Children from Socially and Economically Disadvantaged Families Have Increased Cardiovascular Risks Interview with:
Lead author, Dr Richard Liu, MCRI Ph.D. student and
Senior author – Professor David Burgner PhD
The Child Health CheckPoint Investigator Group
Murdoch Children’s Research Institute
The Royal Children’s Hospital
Parkville, Victoria, Australia What is the background for this study? What are the main findings?

Response: The socioeconomic gradient in cardiovascular disease is well recognised in adults. The more disadvantaged someone is, the higher their risk of heart attack and stroke. The mechanisms by which this occurs are not well understood, but we know the pathological process underlying this, thickening of the arteries, or atherosclerosis, begins very early in life. Our current understanding of the early development of atherosclerosis has previously been limited mainly to autopsy studies. Non-invasive imaging is increasingly being used to examine the early development of atherosclerosis.

We wanted to determine if there was an association between socioeconomic disadvantage and the thickness of the carotid artery wall in mid-childhood, which in adults is a proxy for atherosclerosis and indicates higher risk for heart attack and stroke in later life. We analysed both family and neighbourhood socioeconomic position data from 1477 Australian families, which included data on income, education and occupation of parents, as well as the relative socioeconomic status of the immediate neighbourhood. What are the main findings?

Response: Our main finding was that children from socially and economically disadvantaged families and neighbourhoods appear more likely to have thicker carotid artery walls. The association with family – rather than neighbourhood – socioeconomic position was stronger, and appeared to be independent of other traditional cardiovascular disease risk factors such as smoking exposure, body mass index and blood pressure. What should readers take away from your report?

Response: At this stage it is still unclear what specific factors link early life and childhood disadvantage to atherosclerosis. As this is a study where we only made observations, so cause and effect cannot be proved. However, our results suggest that things such as smoking, blood pressure and obesity, while important factors in heart health, do not fully account for the link between disadvantage and heart health that we found in this study. This is good news because it suggests there are more opportunities for new preventative interventions to reduce the burden of cardiovascular disease in the future, especially at an earlier age and in those from more disadvantaged families. What recommendations do you have for future research as a result of this study?

Response: Risk factors such as smoking, blood pressure, cholesterol, diabetes and obesity are strong predictors of atherosclerosis. Many of these factors act through inflammation, a response in the body that combats infections and other injuries. If inflammation is inappropriate, it can cause damage to your blood vessels and worsen atherosclerosis. Although we have not specifically addressed inflammation in this study, we know that disadvantaged children and adults have more chronic inflammation. In future we hope to investigate whether inflammation in childhood helps explain the socioeconomic gradient in cardiovascular disease and explore additional factors, such as infection, that might contribute to inflammation in childhood.

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Socioeconomic Position Is Associated With Carotid Intima–Media Thickness in Mid‐Childhood: The Longitudinal Study of Australian Children

Richard S. Liu, Fiona K. Mensah, John Carlin, Ben Edwards, Sarath Ranganathan, Michael Cheung, Terence Dwyer, Richard Saffery, Costan G. Magnussen, Markus Juonala, Melissa Wake, David P. Burgner, the Child Health CheckPoint Investigator Group

Journal of the American Heart Association. 2017;6:e005925, originally published August 9, 2017

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on August 10, 2017 by Marie Benz MD FAAD