MedicalResearch.com Interview with:
Jaana Halonen Ph.D
Finnish Institute of Occupational Health
Kuopio, Finland

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Halonen: Research on predictors of cardiovascular disease has increasingly focused on exposures to risk factors other than the conventional behavioral and biological ones, such as smoking, hypertension, dyslipidaemia, or diabetes. One of the potential predictors beyond the conventional risks is exposure to childhood psychosocial adversities. Previous studies have found that people who had experienced financial difficulties, serious conflicts and long-term disease in the family in childhood have a higher level of cardiovascular risk factors and increased cardiovascular morbidity in adulthood, but the underlying mechanisms linking childhood exposure to adult disease remain unclear. It is possible that childhood adversity sets an individual on a risk pathway leading to adverse future exposures. An important source of adversity experienced in adulthood is residence in a socioeconomically disadvantaged neighborhood. However, no previous study had examined the combined effect of childhood psychosocial adversity and adult neighborhood disadvantage on cardiovascular disease risk.

We found that exposure to childhood psychosocial adversity and adult neighborhood disadvantage in combination was associated with a doubling of the risk of incident cardiovascular disease in adulthood when compared to the absence of such exposures. This association was not explained by conventional cardiovascular risk factors. Neither childhood psychosocial adversity nor adult neighborhood disadvantage alone were significantly associated with incident CVD, although they were associated with CVD risk factors.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Halonen: Clinical implications of the present findings should be drawn cautiously. Because factors included in a conventional cardiovascular risk assessment did not explain the association between childhood psychosocial adversity, adult neighborhood disadvantage, and incident cardiovascular heart disease, tackling smoking, hypertension, dyslipidaemia and other conventional risk factors only might not remove the excess CVD risk among individuals exposed to childhood adversity and adult disadvantage. Thus, the reduction of childhood adversity and adult disadvantage remains an important goal for health policies.

MedicalResearch:What recommendations do you have for future research as a result of this study?

More research is needed to increase understanding about the nature of these associations in the aetiology of cardiovascular diseases. We need to assess whether the association is replicable in other populations and whether it is causal or only indicative of other risk factors. We also need evidence of the potential benefits of interventions targeting childhood adversity and adult disadvantage in the prevention of cardiovascular diseases, and how these factors can realistically be modified in clinical settings in a cost-effective manner.