标题：Association Between Childhood Socioeconomic Status and Coronary Heart Disease Risk Among Postmenopausal Women: Findings From the British Women's Heart and Health Study
摘要：Objectives . We assessed the association between childhood socioeconomic status (SES) and coronary heart disease among postmenopausal women. Methods . We conducted a cross-sectional analysis of 3444 women aged 60 to 79 years. Results . There was an independent linear association between childhood and adult SES and coronary heart disease. The association between childhood SES and coronary heart disease was attenuated when we adjusted for insulin resistance syndrome, adult smoking, physical activity, biomarkers of childhood nutrition, and passive smoking. Conclusions . The association between adverse childhood SES and coronary heart disease is in part mediated through insulin resistance, which may be influenced by poor childhood nutrition, and in part through the association between childhood SES and adult behavioral risk factors. Most, 1– 11 but not all, 12 studies that have assessed the association between childhood SES and adult coronary heart disease have found that adverse childhood SES is associated with increased risk of coronary heart disease and that this association is independent of adult SES. To develop effective policy interventions that abolish the link between childhood poverty and coronary heart disease, it is necessary to understand the causal pathways that link them. Adverse childhood SES may result in increased risk for coronary heart disease via an influence on known behavioral risk factors, such as smoking and poor diet. Childhood poverty may be associated with poor nutrition during the intrauterine period or childhood, which in turn may program insulin resistance and thus increase risk for coronary heart disease. 13, 14 Finally, childhood poverty may lead to psychological distress, via a programming effect on cortisol secretion, and consequently increase risk for coronary heart disease. 15, 16 These mechanisms are not necessarily mutually exclusive. We assessed the association between childhood SES and coronary heart disease among a large cohort of postmenopausal women. We also assessed the role of components of the insulin resistance syndrome, adult behavioral risk factors, adult biomarkers of specific childhood exposures, and indicators of psychological distress in these associations.
