Parents of Kids With Neurodevelopmental Disorders May Face Greater Heart Risk

Parents of kids with neurodevelopmental disorders may be at increased risk of cardiovascular disease, a national cohort study from Sweden suggested.

Compared with parents whose children didn’t have a neurodevelopmental disorder, those who did had an increased risk of any cardiovascular disease over a mean follow up of 16 years (hazard ratio [HR] 1.27, 95% CI 1.25-1.29 for mothers and HR 1.20, 95% CI 1.18-1.22 for fathers), reported Hui Wang, PhD, of the Karolinska Institutet in Stockholm, Sweden, and colleagues.

That risk rose with the number of affected children, with HRs among mothers of 1, 2, or 3 children at 1.22, 1.39, and 1.66, respectively, and among fathers 1.16, 1.33, and 1.50, they reported in JAMA Pediatrics.

Risk of any cardiovascular disease also tended to be higher if offspring had comorbid health conditions, they noted.

Also, associations with cardiovascular risk were observed for all 3 neurodevelopmental disorders — intellectual disability, autism spectrum disorder, and attention-deficit/hyperactivity disorder.

“Although the effect sizes were modest and the immediate clinical implications may be limited, the findings could still be relevant at the population level given the high prevalence of neurodevelopmental disorders,” Wang told MedPage Today in an email. “These results highlight the importance of considering the health and well-being of parents, in addition to the needs of the child.”

The study is an important reminder that caregivers must also focus on themselves, “because if we don’t take care of ourselves, then we can’t take better care of our loved ones,” Nishant Shah, MD, a cardiologist at Duke University Medical Center in Durham, North Carolina, who was not involved in the study, told MedPage Today.

Shah, who also is a member of the American College of Cardiology Prevention of Cardiovascular Disease Council, explained that parents of kids with neurodevelopmental disorders may not be able to exercise or focus on their diet as they would like, forget to take their own medications, or not regularly see their own primary care doctor or cardiologist.

Wang and colleagues wrote that chronic psychological stress, which is often observed among parents of kids with neurodevelopmental disorders, can kick off a “range of stress-mediated biological processes.” These processes can lead to higher levels of inflammatory cytokines as well as adverse cardiometabolic and hemostatic changes, they noted, “which over time may contribute to the development and progression of cardiovascular disease.” Furthermore, “shared heritable components can predispose individuals to both psychiatric disorders and cardiovascular disease.”

By specific type of cardiovascular disease, hazard ratios for mothers and fathers, respectively, were:

• Ischemic heart disease: 1.31 (1.24-1.39); 1.13 (1.08-1.17)
• Cerebrovascular disease: 1.27 (1.20-1.35); 1.13 (1.07-1.19)
• Heart failure: 1.28 (1.16-1.40); 1.04 (0.98-1.11)
• Hypertensive disease: 1.34 (1.31-1.38); 1.23 (1.21-1.26)
• Atrial fibrillation: 1.08 (1.01-1.16); 0.97 (0.93-1.02)
• Cardiomyopathy: 1.30 (1.14-1.48); 1.03 (0.92-1.15)
• Peripheral arterial disease: 1.36 (1.16-1.59); 0.96 (0.83-1.11)

Greater relative risk of parental cardiovascular disease among mothers more than fathers was consistent with previous findings that mothers “tend to experience a greater burden of physical and mental health challenges” when children have health issues, Wang and colleagues noted.

In sibling comparison analyses, adjusted hazard ratios remained consistent with those in the main analyses, suggesting the study’s findings “could not fully be explained by genetic or environmental factors,” they wrote.

The study sample included 1,180,457 mothers with a mean age of 49.3 years, and 882,619 fathers with a mean age of 51.2 years. A total of 196,840 mothers (16.7%) and 168,582 fathers (19.1%) were diagnosed with any cardiovascular disease during follow-up.

The researchers linked national registry data of parents in Sweden with at least 1 live singleton birth between January 1, 1987 and December 31, 2014. Parents were followed from the birth of their first child until first diagnosis of cardiovascular disease, death, emigration from Sweden, or December 31, 2023, whichever came first.

Limitations included that the findings may not be generalizable outside of Sweden and that there may have been some misclassification of neurodevelopmental disorders and cardiovascular disease. Also, “caution is needed when interpreting the potential mediating role of postexposure psychiatric disorders,” the researchers added.

Furthermore, potential confounders such as physical activity, sleep patterns, and diet, as well as socioeconomic characteristics, were only measured at baseline. Surveillance bias also was a potential concern.