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Original Investigation
June 26, 2017

Association of Socioeconomic Status in Childhood With Left Ventricular Structure and Diastolic Function in AdulthoodThe Cardiovascular Risk in Young Finns Study

Author Affiliations
  • 1The Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
  • 2Paavo Nurmi Centre, Sports, & Exercise Medicine Unit, Department of Physical Activity and Health, University of Turku, Turku, Finland
  • 3Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
  • 4Department of Medicine and Division of Medicine, Turku University Hospital, Turku, Finland
  • 5Department of Pediatrics, University of Tampere, Tampere University Hospital, Tampere, Finland
  • 6Department of Clinical Physiology, University of Tampere, Tampere University Hospital, Tampere, Finland
  • 7Department of Pediatric Cardiology, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
  • 8Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
  • 9Department of Pediatrics, Oulu University Hospital, PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland
  • 10Helsinki Collegium for Advanced Studies, University of Helsinki, Helsinki, Finland
  • 11Unit of Personality, Work, and Health, Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
  • 13Department of Clinical Physiology and Nuclear Medicine, University of Turku, Turku University Hospital, Turku, Finland
JAMA Pediatr. Published online June 26, 2017. doi:10.1001/jamapediatrics.2017.1085
Key Points

Question  Is childhood family socioeconomic status associated with left ventricular mass and diastolic function in adulthood?

Findings  In this cohort study of 1871 participants, family socioeconomic status in childhood was related to left ventricular mass and diastolic function even after adjustment for age, sex, conventional cardiovascular risk factors both in childhood and adulthood, and participants’ own socioeconomic status in adulthood.

Meaning  These data suggest that adverse childhood socioeconomic environment is associated with higher left ventricular mass and poorer diastolic function in middle age.

Abstract

Importance  Increased left ventricular (LV) mass and diastolic dysfunction are associated with cardiovascular disease. Prospective data on effects of childhood socioeconomic status (SES) on measures of LV structure and function are lacking.

Objective  To examine whether family SES in childhood was associated with LV mass and diastolic function after adjustment for conventional cardiovascular disease risk factors in childhood and adulthood.

Design, Setting, and Participants  The analyses were performed in 2016 using data gathered in 1980 and 2011 within the longitudinal population-based Cardiovascular Risk in Young Finns Study. The sample comprised 1871 participants who reported family SES at ages 3 to 18 years and were evaluated for LV structure and function 31 years later.

Exposures  Socioeconomic status was characterized as annual income of the family and classified on a 3-point scale.

Main Outcomes and Measures  Left ventricular mass indexed according to height at the allometric power of 2.7 and the E/e′ ratio describing LV diastolic performance at ages 34 to 49 years.

Results  The participants were aged 3 to 18 years at baseline (mean [SD], 10.8 [5.0] years), and the length of follow-up was 31 years. Family SES was inversely associated with LV mass (mean [SD] LV mass index, 31.8 [6.7], 31.0 [6.6], and 30.1 [6.4] g/m2.7 in the low, medium, and high SES groups, respectively; differences [95% CI], 1.7 [0.6 to 2.8] for low vs high SES; 0.8 [−0.3 to 1.9] for low vs medium; and 0.9 [0.1 to 1.6] for medium vs high; overall P = .001) and E/e′ ratio (mean [SD] E/e′ ratio, 5.0 [1.0], 4.9 [1.0], and 4.7 [1.0] in the low, medium, and high SES groups, respectively; differences [95% CI], 0.3 [0.1 to 0.4] for low vs high SES; 0.1 [−0.1 to 0.3] for low vs medium; and 0.2 [0 to 0.3] for medium vs high; overall P < .001) in adulthood. After adjustment for age, sex, and conventional cardiovascular disease risk factors in childhood and adulthood, and participants’ own SES in adulthood, the relationship with LV mass (differences [95% CI], 1.5 [0.2 to 2.8] for low vs high SES; 1.3 [0 to 2.6] for low vs medium; and 0.2 [−0.6 to 1.0] for medium vs high; P = .03) and E/e′ ratio (differences [95% CI], 0.2 [0 to 0.5] for low vs high SES; 0.1 [−0.1 to 0.4] for low vs medium; and 0.1 [0 to 0.3] for medium vs high; P = .02) remained significant.

Conclusions and Relevance  Low family SES was associated with increased LV mass and impaired diastolic performance more than 3 decades later. These findings emphasize that approaches of cardiovascular disease prevention must be directed also to the family environment of the developing child.

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