title: Positive childhood experiences and ideal cardiovascular health in midlife: Associations and mediators.
abstract: In 2010, the American Heart Association introduced a new conceptual framework to encourage a focus on primary prevention and provided a definition for "ideal cardiovascular health". In this study we examined the relationship between positive childhood experience and ideal cardiovascular health in mid-life, and the extent to which education, depression, and social support mediate this association. Data are from participants in the Midlife and Aging in the United States study who completed a clinic-based assessment of health (N=1255, aged 34-84years, 2004-2005). We created a positive childhood experiences index based on retrospective report of eight childhood experiences, and calculated a continuous ideal cardiovascular health score for each participant following the American Heart Association's definition of ideal, intermediate and poor cardiovascular health across seven health metrics (analyses conducted in 2015-2016). Positive childhood experiences were associated with ideal cardiovascular health: compared to individuals in the lowest quartile, respondents in the second, third, and fourth quartile of positive childhood experiences scored 0.42 (standard error (SE)=0.18), 0.92 (SE=0.18) and 1.04 (SE=0.18) units higher on ideal cardiovascular health, adjusting for age, sex, and race. Respondent's education, depression status, and social support fully mediated the direct effect of positive childhood experiences on ideal cardiovascular health, with the largest indirect effect for education. These results suggest that positive childhood experiences are associated with ideal cardiovascular health in midlife. Strategies to promote cardiovascular wellbeing may benefit from a focus on social interventions early in life; educational attainment, major depression, and social support may represent key points of intervention.
authors.affiliation: Department of Epidemiology and Biostatistics, University of Maryland, College Park, School of Public Health, United States. Electronic address: nslopen@umd.edu.
authors.forename: Natalie
authors.initials: N
authors.lastname: Slopen
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, United States.
authors.forename: Ying
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Epidemiology and Biostatistics, University of Maryland, College Park, School of Public Health, United States.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Guida
authors.affiliation: Division of Cardiovascular Medicine, Division of Cardiology, Department of Medicine, University of California, San Francisco, United States.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Albert
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, United States; Department of African and African American Studies, Harvard University, United States.
authors.forename: David R
authors.initials: DR
authors.lastname: Williams
mesh_terms: D000375:Aging / Q000523:psychology*; D002318:Cardiovascular Diseases / Q000517:prevention & control* / Q000523:psychology; D003863:Depression; D004522:Educational Status; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012944:Social Support; D011795:Surveys and Questionnaires; D014481:United States
keywords: Aging; Childhood factors; Epidemiology; Ideal cardiovascular health; Life course