title: Cumulative effect of psychosocial factors in youth on ideal cardiovascular health in adulthood: the Cardiovascular Risk in Young Finns Study.
abstract: BACKGROUND
  The American Heart Association has defined a new metric of ideal cardiovascular health as part of its 2020 Impact Goals. We examined whether psychosocial factors in youth predict ideal cardiovascular health in adulthood.
  
  
  RESULTS
  Participants were 477 men and 612 women from the nationwide Cardiovascular Risk in Young Finns Study. Psychosocial factors were measured from cohorts 3 to 18 years of age at the baseline of the study, and ideal cardiovascular health was examined 27 years later in adulthood. The summary measure of psychosocial factors in youth comprised socioeconomic factors, emotional factors, parental health behaviors, stressful events, self-regulation of the child, and social adjustment of the child. There was a positive association between a higher number of favorable psychosocial factors in youth and greater ideal cardiovascular health index in adulthood (β=0.16; P<0.001) that persisted after adjustment for age, sex, medication use, and cardiovascular risk factors in childhood (β=0.15; P<0.001). The association was monotonic, suggesting that each increment in favorable psychosocial factors was associated with improvement in cardiovascular health. Of the specific psychosocial factors, a favorable socioeconomic environment (β=0.12; P<0.001) and participants' self-regulatory behavior (β=0.07; P=0.004) were the strongest predictors of ideal cardiovascular health in adulthood.
  
  
  CONCLUSIONS
  The findings suggest a dose-response association between favorable psychosocial factors in youth and cardiovascular health in adulthood, as defined by the American Heart Association metrics. The effect seems to persist throughout the range of cardiovascular health, potentially shifting the population distribution of cardiovascular health rather than simply having effects in a high-risk population.
authors.affiliation: From IBS, Unit of Personality, Work, and Health, Institute of Behavioural Sciences (L.P.-R., M.E., C.H., J.L., M.H., M. Jokela, T.H., A.S., L.K.-J.), Helsinki Collegium for Advanced Studies (L.P.-R.), and Department of Food and Environmental Sciences (V.M.), University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland (M.E.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K.); Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland (T.L., K.P., M Juonala, J.V., O.T.R.); Department of Physical Activity and Health, Paavo Nurmi Centre, Sports and Exercise Medicine Unit, Turku, Finland (K.P.); School of Health Sciences, University of Tampere, Tampere, Finland (J.N.); Department of Pediatrics, University of Tampere and Tampere University Hospital, Tampere, Finland (N.H.-K.); and Departments of Medicine (M. Juonala, J.V.) and Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, Finland. laura.pulkki-raback@helsinki.fi.
authors.forename: Laura
authors.initials: L
authors.lastname: Pulkki-Råback
authors.affiliation: From IBS, Unit of Personality, Work, and Health, Institute of Behavioural Sciences (L.P.-R., M.E., C.H., J.L., M.H., M. Jokela, T.H., A.S., L.K.-J.), Helsinki Collegium for Advanced Studies (L.P.-R.), and Department of Food and Environmental Sciences (V.M.), University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland (M.E.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K.); Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland (T.L., K.P., M Juonala, J.V., O.T.R.); Department of Physical Activity and Health, Paavo Nurmi Centre, Sports and Exercise Medicine Unit, Turku, Finland (K.P.); School of Health Sciences, University of Tampere, Tampere, Finland (J.N.); Department of Pediatrics, University of Tampere and Tampere University Hospital, Tampere, Finland (N.H.-K.); and Departments of Medicine (M. Juonala, J.V.) and Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, Finland.
authors.forename: Marko
authors.initials: M
authors.lastname: Elovainio
authors.affiliation: From IBS, Unit of Personality, Work, and Health, Institute of Behavioural Sciences (L.P.-R., M.E., C.H., J.L., M.H., M. Jokela, T.H., A.S., L.K.-J.), Helsinki Collegium for Advanced Studies (L.P.-R.), and Department of Food and Environmental Sciences (V.M.), University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland (M.E.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K.); Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland (T.L., K.P., M Juonala, J.V., O.T.R.); Department of Physical Activity and Health, Paavo Nurmi Centre, Sports and Exercise Medicine Unit, Turku, Finland (K.P.); School of Health Sciences, University of Tampere, Tampere, Finland (J.N.); Department of Pediatrics, University of Tampere and Tampere University Hospital, Tampere, Finland (N.H.-K.); and Departments of Medicine (M. Juonala, J.V.) and Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, Finland.
authors.forename: Christian
authors.initials: C
authors.lastname: Hakulinen
authors.affiliation: From IBS, Unit of Personality, Work, and Health, Institute of Behavioural Sciences (L.P.-R., M.E., C.H., J.L., M.H., M. Jokela, T.H., A.S., L.K.-J.), Helsinki Collegium for Advanced Studies (L.P.-R.), and Department of Food and Environmental Sciences (V.M.), University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland (M.E.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K.); Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland (T.L., K.P., M Juonala, J.V., O.T.R.); Department of Physical Activity and Health, Paavo Nurmi Centre, Sports and Exercise Medicine Unit, Turku, Finland (K.P.); School of Health Sciences, University of Tampere, Tampere, Finland (J.N.); Department of Pediatrics, University of Tampere and Tampere University Hospital, Tampere, Finland (N.H.-K.); and Departments of Medicine (M. Juonala, J.V.) and Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, Finland.
authors.forename: Jari
authors.initials: J
authors.lastname: Lipsanen
authors.affiliation: From IBS, Unit of Personality, Work, and Health, Institute of Behavioural Sciences (L.P.-R., M.E., C.H., J.L., M.H., M. Jokela, T.H., A.S., L.K.-J.), Helsinki Collegium for Advanced Studies (L.P.-R.), and Department of Food and Environmental Sciences (V.M.), University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland (M.E.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K.); Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland (T.L., K.P., M Juonala, J.V., O.T.R.); Department of Physical Activity and Health, Paavo Nurmi Centre, Sports and Exercise Medicine Unit, Turku, Finland (K.P.); School of Health Sciences, University of Tampere, Tampere, Finland (J.N.); Department of Pediatrics, University of Tampere and Tampere University Hospital, Tampere, Finland (N.H.-K.); and Departments of Medicine (M. Juonala, J.V.) and Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, Finland.
authors.forename: Mirka
authors.initials: M
authors.lastname: Hintsanen
authors.affiliation: From IBS, Unit of Personality, Work, and Health, Institute of Behavioural Sciences (L.P.-R., M.E., C.H., J.L., M.H., M. Jokela, T.H., A.S., L.K.-J.), Helsinki Collegium for Advanced Studies (L.P.-R.), and Department of Food and Environmental Sciences (V.M.), University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland (M.E.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K.); Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland (T.L., K.P., M Juonala, J.V., O.T.R.); Department of Physical Activity and Health, Paavo Nurmi Centre, Sports and Exercise Medicine Unit, Turku, Finland (K.P.); School of Health Sciences, University of Tampere, Tampere, Finland (J.N.); Department of Pediatrics, University of Tampere and Tampere University Hospital, Tampere, Finland (N.H.-K.); and Departments of Medicine (M. Juonala, J.V.) and Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, Finland.
authors.forename: Markus
authors.initials: M
authors.lastname: Jokela
authors.affiliation: From IBS, Unit of Personality, Work, and Health, Institute of Behavioural Sciences (L.P.-R., M.E., C.H., J.L., M.H., M. Jokela, T.H., A.S., L.K.-J.), Helsinki Collegium for Advanced Studies (L.P.-R.), and Department of Food and Environmental Sciences (V.M.), University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland (M.E.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K.); Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland (T.L., K.P., M Juonala, J.V., O.T.R.); Department of Physical Activity and Health, Paavo Nurmi Centre, Sports and Exercise Medicine Unit, Turku, Finland (K.P.); School of Health Sciences, University of Tampere, Tampere, Finland (J.N.); Department of Pediatrics, University of Tampere and Tampere University Hospital, Tampere, Finland (N.H.-K.); and Departments of Medicine (M. Juonala, J.V.) and Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, Finland.
authors.forename: Laura D
authors.initials: LD
authors.lastname: Kubzansky
authors.affiliation: From IBS, Unit of Personality, Work, and Health, Institute of Behavioural Sciences (L.P.-R., M.E., C.H., J.L., M.H., M. Jokela, T.H., A.S., L.K.-J.), Helsinki Collegium for Advanced Studies (L.P.-R.), and Department of Food and Environmental Sciences (V.M.), University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland (M.E.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K.); Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland (T.L., K.P., M Juonala, J.V., O.T.R.); Department of Physical Activity and Health, Paavo Nurmi Centre, Sports and Exercise Medicine Unit, Turku, Finland (K.P.); School of Health Sciences, University of Tampere, Tampere, Finland (J.N.); Department of Pediatrics, University of Tampere and Tampere University Hospital, Tampere, Finland (N.H.-K.); and Departments of Medicine (M. Juonala, J.V.) and Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, Finland.
authors.forename: Taina
authors.initials: T
authors.lastname: Hintsa
authors.affiliation: From IBS, Unit of Personality, Work, and Health, Institute of Behavioural Sciences (L.P.-R., M.E., C.H., J.L., M.H., M. Jokela, T.H., A.S., L.K.-J.), Helsinki Collegium for Advanced Studies (L.P.-R.), and Department of Food and Environmental Sciences (V.M.), University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland (M.E.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K.); Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland (T.L., K.P., M Juonala, J.V., O.T.R.); Department of Physical Activity and Health, Paavo Nurmi Centre, Sports and Exercise Medicine Unit, Turku, Finland (K.P.); School of Health Sciences, University of Tampere, Tampere, Finland (J.N.); Department of Pediatrics, University of Tampere and Tampere University Hospital, Tampere, Finland (N.H.-K.); and Departments of Medicine (M. Juonala, J.V.) and Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, Finland.
authors.forename: Anna
authors.initials: A
authors.lastname: Serlachius
authors.forename: Tomi T
authors.initials: TT
authors.lastname: Laitinen
authors.affiliation: From IBS, Unit of Personality, Work, and Health, Institute of Behavioural Sciences (L.P.-R., M.E., C.H., J.L., M.H., M. Jokela, T.H., A.S., L.K.-J.), Helsinki Collegium for Advanced Studies (L.P.-R.), and Department of Food and Environmental Sciences (V.M.), University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland (M.E.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K.); Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland (T.L., K.P., M Juonala, J.V., O.T.R.); Department of Physical Activity and Health, Paavo Nurmi Centre, Sports and Exercise Medicine Unit, Turku, Finland (K.P.); School of Health Sciences, University of Tampere, Tampere, Finland (J.N.); Department of Pediatrics, University of Tampere and Tampere University Hospital, Tampere, Finland (N.H.-K.); and Departments of Medicine (M. Juonala, J.V.) and Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, Finland.
authors.forename: Tomi
authors.initials: T
authors.lastname: Laitinen
authors.affiliation: From IBS, Unit of Personality, Work, and Health, Institute of Behavioural Sciences (L.P.-R., M.E., C.H., J.L., M.H., M. Jokela, T.H., A.S., L.K.-J.), Helsinki Collegium for Advanced Studies (L.P.-R.), and Department of Food and Environmental Sciences (V.M.), University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland (M.E.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K.); Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland (T.L., K.P., M Juonala, J.V., O.T.R.); Department of Physical Activity and Health, Paavo Nurmi Centre, Sports and Exercise Medicine Unit, Turku, Finland (K.P.); School of Health Sciences, University of Tampere, Tampere, Finland (J.N.); Department of Pediatrics, University of Tampere and Tampere University Hospital, Tampere, Finland (N.H.-K.); and Departments of Medicine (M. Juonala, J.V.) and Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, Finland.
authors.forename: Katja
authors.initials: K
authors.lastname: Pahkala
authors.affiliation: From IBS, Unit of Personality, Work, and Health, Institute of Behavioural Sciences (L.P.-R., M.E., C.H., J.L., M.H., M. Jokela, T.H., A.S., L.K.-J.), Helsinki Collegium for Advanced Studies (L.P.-R.), and Department of Food and Environmental Sciences (V.M.), University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland (M.E.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K.); Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland (T.L., K.P., M Juonala, J.V., O.T.R.); Department of Physical Activity and Health, Paavo Nurmi Centre, Sports and Exercise Medicine Unit, Turku, Finland (K.P.); School of Health Sciences, University of Tampere, Tampere, Finland (J.N.); Department of Pediatrics, University of Tampere and Tampere University Hospital, Tampere, Finland (N.H.-K.); and Departments of Medicine (M. Juonala, J.V.) and Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, Finland.
authors.forename: Vera
authors.initials: V
authors.lastname: Mikkilä
authors.affiliation: From IBS, Unit of Personality, Work, and Health, Institute of Behavioural Sciences (L.P.-R., M.E., C.H., J.L., M.H., M. Jokela, T.H., A.S., L.K.-J.), Helsinki Collegium for Advanced Studies (L.P.-R.), and Department of Food and Environmental Sciences (V.M.), University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland (M.E.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K.); Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland (T.L., K.P., M Juonala, J.V., O.T.R.); Department of Physical Activity and Health, Paavo Nurmi Centre, Sports and Exercise Medicine Unit, Turku, Finland (K.P.); School of Health Sciences, University of Tampere, Tampere, Finland (J.N.); Department of Pediatrics, University of Tampere and Tampere University Hospital, Tampere, Finland (N.H.-K.); and Departments of Medicine (M. Juonala, J.V.) and Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, Finland.
authors.forename: Jaakko
authors.initials: J
authors.lastname: Nevalainen
authors.affiliation: From IBS, Unit of Personality, Work, and Health, Institute of Behavioural Sciences (L.P.-R., M.E., C.H., J.L., M.H., M. Jokela, T.H., A.S., L.K.-J.), Helsinki Collegium for Advanced Studies (L.P.-R.), and Department of Food and Environmental Sciences (V.M.), University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland (M.E.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K.); Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland (T.L., K.P., M Juonala, J.V., O.T.R.); Department of Physical Activity and Health, Paavo Nurmi Centre, Sports and Exercise Medicine Unit, Turku, Finland (K.P.); School of Health Sciences, University of Tampere, Tampere, Finland (J.N.); Department of Pediatrics, University of Tampere and Tampere University Hospital, Tampere, Finland (N.H.-K.); and Departments of Medicine (M. Juonala, J.V.) and Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, Finland.
authors.forename: Nina
authors.initials: N
authors.lastname: Hutri-Kähönen
authors.affiliation: From IBS, Unit of Personality, Work, and Health, Institute of Behavioural Sciences (L.P.-R., M.E., C.H., J.L., M.H., M. Jokela, T.H., A.S., L.K.-J.), Helsinki Collegium for Advanced Studies (L.P.-R.), and Department of Food and Environmental Sciences (V.M.), University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland (M.E.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K.); Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland (T.L., K.P., M Juonala, J.V., O.T.R.); Department of Physical Activity and Health, Paavo Nurmi Centre, Sports and Exercise Medicine Unit, Turku, Finland (K.P.); School of Health Sciences, University of Tampere, Tampere, Finland (J.N.); Department of Pediatrics, University of Tampere and Tampere University Hospital, Tampere, Finland (N.H.-K.); and Departments of Medicine (M. Juonala, J.V.) and Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, Finland.
authors.forename: Markus
authors.initials: M
authors.lastname: Juonala
authors.affiliation: From IBS, Unit of Personality, Work, and Health, Institute of Behavioural Sciences (L.P.-R., M.E., C.H., J.L., M.H., M. Jokela, T.H., A.S., L.K.-J.), Helsinki Collegium for Advanced Studies (L.P.-R.), and Department of Food and Environmental Sciences (V.M.), University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland (M.E.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K.); Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland (T.L., K.P., M Juonala, J.V., O.T.R.); Department of Physical Activity and Health, Paavo Nurmi Centre, Sports and Exercise Medicine Unit, Turku, Finland (K.P.); School of Health Sciences, University of Tampere, Tampere, Finland (J.N.); Department of Pediatrics, University of Tampere and Tampere University Hospital, Tampere, Finland (N.H.-K.); and Departments of Medicine (M. Juonala, J.V.) and Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, Finland.
authors.forename: Jorma
authors.initials: J
authors.lastname: Viikari
authors.affiliation: From IBS, Unit of Personality, Work, and Health, Institute of Behavioural Sciences (L.P.-R., M.E., C.H., J.L., M.H., M. Jokela, T.H., A.S., L.K.-J.), Helsinki Collegium for Advanced Studies (L.P.-R.), and Department of Food and Environmental Sciences (V.M.), University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland (M.E.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K.); Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland (T.L., K.P., M Juonala, J.V., O.T.R.); Department of Physical Activity and Health, Paavo Nurmi Centre, Sports and Exercise Medicine Unit, Turku, Finland (K.P.); School of Health Sciences, University of Tampere, Tampere, Finland (J.N.); Department of Pediatrics, University of Tampere and Tampere University Hospital, Tampere, Finland (N.H.-K.); and Departments of Medicine (M. Juonala, J.V.) and Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, Finland.
authors.forename: Olli T
authors.initials: OT
authors.lastname: Raitakari
authors.affiliation: From IBS, Unit of Personality, Work, and Health, Institute of Behavioural Sciences (L.P.-R., M.E., C.H., J.L., M.H., M. Jokela, T.H., A.S., L.K.-J.), Helsinki Collegium for Advanced Studies (L.P.-R.), and Department of Food and Environmental Sciences (V.M.), University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland (M.E.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (L.D.K.); Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland (T.L., K.P., M Juonala, J.V., O.T.R.); Department of Physical Activity and Health, Paavo Nurmi Centre, Sports and Exercise Medicine Unit, Turku, Finland (K.P.); School of Health Sciences, University of Tampere, Tampere, Finland (J.N.); Department of Pediatrics, University of Tampere and Tampere University Hospital, Tampere, Finland (N.H.-K.); and Departments of Medicine (M. Juonala, J.V.) and Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Turku, Finland.
authors.forename: Liisa
authors.initials: L
authors.lastname: Keltikangas-Järvinen
mesh_terms: D000293:Adolescent; D000328:Adult; D000572:American Heart Association; D002318:Cardiovascular Diseases / Q000191:economics / Q000453:epidemiology* / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D011584:Psychology; D011610:Psychosocial Deprivation; D012307:Risk Factors; D012944:Social Support; D012959:Socioeconomic Factors; D014481:United States
keywords: cardiovascular system; follow-up studies; prevention and control; psychology; stress, psychological