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JAMA Pediatr. 2017 Aug 1;171(8):781-787. doi: 10.1001/jamapediatrics.2017.1085.

Association of Socioeconomic Status in Childhood With Left Ventricular Structure and Diastolic Function in Adulthood: The Cardiovascular Risk in Young Finns Study.

Author information

1
The Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.
2
Paavo Nurmi Centre, Sports, & Exercise Medicine Unit, Department of Physical Activity and Health, University of Turku, Turku, Finland.
3
Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
4
Department of Medicine and Division of Medicine, Turku University Hospital, Turku, Finland.
5
Department of Pediatrics, University of Tampere, Tampere University Hospital, Tampere, Finland.
6
Department of Clinical Physiology, University of Tampere, Tampere University Hospital, Tampere, Finland.
7
Department of Pediatric Cardiology, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland.
8
Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland.
9
Department of Pediatrics, Oulu University Hospital, PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland.
10
Helsinki Collegium for Advanced Studies, University of Helsinki, Helsinki, Finland.
11
Unit of Personality, Work, and Health, Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland.
12
Department of Clinical Physiology and Nuclear Medicine, University of Turku, Turku University Hospital, Turku, Finland.

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.

PMID:
28655058
PMCID:
PMC5710638
DOI:
10.1001/jamapediatrics.2017.1085
[Indexed for MEDLINE]
Free PMC Article

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