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Review
. 2022 Apr;24(4):253-264.
doi: 10.1007/s11883-022-00998-9. Epub 2022 Mar 23.

How to Mitigate Risk of Premature Cardiovascular Disease Among Children and Adolescents with Mental Health Conditions

Lulu Xu  1 , Martha Zimmermann  1 , Heather Forkey  2 , Jessica Griffin  1   2 , Caitlin Wilds  1   3 , Wynne S Morgan  1 , Nancy Byatt  1 , Catherine J McNeal  4
Affiliations
Review

How to Mitigate Risk of Premature Cardiovascular Disease Among Children and Adolescents with Mental Health Conditions

Lulu Xu et al. Curr Atheroscler Rep. 2022 Apr.

Abstract

Purpose of review: The goal of this article is to characterize the myriad of ways that children with mental health conditions can be at risk for premature cardiovascular disease (CVD) and various modalities to ameliorate this risk in childhood in order to improve the life course of these children.

Review findings: Child and adolescent mental health conditions are a common yet underrecognized risk factor for premature CVD. The American Heart Association has recently included psychiatric conditions as a CVD risk factor (CVDRF) and the evidence linking childhood adversity to cardiometabolic disease. There are bidirectional and additive effects from the intrinsic emotional dysregulation and inflammatory changes from the mental health condition, the associations with risky health behaviors, and in some cases, metabolic side effects from pharmacotherapy. These pathways can be potentiated by toxic stress, a physiologic response to stressors from childhood adversity. Toxic stress is also associated with development of mental health conditions with epigenetic effects that can result in transgenerational inheritance of cardiometabolic risk. Exposure to toxic stress and mental health conditions in isolation sometimes compounded by pharmacotherapies used in treatment increase the risk of cardiometabolic diseases in childhood. The multiple pathways, which adversely influence cardiometabolic outcomes, encourage clinicians to consider strategies to mitigate these factors and justify the importance of early screening and treatment for CVDRFs. Mental health, health behaviors, and environmental factors co-occur and intersect in complex pathways that can increase CVD risk over the lifespan. Early detection and response can mitigate the risks associated with premature development of CVD.

Keywords: Cardiometabolic; Cardiovascular disease; Mental health conditions; Pharmacotherapy; Toxic stress.

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Conflict of interest statement

Dr. Forkey reports book royalties from the American Academy of Pediatrics Press, outside the submitted work.

Dr. Griffin reports book royalties from the American Academy of Pediatrics Press, and personal fees from Consultant/National Trainer in TF-CBT, outside the submitted work.

Dr. Nancy Byatt has received salary and/or funding support from Massachusetts Department of Mental Health via the Massachusetts Child Psychiatry Access Program for Moms (MCPAP for Moms). She is also the statewide Medical Director of MCPAP for Moms and the Executive Director of Lifeline for Families. She has served on the Medscape Steering Committee on Clinical Advances in Postpartum Depression. She received honoraria from Global Learning Collaborative, Medscape, Miller Medical Communications, and Mathematica. She has served on Advisory Boards for Sage Therapeutics. She has also served as a consultant for The Kinetix Group, Ovia Health, Sage Therapeutics, or their agents, and has received speaking honoraria from Sage Therapeutics.

The other authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Overlapping pathways of mental health, health behaviors, and environmental factors that increase risk for CVD
See this image and copyright information in PMC

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