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Abstract
Social determinants of health (SDoH), factors related to the conditions in which people are born, live, work, play, age, and the systems that shape the conditions of daily life, have emerged as key drivers of health and health disparities.1,2 A strong body of research supports that SDoH are associated with cardiovascular risk factors and outcomes, independently or in conjunction with more traditionally recognized risk factors. As a result, efforts to improve cardiovascular health are predicated on improved understanding of the impact of SDoH on cardiovascular disease (CVD) over the life course. Early life adversity encompasses a variety of SDoH and has been recognized as a contributor to poor cardiometabolic health.3,4 Early life adversity and adverse childhood experiences are terms often used interchangeably. Early life adversity includes external stressors and experiences of child maltreatment, household dysfunction,5 bullying, exposure to crime, discrimination, bias, and victimization.6-8 These are highly prevalent (46% of children, ages 0-17 and 61% of adults are estimated to have experienced at least 1 early life adversity9) and disproportionately affect racial/ethnic minorities and families of lower socioeconomic status (SES).9 Early life adversity has been linked to an elevated risk of CVD outcomes in adults, including myocardial infarction, stroke, ischemic heart disease, and coronary heart disease, as well as type 2 diabetes mellitus.10-13 The 2018 American Heart Association Scientific Statement on Childhood and Adolescent Adversity and Cardiometabolic Outcomes highlighted 3 overall mechanisms of how early life adversity may impact cardiometabolic health, including behavioral, biological, and mental health pathways.14 These mechanisms have also been implicated in stress research and influence interrelated physiological systems (eg, neural, autonomic, neuroendocrine, immune responses) through different pathways (ie, direct biological pathways with feedback loops, gene-environment interactions, and indirect behavioral pathways).15 Dysregulation of these systems early in life can result in biological imprints and behavioral patterns that have lasting effects over the lifespan and may be passed on to the next generation.
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