Childhood Adversity May Increase Poor Heart Health Risk in Adulthood

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Childhood trauma may decrease the likelihood of optimal heart health in adulthood, while stable and nurturing experiences are shown to promote heart health.

Adverse family experiences in childhood may increase the probability of poor cardiovascular health in adulthood, while stable childhood relationships may benefit optimal heart health throughout adulthood, according to new research.1

The study showed positive relationships between caregiver and childhood correlated with a higher likelihood of reaching ideal heart health across a two-decade span of adulthood. On the other hand, adversity in childhood, including abuse, showed a lower chance of reaching optimal cardiovascular health in maturity.

“Supporting adults in a way that may promote safe, stable, and nurturing relationships with children in their care may be important in creating healthy habits in childhood that carry through adulthood,” Robin Ortiz, MD, an assistant professor in the pediatrics and population health departments at New York University Grossman School of Medicine, said in a statement.2 “Health care professionals should consider the health and well-being of the household when addressing cardiovascular health at any age.”

Adversity in childhood is widely prevalent, with more than half (59%) of the US population reporting ≥1 adverse event experience, according to a 2018 statement from the American Heart Association (AHA). Evidence has connected childhood difficulties with cardiometabolic disease in later life, including cardiovascular disease, type 2 diabetes (T2D), and stroke.

Ortiz and colleagues sought to identify a connection between childhood family environment and cardiovascular health at various time points across early to later adulthood. The team used data from a long-term study on CVD and risk factors among Black and White adults aged 18 to 30 years to quantify this association and explore if the potential association differed based on income level. Participants had an average of 25 years old at the start of the study, with more than half being women.

Data from approximately 2,074 adults in the Coronary Artery Risk Development in Young Adults (CARDIA) study, initiated between 1985 and 1986, were collected for analysis in the study. Investigators used the framework of the AHA’s Life Simple Seven metrics for the maintenance and improvement of cardiovascular health to calculate scores (range, 0–14) at the study baseline, year 7, and year 20. Adverse childhood experiences were measured at year 15 with the Risky Family Environment questionnaire, which assessed childhood experiences, including emotional and physical abuse, home substance use, and adult affection.

Upon analysis, at the 20-year mark, investigators found a 1-unit higher score on the Risky Family Environment questionnaire was associated with approximately 4% lower odds of attaining a high cardiovascular health score. They noted experiencing abuse was associated with nearly 13% decreased odds of a high heart-health score.

Further data showed positive experiences between the caregiver and child showed 12% higher odds of reaching the highest cardiovascular health scores. Although the connection between childhood exposure and adult heart health was unchanged for the highest annual income (≥$35,000) in adulthood, lower annual income (≤$35,000) in adulthood may cofound early adversity’s effects.

Per their interpretation of these data, Ortiz and colleagues suggested people with low income in adulthood may have faced adversity in both early and later life outside of family relationship experiences, including socioeconomic hardships or structural adversity.

“As we look at primordial prevention of cardiovascular disease, healthy and stable childhood relationships, and lifelong economic equity may play a crucial role in the equitable opportunity for all to attain cardiovascular health across the life course,” Ortiz said.2

Also, the study team acknowledged their expectation that having high caregiver warmth would protect against the relationship between childhood abuse and low heart health scores in adulthood. But, as these data indicated, those with high caregiver warmth who also experienced abuse were still more likely to have lower cardiovascular health scores.

“This suggests that the lack of stability in a caregiver relationship, in other words, the potential to experience abuse and warmth with unpredictability for either, may be as harmful as exposure to high rates of abuse without protective factors,” Ortiz added.2


  1. Ortiz R, Kershaw KN, Zhao S, et al. Evidence for the Association Between Adverse Childhood Family Environment, Child Abuse, and Caregiver Warmth and Cardiovascular Health Across the Lifespan: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. Circ Cardiovasc Qual Outcomes. Published online January 23, 2024. doi:10.1161/CIRCOUTCOMES.122.009794
  2. HeartNews. Childhood relationships, experiences may have good and bad effects on adult heart health. EurekAlert! January 23, 2024. Accessed January 26, 2024.