J Epidemiol Community Health doi:10.1136/jech-2012-201008
  • Research report

Childhood emotional functioning and the developmental origins of cardiovascular disease risk

  1. Laura D Kubzansky4
  1. 1Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
  2. 2Department of Epidemiology, Brown University, Providence, Rhode Island, USA
  3. 3Departments of Epidemiology and Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
  4. 4Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Dr Allison A Appleton, Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, HB 7927, Hanover, NH 03755, USA; Allison.A.Appleton{at}
  • Received 10 January 2012
  • Revised 13 November 2012
  • Accepted 7 December 2012
  • Published Online First 15 January 2013


Background Dysregulated emotional functioning has been linked with higher cardiovascular disease (CVD) risk among adults. Early life experiences may influence the development of adulthood CVD, but few studies have examined whether potential damaging effects of dysregulated emotional function begin earlier in life. Therefore, we examined associations of child emotional functioning and the 10-year risk of developing CVD in midlife.

Methods We studied 377 adult offspring (mean age=42.2) of Collaborative Perinatal Project participants, a US cohort of pregnant women enrolled in 1959–1966. Three measures of child emotional functioning derived from psychologist ratings of behaviour at 7 years of age were examined: distress proneness, attention and inappropriate self-regulation. Adulthood 10-year CVD risk was calculated with the validated Framingham general CVD risk algorithm. Gender-specific multiple regression models assessed associations of childhood emotion and adulthood CVD risk independent of covariates measured across the life course. Potential mediators of the associations were also examined.

Results Women had 31% higher CVD risk per SD increase in childhood distress proneness (p=0.03) and 8% reduced risk per SD increase in attention (p=0.09). For men, each SD increase in childhood distress proneness was associated with 17% higher CVD risk (p=0.02). Associations were partly explained by adulthood body mass index and depressive symptoms in women but not in men. Inappropriate self-regulation was not associated with CVD risk.

Conclusions Several aspects of childhood emotional functioning was associated with adulthood CVD risk, particularly for women. As such, primary prevention of CVD may be associated with addressing early life emotional functioning.

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