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The Childhood Roots of Cardiovascular Disease Disparities
1Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
Insights
Early life stress and low socioeconomic status increase cardiovascular disease (CVD) risk in adults. Chronic stress in children can lead to early atherosclerotic changes, raising the risk of adult CVD.
Area of Science:
- Public Health
- Pediatrics
- Cardiovascular Medicine
Background:
- Poor socioeconomic conditions in early life are linked to increased adult cardiovascular disease (CVD) risk.
- Chronic early childhood stress, indicated by elevated cortisol, can independently trigger early atherosclerotic changes in children.
- These changes include increased intima-media thickness, a marker for CVD risk.
Purpose of the Study:
- To highlight the link between early life stress, socioeconomic factors, and cardiovascular disease risk.
- To emphasize the role of chronic stress and elevated cortisol in pediatric atherosclerosis.
- To advocate for early screening and intervention for toxic stress in children.
Main Methods:
- Review of national data on social determinants of cardiovascular disease.
- Documentation of elevated circulating cortisol levels in children experiencing stressful circumstances.
- Association of increased intima-media thickness with low socioeconomic status and CVD risk.
Main Results:
- Children in stressful environments show elevated cortisol levels as early as age 4.
- Chronic cortisol elevation is linked to increased inflammatory proteins (e.g., interleukin 6), promoting arterial wall fibrosis and scarring.
- Increased carotid artery intima-media thickness is observed in individuals with low socioeconomic status by age 18, correlating with lifelong CVD risk.
Conclusions:
- Pediatricians and healthcare professionals should screen for toxic stress in early childhood.
- Interventions to reduce stress reactivity can mitigate the risk of early atherosclerotic changes.
- Addressing early life stress is crucial for reducing the lifelong burden of cardiovascular disease.
Abstract:
A recent national review of the social determinants of cardiovascular disease (CVD) underscored the growing recognition that poor socioeconomic conditions early in life place children at higher risk for CVD as adults. There is growing evidence that chronic elevation of allostatic load as a consequence of high levels of early childhood stress can trigger early atherosclerotic changes in children independently of behaviors. Elevated levels of circulating cortisol have been documented in children as young as 4 years who were raised in highly stressful circumstances. Chronic elevation of cortisol is associated with increased release of inflammatory proteins such as interleukin 6, which can lead to fibrosis and scarring in the vessel walls of the arterial circulation, resulting in increased intima-media thickness. Increased intima-media thickness of the carotid artery has been found in individuals with low socioeconomic status as early as age 18 years and has been associated with increased CVD risk throughout the adult years. The American Academy of Pediatrics has recommended that it is the task of pediatricians and other health care professionals to screen for toxic stress among children during their early years and to take steps known to reduce stress reactivity, thereby helping these children to reduce their risk of early atherosclerotic changes and increased CVD throughout the life course.
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