Biological Indicators of Cardiovascular Health by Foster Care History in Adults

Introduction: Childhood adversity contributes to adult cardiovascular health disparities, but the cardiovascular health of foster care alumni, who experience unique compounded stressors such as attachment disruption and environmental upheaval, is understudied. In this study, biological cardiovascular health indicators were described among U.S. adults with and without a foster care placement history. Methods: Cross-sectional data from 4,625 adults (representing 17,226,361 U.S. adults) approaching and in early midlife (2016–2018) from The National Longitudinal Study of Adolescent to Adult Health were used. Biological indicators of cardiovascular health included BMI, blood lipids, blood glucose, and blood pressure, which were each scored on a standardized scale of 0–100, with higher scores indicating better cardiovascular health. An unweighted average of these standardized scores was also computed. Incorporating sampling weights, nationally representative estimates of cardiovascular health by foster care history were generated in 2024–2025. Results: There were 113 participants who reported a foster care placement history (1.8% [weighted]), representing 313,604 adults. Foster care alumni had poorer overall cardiovascular health scores (mean=61.8, 95% CI=56.6, 66.9) and blood pressure health scores (mean=48.7 [indicates hypertension], 95% CI=39.8, 57.5) than those without a foster care history (cardiovascular health: mean=70.2, 95% CI=69.1, 71.4; blood pressure: mean=61.6, 95% CI=59.9, 63.2). Notably, common protective factors (e.g., female sex, higher income) did not mitigate cardiovascular health risk in the foster care group. Conclusions: Childhood foster care placement is associated with poorer cardiovascular health, particularly hypertension, even in groups generally at lower risk. Research and clinical initiatives are needed to better understand and address cardiovascular health inequities and promote cardiovascular wellness in this population.