Early adversity is associated with a demand-dependent shift in cardiovascular regulation, with attenuated responses at low demand, but more dramatic increases in pulsatile and myocardial load responses during progressive physiological stress.
Key Findings
Results
Higher adverse childhood family environment (ACFE) exposure was associated with lower systolic blood pressure, heart rate, and rate pressure product at the lowest exercise workload.
SBP: β = -0.304 mmHg/ACFE, P = 0.033.
HR: β = -0.485 beats/min/ACFE, P < 0.001.
RPP: β = -83.404 beats/min·mmHg/ACFE, P = 0.002.
Sample was 3,417 young adults (mean age 25 ± 4 yr; 44% female; 46% Black) who completed graded exercise testing.
Models were adjusted for resting hemodynamics, age, sex, race, study center, BMI, antihypertensive medication, smoking, and alcohol.
Results
Higher ACFE exposure was associated with steeper workload-related increases in SBP, HR, RPP, pulse pressure, and pulse pressure index.
SBP interaction β = 0.044 mmHg/MET/ACFE, P = 0.029.
HR interaction β = 0.061 beats/min/MET/ACFE, P < 0.001.
RPP interaction β = 10.16 beats/min/mmHg/MET/ACFE, P = 0.025.
PP β = 0.052 mmHg/MET/ACFE, P = 0.038; PPI β = 0.000232 units/MET/ACFE, P = 0.018.
Linear mixed-effects models treated workload (METs) as a within-subject, intensity-varying predictor with participant-specific random intercepts and slopes.
Results
Predicted hemodynamic responses converged across ACFE levels at moderate-to-vigorous intensities, and above these workloads higher ACFE was associated with progressively greater responses.
Convergence occurred at 11.0 METs for SBP, 12.0 METs for HR, and 12.3 METs for RPP.
Beyond the convergence points, higher ACFE exposure was associated with progressively greater pulsatile and myocardial load responses.
Results
Sex and race generally did not moderate the associations between ACFE and exercise hemodynamic responses.
Moderation by sex and race was tested as a prespecified aim.
The abstract reports that sex and race 'generally did not moderate' the ACFE-hemodynamic associations.
Discussion
ACFE is associated with an intensity-dependent pattern of cardiovascular regulation, blunted at low workloads and exaggerated at higher intensities, that is not apparent at rest.
Associations were adjusted for resting hemodynamic values, so the differences reflect exercise-specific responses.
The authors interpret this as a latent phenotype of stress-responsive cardiovascular dysfunction that may be an early pathophysiological signature of lifetime cardiovascular risk.
The study is observational, so the findings are associations.
What This Means
This study looked at whether growing up in a difficult family environment is linked to how the heart and blood vessels respond to exercise in young adulthood. Researchers analyzed data from 3,417 young adults in the CARDIA study, who did graded exercise tests in which the workload gradually increased while blood pressure and heart rate were measured. Participants' childhood family adversity was also assessed.
People with more adverse childhood family environments had slightly lower blood pressure, heart rate, and heart workload at the easiest stage of exercise. As exercise got harder, however, their responses rose more steeply. At roughly moderate-to-vigorous intensities the predicted responses were similar across adversity levels, and at higher intensities those with more adversity showed greater increases in pulse pressure and in the heart's workload. These patterns were not clearly different between men and women or between Black and White participants, and they held after accounting for resting values and other factors such as BMI, smoking, and alcohol.
This research suggests that early-life adversity may be linked to subtle changes in cardiovascular regulation that do not show up at rest but appear under physical stress. The authors propose this could be an early sign of later cardiovascular risk. Because this is an observational study, it cannot show that childhood adversity causes these differences, and it does not by itself indicate any clinical action.
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Jenkins N, Robinson A, Hornikel B, Whitaker K, Jacobs D, Kershaw K, et al.. (2026). Adverse childhood family environment is associated with altered cardiovascular regulation during exercise: the CARDIA study.. American journal of physiology. Heart and circulatory physiology. https://doi.org/10.1152/ajpheart.90247.2026