Canadian Journal of Cardiology
Systematic Review/Meta-analysis| Volume 33, ISSUE 2, P232-242, February 2017

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Associations Between Childhood Cognition and Cardiovascular Events in Adulthood: A Systematic Review and Meta-analysis

Published:August 29, 2016DOI:



      The success of behavioural interventions to optimize cardiovascular health is dependent on adequate cognitive functioning beginning in early life. In this study we aimed to systematically review studies that examined associations between childhood cognition and cardiovascular disease (CVD) events in adulthood.


      This study followed the Meta-analysis Of Observational Studies in Epidemiology guidelines to systematically examine associations between childhood cognition and adult CVD, coronary heart disease, and stroke hospitalization or mortality events. Literature was retrieved from EMBASE, MEDLINE, PsycInfo, and CINAHL.


      Five longitudinal studies that examined links between childhood cognition and CVD in adulthood were included. Pooled estimates of unadjusted CVD events indicated a relative risk of 1.23 (95% confidence interval, 1.12-1.34) per standard deviation decrease in childhood IQ, whereas the pooled estimate adjusted for biopsychosocial confounding factors indicated an overall relative risk of 1.16 (95% confidence interval, 1.07-1.26).


      Lower childhood IQ is associated with an increased risk of cardiovascular events in adulthood, even after adjustment for confounding variables. Future research should examine the behavioural mechanisms by which these risks are mediated to optimize cardiovascular health.



      Le succès des interventions comportementales sur l’optimisation de la santé cardiovasculaire dépend d’un fonctionnement cognitif adéquat dès les premières années de la vie. Dans la présente étude, nous avions pour objectif de réaliser une revue systématique des études qui ont examiné les associations entre la cognition infantile et les événements liés à la maladie cardiovasculaire (MCV) à l’âge adulte.


      Cette étude a suivi les lignes directrices de la MOOSE (Meta-analysis Of Observational Studies in Epidemiology, soit la méta-analyse d’études par observation en épidémiologie) pour examiner systématiquement les associations entre la cognition infantile et la MCV chez l’adulte, la coronaropathie, et l’hospitalisation à la suite d’un accident vasculaire cérébrale ou la mortalité. La littérature a été extraite d’EMBASE, de MEDLINE, de PsycINFO et de CINAHL.


      Cinq études longitudinales qui ont examiné les liens entre la cognition infantile et la maladie cardiovasculaire chez les adultes ont été incluses. Les estimations pondérées des événements non ajustés liés à la MCV ont indiqué un risque relatif de 1,23 (intervalle de confiance à 95 %, 1,12-1,34) par diminution de l’ÉT du QI durant l’enfance, tandis que l’estimation pondérée ajustée aux facteurs confusionnels biopsychosociaux a indiqué un risque relatif global de 1,16 (intervalle de confiance à 95 %, 1,07-1,26).


      Un QI plus faible durant l’enfance est associé à une augmentation du risque d’événements cardiovasculaires à l’âge adulte, même après l’ajustement des variables confusionnelles. Les recherches futures devraient examiner les mécanismes comportementaux par lesquels ces risques sont influencés pour optimiser la santé cardiovasculaire.
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        • Manuel D.G.
        • Tuna M.
        • Hennessy D.
        • et al.
        Projections of preventable risks for cardiovascular disease in Canada to 2021: a microsimulation modelling approach.
        CMAJ Open. 2014; 2: E94-E101
        • Public Health Agency of Canada
        Tracking Heart Disease and Stroke in Canada.
        (Ottawa)2009 (Available at:) (Accessed February 1, 2016)
        • Toback M.
        • Clark N.
        The association between cognitive impairment and unsuccessful self-management in patients with heart failure [abstract N046].
        Can J Cardiol. 2015; 31: S328-S329
        • Deary I.J.
        • Batty G.D.
        Cognitive epidemiology.
        J Epidemiol Community Health. 2007; 61: 378-384
        • Starr J.M.
        • Deary I.J.
        • Lemmon H.
        • Whalley L.J.
        Mental ability age 11 years and health status age 77 years.
        Age Ageing. 2000; 29: 523-528
        • Lawlor D.A.
        • David Batty G.
        • Clark H.
        • McIntyre S.
        • Leon D.A.
        Association of childhood intelligence with risk of coronary heart disease and stroke: findings from the Aberdeen Children of the 1950s cohort study.
        Eur J Epidemiol. 2008; 23: 695-706
        • Batty G.D.
        • Mortensen E.L.
        • Nybo Andersen A.M.
        • Osler M.
        Childhood intelligence in relation to adult coronary heart disease and stroke risk: evidence from a Danish birth cohort study.
        Paediatr Perinat Epidemiol. 2005; 19: 452-459
        • Batty G.D.
        • Deary I.J.
        • Macintyre S.
        Childhood IQ in relation to risk factors for premature mortality in middle-aged persons: the Aberdeen Children of the 1950s study.
        J Epidemiol Community Health. 2007; 61: 241-247
        • Hart C.L.
        • Taylor M.D.
        • Smith G.D.
        • et al.
        Childhood IQ and cardiovascular disease in adulthood: prospective observational study linking the Scottish Mental Survey 1932 and the Midspan studies.
        Soc Sci Med. 2004; 59: 2131-2138
        • Roberts B.A.
        • Batty G.D.
        • Gale C.R.
        • et al.
        IQ in childhood and atherosclerosis in middle-age: 40 year follow-up of the Newcastle Thousand Families cohort study.
        Atherosclerosis. 2013; 231: 234-237
        • Power C.
        • Jefferis B.J.
        • Manor O.
        Childhood cognition and risk factors for cardiovascular disease in midadulthood: the 1958 British birth cohort study.
        Am J Public Health. 2010; 100: 129-136
        • Conner M.
        Chapter 2: cognitive determinants of health behavior.
        in: Steptoe A. Handbook of Behavioral Medicine: Methods and Applications. Springer, New York2010: 19-31
        • Hatch S.L.
        • Jones P.B.
        • Kuh D.
        • et al.
        Childhood cognitive ability and adult mental health in the British 1946 Birth Cohort.
        Soc Sci Med. 2007; 64: 2285-2296
        • Hagger-Johnson G.
        • Mõttus R.
        • Craig L.
        • Starr J.
        • Deary I.
        Pathways from childhood intelligence and socioeconomic status to late-life cardiovascular disease risk.
        Health Psychol. 2012; 31: 403-412
        • Kilgour A.H.
        • Starr J.M.
        • Whalley L.J.
        Associations between childhood intelligence (IQ), adult morbidity and mortality.
        Maturitas. 2010; 65: 98-105
      1. The National Bureau of Economic Research. Meghir C, Palme M, Simeonova E. Education, Cognition and Health: Evidence From a Social Experiment. Report No. w19002. 2013. Available at: Accessed May 1, 2016.

        • Stroup D.F.
        • Berlin J.A.
        • Morton S.C.
        • et al.
        Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group.
        JAMA. 2000; 283: 2008-2012
        • Kaufman J.C.
        • Kaufman A.S.
        Time for the changing of the guard: a farewell to short forms of intelligence tests.
        J Psychoeduc Assess. 2001; 19: 245-267
        • Deary I.J.
        • Whalley L.J.
        • Lemmon H.
        • Crawford J.R.
        • Starr J.M.
        The stability of individual differences in mental ability from childhood to old age: follow-up of the 1932 Scottish Mental Survey.
        Intelligence. 2000; 28: 49-55
        • Birman-Deych E.
        • Waterman A.D.
        • Yan Y.
        • et al.
        Accuracy of ICD-9-CM codes for identifying cardiovascular and stroke risk factors.
        Med Care. 2005; 43: 480-485
      2. Wells GA, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses; 2000. Available at: Accessed January 20, 2015.

        • Meader N.
        • King K.
        • Llewellyn A.
        • et al.
        A checklist designed to aid consistency and reproducibility of GRADE assessments: development and pilot validation.
        Syst Rev. 2014; 3: 82
      3. Higgins JP, Green, S. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration. 2011. Available at: Accessed January 20, 2015.

        • Yaffe K.
        • Vittinghoff E.
        • Pletcher M.J.
        • et al.
        Early adult to midlife cardiovascular risk factors and cognitive function.
        Circulation. 2014; 129: 1560-1567
        • Khandaker G.M.
        • Barnett J.H.
        • White I.R.
        • Jones P.B.
        A quantitative meta-analysis of population-based studies of premorbid intelligence and schizophrenia.
        Schizophr Res. 2011; 132: 220-227
        • Hart C.L.
        • Taylor M.D.
        • Smith G.D.
        • et al.
        Childhood IQ, social class, deprivation, and their relationship with mortality and morbidity risk in later life: prospective observational study linking the Scottish Mental Survey 1932 and the Midspan studies.
        Psychosom Med. 2003; 65: 877-883
        • Osler M.
        • Andersen A.M.
        • Due P.
        • et al.
        Socioeconomic position in early life, birth weight, childhood cognitive function, and adult mortality. A longitudinal study of Danish men born in 1953.
        J Epidemiol Community Health. 2003; 57: 681-686
        • Starr J.M.
        • Taylor M.D.
        • Hart C.L.
        • et al.
        Childhood mental ability and blood pressure at midlife: linking the Scottish Mental Survey 1932 and the Midspan studies.
        J Hypertens. 2004; 22: 893-897
        • Deary I.J.
        • Whiteman M.C.
        • Starr J.M.
        • Whalley L.J.
        • Fox H.C.
        The impact of childhood intelligence on later life: following up the Scottish Mental Surveys of 1932 and 1947.
        J Pers Soc Psychol. 2004; 86: 130-147
        • Scottish Council for Research in Education
        The Intelligence of Scottish Children: A National Survey of an Age Group.
        University of London Press, London1933
        • Yu Z.B.
        • Han S.P.
        • Cao X.G.
        • Guo X.R.
        Intelligence in relation to obesity: a systematic review and meta-analysis.
        Obes Rev. 2010; 11: 656-670
        • Batty G.D.
        • Kivimäki M.
        • Deary I.J.
        Intelligence, education, and mortality.
        BMJ. 2010; 340: c563
        • Batty G.D.
        • Der G.
        • Macintyre S.
        • Deary I.J.
        Does IQ explain socioeconomic inequalities in health? Evidence from a population based cohort study in the west of Scotland.
        BMJ. 2006; 332: 580-584
        • Kickbusch I.S.
        Health literacy: addressing the health and education divide.
        Health Promot Int. 2001; 16: 289-297
        • Rosenstock I.M.
        • Strecher V.J.
        • Becker M.H.
        Social learning theory and the Health Belief Model.
        Health Educ Q. 1988; 15: 175-183
        • Kuh D.
        • Richards M.
        • Hardy R.
        • Butterworth S.
        • Wadsworth M.E.
        Childhood cognitive ability and deaths up until middle age: a post-war birth cohort study.
        Int J Epidemiol. 2004; 33: 408-413
        • Flynn J.R.
        What Is Intelligence? Beyond the Flynn Effect.
        Cambridge University Press, Cambridge2007
        • Hanscombe K.B.
        • Trzaskowski M.
        • Haworth C.M.
        • et al.
        Socioeconomic status (SES) and children's intelligence (IQ): In a UK-representative sample SES moderates the environmental, not genetic, effect on IQ.
        PLoS One. 2012; 7: e30320
        • Batty G.D.
        • Deary I.J.
        • Schoon I.
        • Gale C.R.
        Mental ability across childhood in relation to risk factors for premature mortality in adult life: the 1970 British Cohort Study.
        J Epidemiol Community Health. 2007; 61: 997-1003
        • Nowbar A.N.
        • Howard J.P.
        • Finegold J.A.
        • Asaria P.
        • Francis D.P.
        2014 Global geographic analysis of mortality from ischaemic heart disease by country, age and income: statistics from World Health Organisation and United Nations.
        Int J Cardiol. 2014; 174: 293-298