Department of Psychiatry, UMass Chan Medical School, Worcester, MA, 01655, USA.
Department of Pediatrics, UMass Chan Medical School, Worcester, MA, 01655, USA.
Curr Atheroscler Rep. 2022 Apr;24(4):253-264. doi: 10.1007/s11883-022-00998-9. Epub 2022 Mar 23.
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.
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.
本文旨在描述儿童心理健康状况可能导致心血管疾病（CVD）过早发生的多种方式，以及在儿童时期改善这种风险的各种方法，以改善这些儿童的生命历程。
儿童和青少年的心理健康状况是导致 CVD 过早发生的常见但未被充分认识的危险因素。美国心脏协会最近将精神疾病列为 CVD 危险因素（CVDRF），并将儿童期逆境与心血管代谢疾病联系起来。心理健康状况本身的内在情绪失调和炎症变化、与危险健康行为的关联，以及在某些情况下，药物治疗的代谢副作用，这些途径具有双向和叠加效应。这些途径可能会因毒性应激而加剧，毒性应激是对儿童期逆境应激源的生理反应。毒性应激也与心理健康状况的发展有关，具有表观遗传效应，可能导致心血管代谢风险的代际遗传。接触毒性应激和心理健康状况（有时单独发生，有时因治疗而使用药物治疗）会增加儿童患心血管代谢疾病的风险。这些不利影响心血管代谢结果的多种途径促使临床医生考虑采取策略来减轻这些因素，并证明早期筛查和治疗 CVDRF 的重要性。心理健康、健康行为和环境因素共同存在，并以复杂的途径相互交叉，这些途径会随着寿命的延长增加 CVD 的风险。早期发现和响应可以减轻与 CVD 过早发生相关的风险。
