1.6%; 95% CI -0.5% to -2.6%; P = .004), for a 20% reduction in cardiovascular disease risk. The program group was also less likely to have high-risk FRS status, including being in the top quartile of hard FRS (marginal coefficient, -7.2%; 95% CI, -0.3% to -11.6%; P = .02). Those who participated for 4 to 6 years (CPC P-3) had lower general FRS than those who participated for fewer years, but the difference was not significant (marginal coefficient, -1.2%; 95% CI, -2.5% to 0.2%; P = .09); longer participation was associated with placement in the median or higher risk category for general FRS (marginal coefficient, -7.9%; 95% CI -0.7% to -12.4%; P = .007) and hard FRS (marginal coefficient, -9.0%; 95% CI -0.6% to -11.4%; P = .02). Years of education completed by age 34 years accounted for up to 23% of the observed group differences for FRSs, including CPC preschool (general FRS, from -2.16% to -1.66%; difference = -0.5%) and P-3 (general FRS, from -1.16% to -0.71%; difference = -0.45%).Conclusions and relevanceIn this quasi-experimental design study, a comprehensive early childhood program for a community cohort at high risk of disparities was associated with lower CVD risk later in life. Corroborating previous research, years of education through college matriculation accounted for a sizable percentage of this association. Early childhood enrichment may contribute to CVD prevention.
| S-EPMC8379657 | biostudies-literature
Project description:Background Cardiovascular health (CVH) status is associated with cardiovascular diseases (CVD). However, evidence for association of CVH change with risk of CVD is scarce. Methods and Results Seven metrics (smoking status, body mass index, physical activity, diet, total cholesterol, blood pressure, and fasting blood glucose) were used to evaluate the CVH status. Having 0 to 2, 3 to 4, and 5 to 7 ideal cardiovascular metrics were categorized as low, moderate, and high CVH status, respectively. Change in CVH status was assessed from 2006/2007 to 2010/2011. We calculated lifetime risk of CVD using a modified Kaplan-Meier method, and life expectancy was evaluated via the multistate lifetable method. There were 82 349 participants included in our analysis. At 35 years index age, the age-adjusted incident rate and lifetime risk of CVD were increased with decreasing number of ideal CVH metrics. The direction of change in status of CVH was consistently associated with age-adjusted incident rate and lifetime risk of CVD. At 35 years index age, improvement from low to moderate (37.6% [95% CI, 32.8%-42.4%]) or to high status (24.4% [95% CI, 12.7%-36.0%]) had lower lifetime risk of CVD compared with consistently low status (44.6% [95% CI, 40.8%-48.5%]). The improvement in CVH could prolong the years of life free from CVD. The pattern of incident rate and lifetime risk across change in CVH status was similar at 45 and 55 years index age. Conclusions Higher number of CVH metrics was associated with lower lifetime risk of CVD. The improvement of CVH status could reduce the lifetime risk of CVD and prolonged the year of life free from CVD.
| S-EPMC8751933 | biostudies-literature
Project description:BackgroundPrimordial prevention may be a relevant strategy for the prevention of cancer. Given the commonality of risk factors and mechanisms between cancer and cardiovascular disease, we examined the associations between the number of ideal cardiovascular health metrics in midlife and incident cancer.MethodsIn 3 European cohorts (NutriNet-Santé and GAZEL, France; Whitehall II, United Kingdom), the number of ideal cardiovascular health metrics was determined at baseline (range 0-7). Follow-up for cancer events was until October 2020 (NutriNet-Santé), March 2017 (Whitehall II) and December 2015 (GAZEL). Cox regression was conducted in each cohort, and results were thereafter pooled using a random-effects model.ResultsData were available on 39 718 participants. A total of 16 237 were from NutriNet-Santé (mean age 51.3 yr; 28% men), 9418 were from Whitehall II (mean age 44.8 yr; 68% men) and 14 063 were from GAZEL (mean age 45.2 yr; 75% men). The median follow-up was 8.1 years in NutriNet-Santé, 29.6 years in Whitehall II and 24.8 years in GAZEL, and yielded a total of 4889 cancer events. A greater number of ideal cardiovascular health metrics was associated with a lower overall cancer risk in each cohort, with an aggregate hazard ratio (HR) per 1 increment in number of ideal metrics of 0.91 (95% confidence interval [CI] 0.88-0.93). This association remained after removal of the smoking metric (aggregate HR per unit increment in number of ideal metrics: 0.94, 95% CI 0.90-0.97), and site-specific analysis demonstrated a significant association with lung cancer.InterpretationA greater number of ideal cardiovascular health metrics in midlife was associated with lower cancer risk, notably lung cancer. Primordial prevention of cardiovascular risk factors in midlife may be a complementary strategy to prevent the onset of cancer.
| S-EPMC10449017 | biostudies-literature
Project description:Growing evidence suggests that childhood trauma is associated with poorer cardiovascular health in adulthood, but few studies have examined potential mediators of these associations. We examined the links between different forms of childhood trauma (i.e., abuse, neglect, cumulative trauma) and cardiovascular health and explored potential mediators. Cross-sectional data from 1,251 participants in the National Survey of Midlife Development in the United States' II Biomarker Project were analyzed. Path analyses were conducted to examine the associations between childhood trauma and cardiovascular health (i.e., American Heart Association's Life's Simple 7 [LS7] score). Depressive symptoms and sleep quality were explored as potential mediators, and exploratory analyses examined whether these associations were moderated by sex. Women reported more severe childhood emotional and sexual abuse and emotional neglect, p < .001 to p = .018, and higher LS7 scores, p = .027, than men. Path analyses demonstrated the total effects of increasing severity of all forms of childhood trauma with LS7 scores were significant, and cumulative childhood trauma was inversely associated with LS7 score Bs = -0.306- -0.076, p < .001-p = .048. The range of total effects of different forms of childhood trauma on LS7 scores mediated by depressive symptoms and sleep quality was 26.8%-57.5%. Sex moderated the associations between all forms of childhood trauma and cardiovascular health. Longitudinal studies are needed that examine mediators of the associations between childhood trauma and cardiovascular health. Findings suggest sex-specific, trauma-informed approaches for cardiovascular disease prevention in adults exposed to childhood trauma may be needed.
| S-EPMC9035028 | biostudies-literature
Project description:BackgroundThe updated definition of hypertension by the American College of Cardiology (ACC) and the American Heart Association (AHA) is an important paradigm shift and has lead to extensive discussion. We aimed to examine the association between the updated blood pressure (BP) categories and the risk of cardiovascular diseases (CVDs) with potential modifications from other cardiovascular health metrics (CVHMs).MethodsThis prospective study included 91,204 participants ≥40 years recruited from 20 community sites across mainland China. Participants were followed up during 2010-2016 for CVD events including nonfatal myocardial infarction, stroke, heart failure, and cardiovascular death. BP categories were defined according to the 2017 ACC/AHA guideline and CVHMs included smoking, physical activity, diet, body-mass index, total cholesterol, and fasting glucose.FindingsOverall, 1,985 major CVD events occurred during a mean follow-up of 3.7 years. Having more ideal CVHMs significantly reduced the risk of CVD events in both stage 1 and stage 2 hypertension. Compared with participants without hypertension, participants having ≥4 ideal CVHMs were no longer associated with an increased CVD risk in stage 1 hypertension (HR=1·04; 95% CI=0·83-1·31), but less so in stage 2 hypertension (HR=1·90, 95% CI=1·70-2·13). Such pattern of association was more evident in participants aged <60 years (P for interaction <0·05).InterpretationStage 1 hypertension defined by the ACC/AHA identifies individuals at increased CVD risk, which can be attenuated by achieving more preferable cardiovascular health, especially in adults aged <60 years.
| S-EPMC8749453 | biostudies-literature
Project description:Background: No study has explored the modification effect of ideal cardiovascular health metrics (ICVHMs) on the association between famine exposure and risk of cardiovascular disease (CVD) so far. We aim to examine the effect of ICVHMs on the association between exposure to famine early in life and the risk of CVD in adulthood. Methods: A total of 61,527 participants free of CVD were included in this study from the Kailuan Study. All participants were divided into three groups, included nonexposed, fetal-exposed, and childhood-exposed groups. Cox regression was used to estimate the effect of famine exposure and ICVHMs on CVD risk. Results: After a median of 13.0 (12.7-13.2) years follow-up, 4,814 incident CVD cases were identified. Compared with nonexposed participants, the CVD risk increased in participants with fetal famine exposure (hazard ratio [HR]: 1.21; 95% CI: 1.07-1.37), but not in childhood famine-exposed participants. After stratifying by the number of ICVHMs, the increased CVD risk associated with fetal famine exposure was only observed in participants with less ICVHMs ( ≤ 2) (HR: 1.30; 95% CI: 1.11-1.52, P for interaction=0.008), but disappeared in those with three or more ICVHMs. The modified effect of ICVHMs was sex specific (P for sex interaction = 0.031). Conclusions: Exposing to famine in the fetal period could increase the risk of CVD in late life; however, ICVHMs might modify the effect of famine exposure on CVD risk, especially in men.
| S-EPMC8599955 | biostudies-literature
Project description:BackgroundThe American Heart Association has prioritised seven cardiovascular health metrics to reduce the cardiovascular burden, including: body mass index, healthy diet, physical activity, smoking status, blood pressure, glycated haemoglobin A1c and total cholesterol. The aim of the current study was to assess the association between the American Heart Association-defined health metrics and the risk of cardiovascular events in the EPIC-Norfolk prospective study.DesignProspective cohort study.MethodsAn overall cardiovascular health score was calculated based on the number of health metrics including ideal, intermediate or poor. Cox proportional hazards models were used to describe the association of the seven metrics separately and the overall health score with risk of coronary heart disease, stroke and cardiovascular disease. A total of 10,043 participants was included in the analysis (follow-up 1993-2008). For all individual health metrics a more ideal status was associated with a lower risk of cardiovascular events.Results and conclusionAs for the overall cardiovascular health score, those in the highest (i.e. healthiest) category (score 12-14) had an adjusted hazard ratio for coronary heart disease of 0.07 (95% confidence interval (CI) 0.02-0.29, P < 0.001), for stroke of 0.16 (95% CI 0.02-1.37, P = 0.09) and for cardiovascular disease of 0.07 (95% CI 0.02-0.23, P < 0.001), compared to people in the lowest (i.e. unhealthiest) category (score 0-2). The overall cardiovascular health score was strongly and inversely associated with risk of coronary heart disease, stroke and cardiovascular disease. Our data suggest that even small improvements in modifiable risk factors may lead to substantial reductions in the risks of cardiovascular events.
| S-EPMC6215703 | biostudies-literature
Project description:BACKGROUND:Allostatic load has been suggested as a pathway through which experiences become biologically embedded to influence health. Research on childhood predictors of allostatic load has focused on socioeconomic and psychosocial exposures, while few studies include prospective measures of biomedical exposures. Further, findings on sex differences in the association of childhood predictors with various health outcomes related to allostatic load are ambiguous. AIMS:To examine the influence of early life biomedical and social factors in the first year of life on midlife allostatic load, assessing potential sex differences. METHODS:This prospective cohort study includes early life information collected at birth and a one year examination for 1,648 members of the Copenhagen Perinatal Cohort who also participated in the Copenhagen Aging and Midlife Biobank study (aged 49-52 years, 56% women). Allostatic load based on 14 biomarkers was selected as a measure of midlife health status. Early life factors were categorized as predominantly biomedical or social, and their associations with midlife allostatic load were examined in domain-specific and combined sex-stratified multiple regression models. RESULTS:The biomedical factors model explained 6.6% of the variance in midlife allostatic load in men and 6.7% in women, while the social model explained 4.1% of the variance in men and 7.3% in women. For both sexes, parental socioeconomic position at one year and maternal BMI significantly predicted midlife allostatic load in a model containing all early life factors. For women, additional significant predictors were complications at birth, birth weight and not living with parents at one year. CONCLUSION:The results confirm an association of lower childhood socioeconomic position with higher adult allostatic load while demonstrating the importance of other prenatal and early life exposures and highlighting potential sex differences.
| S-EPMC6095582 | biostudies-literature
Project description:ImportanceEducational attainment is a key social determinant of health and can be particularly consequential for racial and ethnic minority populations. Although the consequences of adverse childhood experiences (ACEs) are well established, there is little research on protective factors and policy-relevant strategies to mitigate ACE-related inequities.ObjectiveTo examine associations between early ACEs, comprehensive early intervention, and midlife educational attainment in a cohort of predominantly Black participants.Design, setting, and participantsThe Chicago Longitudinal Study is a prospective cohort study of Black and Latinx children from Chicago, Illinois. The intervention group included 989 children entering the Child-Parent Center (CPC) preschool Early Childhood Education (ECE) program in the 1980s. The comparison group comprised 550 children participating in usual early childhood services. All participants were followed up for 30 years after the end of the intervention. Analyses were conducted from July 1 to September 1, 2022.InterventionAttendance at the CPC preschool ECE program.Main outcomes and measuresA standard battery of early childhood ACEs (conventional ACEs), a set of early childhood ACEs more commonly associated with high-poverty contexts (expanded ACEs), and educational attainment at 35 years of age were measured from self-report and administrative records.ResultsThe original Chicago Longitudinal Study sample comprised 1539 participants (1430 Black participants [92.9%]; 774 female participants [50.3%]). Data on educational attainment and ACEs were available for 1083 of 1467 living participants (73.8%). Participants in the present study (1013 Black participants [93.5%]; 594 female participants [54.9%]) were a mean (SD) age of 35.1 (0.3) years at completion of the midlife survey. For the comparison group but not the CPC intervention group, having 1 or more conventional or expanded ACEs in early childhood was associated with fewer years of education (β = -0.64; 95% CI, -1.02 to -0.26), reduced likelihood of attaining a bachelor's degree or higher (odds ratio, 0.26; 95% CI, 0.09-0.70), and reduced likelihood of attaining an associate's degree or higher (odds ratio, 0.26; 95% CI, 0.11-0.62) after adjusting for covariates. Moderation analyses indicated that CPC participants with either conventional or expanded ACEs in early childhood attained a bachelor's degree or higher and an associate's degree or higher at rates similar to CPC participants without early ACEs (15.4% vs 13.6% for bachelor's degree or higher; 22.4% vs 19.9% for associate's degree or higher). Conversely, comparison group participants with early ACEs had significantly lower rates of educational attainment than their counterparts without ACEs (3.7% vs 12.1% for bachelor's degree or higher; 5.6% vs 17.1% for associate's degree or higher).ConclusionsThis cohort study suggests that early ACEs were associated with reduced educational attainment for the comparison group but not for the group participating in the CPC comprehensive early intervention. These results build on research suggesting that youths at higher risk can benefit most from intervention and support ECE as a tool for reducing ACE-related disparities.
| S-EPMC10288333 | biostudies-literature
Project description:Previous studies examining blood pressure change over time have modeled an average population trajectory. Recent research among older adults suggests there may be subgroups with different blood pressure trajectories. Identifying subgroups at risk of developing adult hypertension early in life can inform effective risk reduction efforts. We sought to identify different systolic blood pressure trajectories from childhood, their correlated risk factors, and early-midlife cardiovascular outcomes. Blood pressure data at ages 7, 11, 18, 26, 32, and 38 years from a longitudinal, representative birth cohort study (n=975) were used to identify 4 distinct trajectory groups via group-based trajectory modeling: normal (21.8%), high-normal (43.3%), prehypertensive (31.6%), and hypertensive (4.2%). The categories refer to blood pressure beginning at the age of 7 years and most recently measured at the age of 38 years. Family history of high blood pressure (odds ratio [OR], 43.23; 95% confidence interval [CI], 5.27-354.65), male sex (OR, 109.48; 95% CI, 26.82-446.96), being first born (OR, 2.5; 95% CI, 1.00-8.69) and low birth weight (OR, 2.79; 95% CI, 2.49-3.09) were associated with hypertensive group membership (compared with the normal group). Higher body mass index and cigarette smoking resulted in increasing blood pressure across trajectories, particularly for the higher blood pressure groups. Prehypertensive and hypertensive trajectory groups had worse cardiovascular outcomes by early midlife. Harmful blood pressure trajectories are identifiable in childhood, associated with both antecedent and modifiable risk factors over time, and predict adult cardiovascular disease risk. Early detection and subsequent targeted prevention and intervention may reduce the lifecourse burden associated with higher blood pressure.
| S-EPMC4646716 | biostudies-literature