Socioeconomic circumstances in childhood and blood pressure in adulthood: the cardiovascular risk in young Finns study

DNA Methylation Mediates the Association Between Individual and Neighborhood Social Disadvantage and Cardiovascular Risk Factors

Low socioeconomic status (SES) and living in a disadvantaged neighborhood are associated with poor cardiovascular health. Multiple lines of evidence have linked DNA methylation to both cardiovascular risk factors and social disadvantage indicators. However, limited research has investigated the role of DNA methylation in mediating the associations of individual- and neighborhood-level disadvantage with multiple cardiovascular risk factors in large, multi-ethnic, population-based cohorts. We examined whether disadvantage at the individual level (childhood and adult SES) and neighborhood level (summary neighborhood SES as assessed by Census data and social environment as assessed by perceptions of aesthetic quality, safety, and social cohesion) were associated with 11 cardiovascular risk factors including measures of obesity, diabetes, lipids, and hypertension in 1,154 participants from the Multi-Ethnic Study of Atherosclerosis (MESA). For significant associations, we conducted epigenome-wide mediation analysis to identify methylation sites mediating the relationship between individual/neighborhood disadvantage and cardiovascular risk factors using the JT-Comp method that assesses sparse mediation effects under a composite null hypothesis. In models adjusting for age, sex, race/ethnicity, smoking, medication use, and genetic principal components of ancestry, epigenetic mediation was detected for the associations of adult SES with body mass index (BMI), insulin, and high-density lipoprotein cholesterol (HDL-C), as well as for the association between neighborhood socioeconomic disadvantage and HDL-C at FDR q < 0.05. The 410 CpG mediators identified for the SES-BMI association were enriched for CpGs associated with gene expression (expression quantitative trait methylation loci, or eQTMs), and corresponding genes were enriched in antigen processing and presentation pathways. For cardiovascular risk factors other than BMI, most of the epigenetic mediators lost significance after controlling for BMI. However, 43 methylation sites showed evidence of mediating the neighborhood socioeconomic disadvantage and HDL-C association after BMI adjustment. The identified mediators were enriched for eQTMs, and corresponding genes were enriched in inflammatory and apoptotic pathways. Our findings support the hypothesis that DNA methylation acts as a mediator between individual- and neighborhood-level disadvantage and cardiovascular risk factors, and shed light on the potential underlying epigenetic pathways. Future studies are needed to fully elucidate the biological mechanisms that link social disadvantage to poor cardiovascular health.

Role of confirmed and potential predictors of an unfavorable outcome in heart failure in everyday clinical practice

Heart failure (HF) is the only cardiovascular disease with an ever increasing incidence. HF, through reduced functional capacity, frequent exacerbations of disease, and repeated hospitalizations, results in poorer quality of life, decreased work productivity, and significantly increased costs of the public health system. The main challenge in the treatment of HF is the availability of reliable prognostic models that would allow patients and doctors to develop realistic expectations about the prognosis and to choose the appropriate therapy and monitoring method. At this moment, there is a lack of universal parameters or scales on the basis of which we could easily capture the moment of deterioration of HF patients' condition. Hence, it is crucial to identify such factors which at the same time will be widely available, cheap, and easy to use. We can find many studies showing different predictors of unfavorable outcome in HF patients: thorough assessment with echocardiography imaging, exercise testing (e.g., 6-min walk test, cardiopulmonary exercise testing), and biomarkers (e.g., N-terminal pro-brain type natriuretic peptide, high-sensitivity troponin T, galectin-3, high-sensitivity C-reactive protein). Some of them are very promising, but more research is needed to create a specific panel on the basis of which we will be able to assess HF patients. At this moment despite identification of many markers of adverse outcomes, clinical decision-making in HF is still predominantly based on a few basic parameters, such as the presence of HF symptoms (NYHA class), left ventricular ejection fraction, and QRS complex duration and morphology.

Early life predictors of development of blood pressure from childhood to adulthood: Evidence from a 30-year longitudinal birth cohort study

BACKGROUND AND AIMS

The early life predictors of changes in the blood pressures of offspring between childhood and young adulthood have not been well defined. Thus, this study aimed to determine the life course association of offspring's blood pressure with prenatal and early infancy lifestyle, and other factors taking advantage of a large community-based, longitudinal study of a birth cohort in Australia - the MUSP study.

METHODS

The systolic and diastolic blood pressure (SBP, DBP) was measured for 3793, 3782, 2628 and 1780 offspring of the Australian longitudinal cohort study at 5, 14, 21 and 30 years of their age, respectively. Individual PP and mean arterial pressure (MAP) was equated, and Generalized Estimating Equations with time (age) and predictor interaction modelling were performed.

RESULTS

Blood pressures of the offspring increased significantly between 5 and 30 years. Early life factors such as pre-pregnancy overweight/obesity, and hypertensive disorder in pregnancy were significantly positively associated, and duration of gestation and pre-pregnancy thinness of the mothers negatively associated with this life course increase in the offspring's blood pressure. Rapid increase in body weight from birth to 5 years had a strong association with increasing blood pressures components throughout their life course.

CONCLUSIONS

Several maternal pre-pregnancy and pregnancy factors along with the early life growth characteristics of offspring are important predictors of increase in blood pressure of the offspring from their childhood to adulthood.

Preterm Birth is Associated With Increased Blood Pressure in Young Adult Women

Background While there is some evidence of elevated blood pressure later in life in preterm survivors, data on adult women are still lacking. Thus, we assessed the associations between preterm birth and blood pressure in young adult women. Methods and Results We studied 5232 young adult women who volunteered for military service in Sweden between 1990 and 2007. Anthropometric and clinic blood pressure data were collected during the medical examination at the time of conscription. There was a progressive decline in systolic and diastolic blood pressures, as well as in mean arterial pressure, with increasing gestational age. Women born preterm had an adjusted increase in systolic blood pressure of 3.8 mm Hg (95% CI , 2.5-5.1; P<0.0001) and mean arterial pressure of 1.9 mm Hg (95% CI , 0.9-2.8; P=0.0001) compared with young women born at term. Rates of systolic hypertension were also considerably higher in young women born preterm (14.0% versus 8.1%, P<0.0001), as were rates of isolated systolic hypertension. The adjusted relative risk of systolic hypertension in women born preterm was 1.72 (95% CI , 1.26-2.34; P<0.001) that of women born at term or post-term, but there was no significant difference in the risk of diastolic hypertension (adjusted relative risk, 1.60; 95% CI , 0.49-5.20). Conclusions Young adult women born preterm display elevated systolic blood pressure and an increased risk of hypertension compared with peers born at term or post-term.

Associations of adversity in childhood and risk factors for cardiovascular disease in mid-adulthood

Studies assessing associations of childhood psychosocial adversity (e.g. sexual abuse, physical neglect, parental death), as opposed to socioeconomic adversity, with cardiovascular disease (CVD) risk factors in adulthood are scarce. The aim of this study is to assess associations of various types of psychosocial adversity and cumulative adversity in childhood, with multiple CVD risk factors in mid-life. At study enrolment, women from the Avon Longitudinal Study of Parents and Children (N=3612) retrospectively reported: lack of maternal care, maternal overprotection, parental mental illness, household dysfunction, sexual abuse, physical and emotional abuse, and neglect in childhood. Approximately 23 years later, body mass index (BMI), waist circumference, systolic and diastolic blood pressure, plasma glucose, insulin, triglycerides, low and high density lipoprotein cholesterol, C-reactive protein, carotid intima-media thickness (cIMT) and arterial distensibility were assessed (mean age 51 years). We examined associations of each specific type of psychosocial adversity and cumulative adversity with CVD risk factors. No specific type of psychosocial adversity was consistently associated with the CVD risk factors. There was evidence that a one standard deviation greater cumulative psychosocial adversity was associated with 0.51cm greater waist circumference (95% confidence interval [CI]: 0.02cm, 1.00cm, p=0.04) and a lower arterial distensibility, even after adjustment for age, ethnicity and childhood and adult socioeconomic position. We found no consistent evidence that any specific type of psychosocial adversity, or cumulative psychosocial adversity in childhood, is associated with CVD risk factors in adult women.

Receipt of public assistance during childhood and hypertension risk in adulthood

PURPOSE

We examined if receipt of public assistance during childhood lowered risk for hypertension by mid-life in a cohort of African Americans in the Southeastern United States.

METHODS

We used multiple logistic regression models to assess the relationship between receipt of public assistance during childhood and adult hypertension among 405 male and 737 female adult participants enrolled between 1988 and 2001 in the Pitt County Study, a community-based prospective cohort study of African Americans in North Carolina. Statistical analyses were adjusted for child and adult sociodemographic measures as well as adult psychosocial and lifestyle factors.

RESULTS

Women who grew up in economically disadvantaged families and who received public assistance during childhood had a 66% decreased odds of hypertension by mid-life compared with women similarly disadvantaged in childhood but who did not receive public assistance, odds ratio = 0.34; 95% confidence interval: 0.14-0.83. No association was observed for African American men.

CONCLUSIONS

Receipt of anti-poverty federal assistance during childhood was associated with reduced risk for hypertension by mid-life among African American women. It is possible that social expenditures on public assistance programs for families in need could produce long-term health benefits for children.

Association of socioeconomic status change between infancy and adolescence, and blood pressure, in South African young adults: Birth to Twenty Cohort

OBJECTIVE

Social epidemiology models suggest that socioeconomic status (SES) mobility across the life course affects blood pressure. The aim of this study was to investigate the association between SES change between infancy and adolescence, and blood pressure, in young adults, and the impact of early growth on this relationship.

SETTING

Data for this study were obtained from a 'Birth to Twenty' cohort in Soweto, Johannesburg, in South Africa.

PARTICIPANTS

The study included 838 Black participants aged 18 years who had household SES measures in infancy and at adolescence, anthropometry at 0, 2, 4 and 18 years of age and blood pressure at the age of 18 years.

METHODS

We computed SES change using asset-based household SES in infancy and during adolescence as an exposure variable, and blood pressure and hypertension status as outcomes. Multivariate linear and logistic regressions were used to investigate the associations between SES change from infancy to adolescence, and age, height and sex-specific blood pressure and hypertension prevalence after adjusting for confounders.

RESULTS

Compared to a persistent low SES, an upward SES change from low to high SES tertile between infancy and adolescence was significantly associated with lower systolic blood pressure (SBP) at the age of 18 years (β=-4.85; 95% CI -8.22 to -1.48; p<0.01; r(2)=0.1804) after adjusting for SES in infancy, small-for-gestational-age (SGA) and weight gain. Associations between SES change and SBP were partly explained by weight gain between birth and the age of 18 years. There was no association between SES mobility and diastolic blood pressure, mean arterial pressure or hypertension status.

CONCLUSIONS

Our study confirms that upward SES change has a protective effect on SBP by the time participants reach young adulthood. Socioeconomic policies and interventions that address inequality may have the potential to reduce cardiovascular disease burden related to BP in later life.

Social Patterning in Adiposity in Adolescence: Prospective Observations from the Chinese Birth Cohort ''Children of 1997''

INTRODUCTION

Low early life socio-economic position is more strongly associated with adiposity among women than men. We examined whether the sex difference of social patterning in general and central adiposity exists before adulthood.

METHODS

In Hong Kong's "Children of 1997" birth cohort, we used multivariable regression to examine the association of parental education, a marker of early life socio-economic position, with body mass index (BMI) (n = 7252, 88% follow-up) and waist-height ratio (n = 5636, 68% follow-up), at 14 years.

RESULTS

Parental education of Grade 9 or below, compared to Grade 12 or above, was associated with higher waist-height ratio z-score particularly in girls (0.30, 95% confidence interval (CI) 0.19, 0.41) compared to boys (0.12, 95% CI 0.02, 0.22) (p for sex interaction = 0.02). Lower parental education was associated with greater BMI z-score in adolescents of locally born mothers, but not adolescents of migrant mothers, with no difference by sex.

CONCLUSIONS

Different social patterning in different markers of adiposity may imply different sociological and biological mediating pathways. A stronger association between low early life socio-economic position and waist-height ratio in adolescent girls may indicate sex-specific influences of SEP related early life exposures on central adiposity.

Childhood Psychosocial Adversity and Adult Neighborhood Disadvantage as Predictors of Cardiovascular Disease: A Cohort Study

BACKGROUND

Childhood adverse psychosocial factors (eg, parental divorce, long-term financial difficulties) and adult neighborhood disadvantage have both been linked to increased cardiovascular disease (CVD). However, their combined effects on disease risk are not known.

METHODS AND RESULTS

Participants were 37 699 adults from the Finnish Public Sector study whose data were linked to a national neighborhood disadvantage grid with the use of residential addresses between the years 2000 and 2008 and who responded to a survey on childhood psychosocial adversities and adult CVD risk behaviors in 2008 to 2009. Survey data were also linked to national registers on hospitalization, mortality, and prescriptions to assess CVD risk factors in 2008 to 2009 and to ascertain incident CVD (coronary heart disease or cerebrovascular disease) between the survey and the end of December 2011 (mean follow-up, 2.94 years; SD=0.44 years). Combined exposure to high childhood adversity and high adult disadvantage was associated with CVD risk factors (hypertension, dyslipidemia, diabetes mellitus, obesity, smoking, heavy alcohol use, and physical inactivity) and with a 2.25-fold (95% confidence interval, 1.39-3.63) hazard of incident CVD compared with a low childhood adversity and low adult disadvantage. This hazard ratio was attenuated by 16.6% but remained statistically significant after adjustment for the CVD risk factors (1.96; 95% confidence interval, 1.22-3.16). Exposure to high childhood adversity or high adult neighborhood disadvantage alone was not significantly associated with CVD in fully adjusted models.

CONCLUSIONS

These findings suggest that individuals with both childhood psychosocial adversity and adult neighborhood disadvantage are at an increased risk of CVD. In contrast, those with only 1 of these exposures have little or no excess risk after controlling for conventional risk factors.

Childhood adversity as a predictor of non-adherence to statin therapy in adulthood

Purpose

To investigate whether adverse experiences in childhood predict non-adherence to statin therapy in adulthood.

Methods

A cohort of 1378 women and 538 men who initiated statin therapy during 2008–2010 after responding to a survey on childhood adversities, was followed for non-adherence during the first treatment year. Log-binomial regression was used to estimate predictors of non-adherence, defined as the proportion of days covered by dispensed statin tablets <80%. In fully adjusted models including age, education, marital status, current smoking, heavy alcohol use, physical inactivity, obesity, presence of depression and cardiovascular comorbidity, the number of women ranged from 1172 to 1299 and that of men from 473 to 516, because of missing data on specific adversities and covariates.

Results

Two in three respondents reported at least one of the following six adversities in the family: divorce/separation of the parents, long-term financial difficulties, severe conflicts, frequent fear, severe illness, or alcohol problem of a family member. 51% of women and 44% of men were non-adherent. In men, the number of childhood adversities predicted an increased risk of non-adherence (risk ratio [RR] per adversity 1.11, 95% confidence interval [CI] 1.01–1.21], P for linear trend 0.013). Compared with those reporting no adversities, men reporting 3–6 adversities had a 1.44-fold risk of non-adherence (95% CI 1.12–1.85). Experiencing severe conflicts in the family (RR 1.27, 95% CI 1.03–1.57]) and frequent fear of a family member (RR 1.27, 95% CI 1.00–1.62]) in particular, predicted an increased risk of non-adherence. In women, neither the number of adversities nor any specific type of adversity predicted non-adherence.

Conclusions

Exposure to childhood adversity may predict non-adherence to preventive cardiovascular medication in men. Usefulness of information on childhood adversities in identification of adults at high risk of non-adherence deserves further research.

Childhood family living arrangements and blood pressure in black men: the Howard University Family Study

Black men have higher blood pressure (BP) levels and consequently higher prevalence of hypertension compared with men from other ethnic groups in the United States. Socio-familial factors in childhood have been found to play an important role in hypertension, but few studies have examined this relationship among black men. We investigated whether childhood family living arrangements are independently associated with mean BP and hypertension in a cross-sectional sample of 515 unrelated black male participants aged ≥20 years enrolled in the Howard University Family Study between 2001 and 2008. Black men who lived with both parents compared with the reference group of men who never lived with both parents during their lifetime had lower systolic BP (-4.4 mm Hg [95% confidence interval {CI}, -7.84 to -0.96]), pulse pressure (-3.9 mm Hg [95% CI, -6.28 to -1.51]), and mean arterial BP (-2.0 mm Hg [95% CI, -4.44 to 0.51]). This protective effect was more pronounced among men who lived with both parents for 1 to 12 years of their lives; they had decreased systolic BP (-6.5 mm Hg [95% CI, -10.99 to -1.95]), pulse pressure (-5.4 mm Hg [95% CI, -8.48 to -2.28]), mean arterial pressure (-3.3 mm Hg [95% CI, -6.56 to 0.00]), and a 46% decreased odds of developing hypertension (odds ratio=0.54; 95% CI, 0.30 to 0.99). No statistically significant associations were found for diastolic BP. These results provide preliminary evidence that childhood family structure exerts a long-term influence on BP among black men.

The association of educational attainment and SBP among older community-living adults: the Maintenance of Balance, Independent Living, Intellect and Zest in the Elderly (MOBILIZE) Boston Study

OBJECTIVE

Educational attainment is inversely associated with SBP level in young adulthood. This association has not been studied in an older cohort, and confounding and mediating factors are not well known.

METHODS

The authors hypothesized that higher education is associated with lower levels of SBP independent of many risk factors for hypertension. This prospective observational study included a sample of 764 older community-living participants in the Maintenance of Balance, Independent Living, Intellect and Zest in the Elderly (MOBILIZE) Boston Study.

RESULTS

Compared to participants with more than college education, regression analyses showed those with a high school education or less had a SBP value 6.33 mmHg higher [95% confidence interval (CI): 2.55-10.10], and those who had a college education had a SBP value 4.01 mmHg higher (95% CI: 0.77-7.25) independent of many hypothesized confounders and mediators.

DISCUSSION

Results of a path analysis confirmed that higher level of education was associated with lower SBP even after adjustment for hypothesized mediators. Although slightly attenuated by multivariable adjustment for hypertension risk factors, the significant inverse association between educational attainment and SBP was not entirely mediated by these risk factors. These findings indicate that education is inversely associated with SBP in a diverse cohort of community-living older adults, independent of many known or suspected risk factors.

CONCLUSION

This study is the first to report the association between education and SBP in an older sample, representing a population at the highest risk for hypertension-related morbidity and mortality.

Blood pressure tracking over the adult life course: patterns and correlates in the Framingham heart study

The extent to which select vascular risk factors differentially influence blood pressure (BP) is incompletely understood. Thus, we used multilevel modeling to analyze serial BP measurements using 21 732 person-observations obtained on Framingham Heart Study participants (mean age, 38 years, 52% women; 4993 unique individuals) over a 28-year period. We related longitudinal tracking of each BP measure (systolic BP, diastolic BP, mean arterial pressure, and pulse pressure) to age, sex, body mass index, smoking, diabetes mellitus, total/high-density lipoprotein cholesterol ratio, and heart rate. In multivariable-adjusted analyses, we observed that older age, male sex, greater body mass index, and higher heart rate were positively associated with increase in all BP measures (P<0.0001). Notably, higher total/high-density lipoprotein cholesterol ratio was associated with greater mean arterial pressure (P<0.01). Conversely, diabetes mellitus and smoking were associated with higher pulse pressure (P<0.01). We also observed effect modification by sex: the increase in pulse pressure with age and body mass index was more pronounced in women compared with men (P<0.0001). All BP measures tracked at higher levels in both men and women with multiple vascular risk factors. Taken together, our longitudinal observations in a large community-based sample demonstrate a greater pulsatile load in women than in men with increasing age. We also observed a differential impact of select vascular risk factors on the individual components of BP, underscoring distinct regulation of these measures over the life course.

Sex differences in the association of childhood socioeconomic status with adult blood pressure change: the CARDIA study

OBJECTIVE

To examine sex differences in the relation of childhood socioeconomic status (CSES) to systolic (SBP) and diastolic blood pressure (DBP) trajectories during 15 years, spanning young (mean [M] [standard deviation {SD}] = 30 [3] years) and middle (M [SD] = 45 [3] years) adulthood, independent of adult SES.

METHODS

A total of 4077 adult participants reported father's and mother's educational attainments at study enrollment (Year 0) and own educational attainment at enrollment and at all follow-up examinations. Resting BP also was measured at all examinations. Data from examination Years 5 (when participant M [SD] age = 30 [3] years), 7, 10, 15, and 20 are examined here. Associations of own adult (Year 5), mother's, and father's educations with 15-year BP trajectories were examined in separate multilevel models. Fully controlled models included time-invariant covariates (age, sex, race, recruitment center) and time-varying covariates that were measured at each examination (marital status, body mass, cholesterol, oral contraceptives/hormones, and antihypertensive drugs). Analyses of parental education controlled for own education.

RESULTS

When examined without covariates, higher education - own (SBP γ = -0.03, DBP γ = -0.03), mother's (SBP γ = -0.02, DBP γ = -0.02), and father's (SBP γ = -0.02, DBP γ = -0.01) - were associated with attenuated 15-year increases in BP (p < .001). Associations of own (but not either parent's) education with BP trajectories remained independent of standard controls. Sex moderated the apparent null effects of parental education, such that higher parental education-especially mother's, predicted attenuated BP trajectories independent of standard covariates among women (SBP γ = -0.02, p = .02; DBP γ = -0.01, p = .04) but not men (SBP γ = 0.02, p = .06; DBP γ = 0.005, p = .47; p interaction SBP < .001, p interaction DBP = .01).

CONCLUSIONS

Childhood socioeconomic status may influence women's health independent of their own adult status.

Established preeclampsia risk factors are related to patterns of blood pressure change in normal term pregnancy: findings from the Avon Longitudinal Study of Parents and Children

OBJECTIVE

Hypertension during pregnancy is one of the diagnostic criteria for preeclampsia. We investigated the pattern of blood pressure (BP) change across pregnancy and associations of risk factors for preeclampsia with BP changes in normal pregnancy.

METHODS

We examined repeat antenatal BP measurements (median 14 per woman) of 11,789 women from the Avon Longitudinal Study of Parents and Children cohort with a live-term birth and no evidence of preeclampsia or previous hypertension. Linear spline random effects models with knots at 18, 30 and 36 weeks gestation described changes in BP with gestational age.

RESULTS

On average, SBP and DBP decreased slowly until 18 weeks and rose from 18 weeks onwards, with increasing rate at 30 weeks and then again at 36 weeks. In obese women, BP was higher at 8 weeks and rose more slowly between 18 and 30 weeks and more rapidly between 30 and 36 weeks than in normal-weight women. Nulliparous women had higher BP at 8 weeks and faster increases in DBP from 30 weeks and SBP from 36 weeks onwards than multiparas. Women who smoked throughout pregnancy had lower BP at 8 weeks and throughout pregnancy; women who only smoked in the first trimester soon attained the same pattern of change as never smokers. In twin pregnancies, BP rose more rapidly from 30 weeks onwards than in singleton pregnancies.

CONCLUSION

Established preeclampsia risk factors are associated with higher BP in early pregnancy and faster BP increases later in gestation in normal pregnancy, suggesting a continuum of risk.

Childhood social class and adult adiposity and blood-pressure trajectories 36-53 years: gender-specific results from a British birth cohort

BACKGROUND

In this study, the authors investigate gender-specific effects of childhood socio-economic position (SEP) on adiposity and blood pressure at three time points in adulthood.

METHODS

Mixed models were used to assess the association of childhood SEP with body mass index (BMI), waist circumference, systolic blood pressure (SBP) and diastolic blood pressure (DBP) at ages 36, 43 and 53 years in a British birth cohort.

RESULTS

The adverse effect of lower childhood SEP on adiposity increased between ages 36 and 53 years in women (BMI: trend test: p=0.03) and remained stable in men, but the opposite was seen for SBP, where inequalities increased in men (p=0.01). Childhood SEP inequalities in DBP were stable with age in both men and women. Educational attainment mediated some but not all of the effects of childhood SEP on adiposity and SBP, and their rate of change; adult social class was a less important mediator.

CONCLUSION

Childhood SEP is important for adult adiposity and blood pressure across midlife, especially for BMI in women and for blood pressure in men. Thus, pathways to adult health differ for men and women, and public health policies aimed at reducing social inequalities need to start early in life and take account of gender.

Influence of life-course socioeconomic position on incident heart failure in blacks and whites: the Atherosclerosis Risk in Communities Study

The influence of early-life socioeconomic position (SEP) on incident heart failure in blacks and whites is unknown. The authors examined the relation between early-life SEP and incident, hospitalized heart failure among middle-aged US participants (2,503 black and 8,519 white) in the Atherosclerosis Risk in Communities (ARIC) Study. Early-life SEP indicators assessed included parental education, occupation, and home ownership. From 1987 to 2004, 221 and 537 incident heart failure events were identified in blacks and whites, respectively. In Cox proportional hazards regression, early-life SEP was inversely related to incident heart failure after adjustment for age, gender, and study center (for blacks, hazard ratio (HR) = 1.39, 95% confidence interval (CI): 1.00, 1.95; for whites, HR = 1.32, 95% CI: 1.06, 1.64). Additional adjustment for young and mid-to-older adulthood SEP and established heart failure risk factors attenuated this association towards the null in both blacks and whites. Of the SEP measures, mid-to-older adulthood SEP showed the strongest association with incident heart failure in both blacks (HR = 1.32, 95% CI: 0.90, 1.96) and whites (HR = 1.39, 95% CI: 1.11, 1.75). SEP over the life course is related to the risk of incident heart failure, with SEP later in adulthood having a more prominent role than earlier SEP.

Lipid trajectories as predictors of depressive symptoms: the Young Finns Study

OBJECTIVE

The aim of this study was to identify common trajectories of lipid levels across childhood and early adulthood life span.

DESIGN

The sample was a subpopulation of 824 young adults (3 to 9 years of age at baseline in 1980) of the ongoing population-based prospective Cardiovascular Risk in Young Finns Study. Lipid levels were determined in 1980, 1983, 1986, and 2001.

MAIN OUTCOME MEASURES

Depressive symptoms were assessed using a modified version of Beck's Depression Inventory (Beck, 1967) in 1992 and 2001.

RESULTS

The 2 triglycerides trajectories (steeply vs. moderately increasing) were differently related to depressive symptoms in adulthood. The trajectory showing steep increase over time was associated with higher level of depressive symptoms (M 2.18, 95% CI [2.08, 2.28] vs. 1.99, [1.95, 2.04]). This relationship persisted after adjustments for various risk factors. These triglycerides trajectories accounted for part of the association between high body mass index and depressive symptoms.

CONCLUSION

A pattern of steeply increasing triglyceride levels throughout childhood and adulthood may be associated with increased the risk of depressive symptoms in adulthood. This pattern may also be one link between obesity and depressive symptoms.

Ambulatory blood pressure in young adults with very low birth weight

OBJECTIVE

We hypothesized that, as compared with a matched control group born at term, young adults with very low birth weight (VLBW <1.5 kg) would have higher 24-hour ambulatory blood pressure.

STUDY DESIGN

We studied 118 18- to 27-year-old subjects born with VLBW within the greater Helsinki area and 120 term-born control subjects with similar age, sex, and birth hospital. The mean birth weight for VLBW subjects was 1.1 kg (standard deviation [SD], 0.2) and for controls, 3.6 kg (SD, 0.5). Gestational ages were 29.2 (SD, 2.3) and 40.1 (SD, 1.0) weeks. Current education of higher-educated parents served as an indicator of childhood socioeconomic status. Ambulatory blood pressure was measured during a 24-hour period with an oscillometric device (Spacelabs 90207).

RESULTS

VLBW subjects had, with sex, age, and body mass index adjustment, a 2.4 mm Hg (95% confidence interval, 0.2 to 4.6) higher 24-hour systolic pressure. We found hypertension in 11 VLBW subjects and in 3 term-born subjects, giving an adjusted odds ratio of 4.0 (1.1 to 14.8). When socioeconomic status was taken into account, results remained unchanged.

CONCLUSIONS

Higher rates of hypertension and higher 24-hour blood pressure among young adults with VLBW may indicate higher risk for adverse cardiovascular outcomes.

Substantial intergenerational increases in body mass index are not explained by the fetal overnutrition hypothesis: the Cardiovascular Risk in Young Finns Study

BACKGROUND

According to the fetal overnutrition hypothesis, intrauterine influences of maternal obesity increased lifelong obesity risk in the offspring. If the hypothesis is true, then the association between maternal body mass index (BMI; in kg/m(2)) and offspring BMI should be stronger than the association between paternal BMI and offspring BMI, because only the mother directly influences the fetal environment.

OBJECTIVES

We prospectively examined intergenerational change in BMI and tested the fetal overnutrition hypothesis.

DESIGN

Data on offspring weight were obtained from mothers. BMI was assessed from 2980 complete parent-offspring trios when the offspring were 3 to 18 y of age. The assessment of offspring BMI was repeated 21 y later at age 24-39 y.

RESULTS

Adult BMI of the offspring was 1.21 units higher than the BMI of their parents at the same age, which indicates an increase in obesity levels across generations (P < 0.0001). Maternal BMI was more strongly associated with offspring birth weight than was paternal BMI (P = 0.0009). However, there were no such differences in parent-offspring associations for BMI at later developmental stages when offspring were aged 3-39 y (P > 0.35). The results did not materially change in a sensitivity analysis for 1% to 15% nonpaternity.

CONCLUSIONS

Because offspring share all genes with their parents, the observed substantially higher adult BMI for offspring than for parents is likely explained by environmental influences. No support was found for any specific influence from fetal environment on this intergenerational increase in adult obesity. The findings were consistent with the fetal overnutrition hypothesis only in relation to birth weight.

Why do children from socioeconomically disadvantaged families suffer from poor health when they reach adulthood? A life-course study

The authors investigated what risk factors contribute to an excess risk of poor adult health among children who experience socioeconomic disadvantage. Data came from 1,037 children born in Dunedin, New Zealand, in 1972-1973, who were followed from birth to age 32 years (2004-2005). Childhood socioeconomic status (SES) was measured at multiple points between birth and age 15 years. Risk factors evaluated included a familial liability to poor health, childhood/adolescent health characteristics, low childhood intelligence quotient (IQ), exposure to childhood maltreatment, and adult SES. Adult health outcomes evaluated at age 32 years were major depressive disorder, anxiety disorders, tobacco dependence, alcohol or drug dependence, and clustering of cardiovascular disease risk factors. Results showed that low childhood SES was associated with an increased risk of substance dependence and poor physical health in adulthood (for tobacco dependence, sex-adjusted relative risk (RR) = 2.27, 95% confidence interval (CI): 1.41, 3.65; for alcohol or drug dependence, RR = 2.11, 95% CI: 1.16, 3.84; for cardiovascular risk factor status, RR = 2.55, 95% CI: 1.46, 4.46). Together, the risk factors studied here accounted for 55-67% of poor health outcomes among adults exposed to low SES as children. No single risk factor emerged as the prime explanation, suggesting that the processes mediating the link between childhood low SES and adult poor health are multifactorial.

Life-course influences on health in British adults: effects of socio-economic position in childhood and adulthood

BACKGROUND

Little evidence exists on the role of socio-economic position (SEP) in early life on adult disease other than for cardiovascular mortality; data is often retrospective. We assess whether childhood SEP influences disease risk in mid-life, separately from the effect of adult position, and establish how associations vary across multiple measures of disease risk.

METHODS

Prospective follow-up to adulthood of all born in England, Scotland and Wales during 1 week in 1958, and with medical data at age 45 years (n = 9377). Outcomes include: blood pressure, body mass index (BMI), glycosylated haemoglobin (HbA1c), total and high density lipoprotein (HDL) cholesterol, triglycerides, fibrinogen, total immunoglobulin E (IgE), one-second forced expiratory volume (FEV1), hearing threshold (4 kHz), visual impairment, symptoms of depression and anxiety, chronic widespread pain.

RESULTS

Social class in childhood was associated with blood pressure, BMI, HbA1c, HDL cholesterol, triglycerides, fibrinogen, FEV1, hearing threshold, depressive symptoms and chronic widespread pain, with a general trend of deteriorating health from class I to V. Adult social class was also associated with these measures. Mutually adjusted analyses of child and adult social class suggest that both contribute to disease risk in mid-life: in general, associations for childhood class were as strong as for adult class. Individuals with a manual class at both time-points tended to have the greatest health deficits in adulthood.

CONCLUSIONS

Adverse SEP in childhood is associated with a poorer health profile in mid-adulthood, independently of adult social position, and across diverse measures of disease risk and physical and mental functioning.

Socioeconomic position in childhood and adult cardiovascular risk factors, vascular structure, and function: cardiovascular risk in young Finns study

OBJECTIVE

To examine the association of childhood socioeconomic position (SEP) with adult cardiovascular risk factors, vascular structure, and vascular function in a contemporary population of young adults.

DESIGN

Population based prospective cohort study with baseline assessment in 1980.

SETTING

Finland.

PARTICIPANTS

856 men and 1066 women whose childhood SEP was determined by parental occupational status (manual, lower non-manual, upper non-manual) at age 3-18 years.

MAIN OUTCOME MEASURES

Cardiovascular risk factors, carotid artery intima-media thickness, and brachial artery flow mediated vasodilatation, assessed at age 24-39 years.

RESULTS

After adjustment for age and adult SEP, systolic pressure was 2.3 mm Hg higher (p = 0.0002), high density lipoprotein (HDL) cholesterol 0.03 mmol/l lower (p = 0.02), and insulin resistance score (homeostasis model assessment index) 0.12 units greater (p = 0.05) among men; and systolic pressure was 1.3 mm Hg higher (p = 0.02), diastolic pressure 1.1 mm Hg higher (p = 0.01), and height 1.1 cm lower (p < 0.0001) among women for each step down the childhood SEP hierarchy. Lower childhood SEP was associated with a 20% increase in the odds of having a waist circumference > 102 cm in men and > 88 cm in women (overall p = 0.05). Childhood SEP was not associated with intima-media thickness, flow mediated vasodilatation, the metabolic syndrome, low density lipoprotein cholesterol, triglycerides, body mass index, alcohol consumption, or smoking.

CONCLUSIONS

Among adults under 40, low childhood SEP predicted higher blood pressure and central obesity and, among men, unfavourable HDL cholesterol and insulin resistance, independent of current SEP. No independent effects were found on adult vascular structure, vascular function, or health related behaviours at this life stage.