Cardiovascular
Estimating the Causal Effects of Adolescent Health Behaviors on Future Cardiovascular Risk Prince Addo* Prince Nii Ossah Addo Addo Addo Addo Addo Addo College of Medicine, Florida State University
Background: While research indicates that poor sleep health, depressive symptoms, and substance use are each linked to poor cardiovascular health independently, their combined effects during adolescence on future cardiovascular disease (CVD) risk remain unclear. We aimed to study how the occurrence of these factors during adolescence influences subsequent CVD risk.
Methods: We performed a secondary analysis using Waves I, II, and IV of the Add Health dataset. The main exposure variable (sleep health) was calculated from three sleep factors, sleep duration, bedtime, and insomnia, measured at Wave I. Depressive symptoms were evaluated at Wave II with the Center for Epidemiological Studies Depression Scale (CES-D). A combined substance use measure was created based on self-reported smoking, binge drinking, and marijuana use at Wave II. The primary outcome variable was the 30-year Framingham CVD risk score, measured at Wave IV. Using marginal structural models, we estimated the controlled direct effect of adolescent sleep health on future cardiovascular disease, mediated through depressive symptoms and substance use during adolescence, while adjusting for potential confounders. Essentially, this analysis addressed: “What is the impact of poor adolescent sleep health on adult CVD risk if all participants were depressed or used substances versus if they were not?”
Results: Approximately 61% of study participants (n=1,942) experienced poor sleep health. The prevalence of depressive symptoms and substance use was 7.8% and 25%, respectively. Adolescents with poor sleep health who also used substances had a significantly higher CVD risk in adulthood (OR: 1.83, 95% CI: 1.28, 2.64) compared to those with poor sleep health who did not use substances.
Conclusion: Adolescents with poor sleep health who use substances are more likely to develop CVD in adulthood. Future initiatives should target adolescents with sleep problems and substance use to effectively lower CVD risk.