Stress, depression, and cardiovascular risk in children

The effective prevention of cardiovascular disease (CVD) lies with the identification and modification of risk markers known to be causally associated with clinical events of CVD - and the evidence would support the view that the earlier this can take place, the more effective CVD prevention will be. Thus, intervention programs targeting such things as diet and obesity, cigarette smoking, and sedentary physical behavior in children and adolescents have been reported in abundance in the public health literature. A host of risk markers for CVD is now well documented, and their predictive associations with clinical CVD are well established by epidemiological evidence. Among these, psychological risk markers, and in particular psychosocial stress and depression, have recently been prominent in the literature examining CVD risk in adults. It is now clear, however, that children experience both psychosocial stress and depression to a significant degree not really recognized prior to the past two decades. This chapter addresses both stress and depression in children, evident in a large epidemiological study (the LOOK study), which has allowed these psychological states to be related to behavioral, fitness, and metabolic risk markers for future CVD over a 4-year period. The evidence from the LOOK study links both stress and depression in young children (7-8 years old at intake) with fitness deficits 4 years later. It also links stress with unhealthy levels of insulin resistance over the same time course. Both these findings point to the need to address psychosocial stress and depression early in life - along with perhaps more traditionally recognized risk markers for CVD - in the overall public health effort to reduce the incidence of this chronic and potentially life-threatening clinical condition.