Is childhood family socioeconomic status associated with left ventricular mass and diastolic function in adulthood?
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.
These data suggest that adverse childhood socioeconomic environment is associated with higher left ventricular mass and poorer diastolic function in middle age.
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.
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.
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.
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.
Laitinen TT, Puolakka E, Ruohonen S, Magnussen CG, Smith KJ, Viikari JSA, Heinonen OJ, Kartiosuo N, Hutri-Kähönen N, Kähönen M, Jokinen E, Laitinen TP, Tossavainen P, Pulkki-Råback L, Elovainio M, Raitakari OT, Pahkala K, Juonala M. Association of Socioeconomic Status in Childhood With Left Ventricular Structure and Diastolic Function in AdulthoodThe Cardiovascular Risk in Young Finns Study. JAMA Pediatr. Published online June 26, 2017. doi:10.1001/jamapediatrics.2017.1085