Cardiovascular diseases (CVDs) are a significant public health concern and are a leading cause of mortality, representing 31% of all global deaths in 2017. These diseases often have their origins in childhood. Ample evidence suggests that exposure to childhood adversity, such as experiences of violence, parent imprisonment, household mental illness or substance use, has harmful effects on cardiovascular and other non-communicable diseases. Experiencing two or more adversities is associated with higher risk of cardiovascular disease in Europe and North America, respectively, corresponding to US$150 and US$164 billion in associated costs. Whilst there is evidence that adverse childhood experiences are associated with higher cardiovascular risk, whether socioeconomic inequalities in cardiovascular risk might be explained by childhood adversities. Understanding the extent to which adverse experiences in childhood could potentially explain socioeconomic inequities in CVD risk would help to inform the targeting of resources.

Further, the milieu of the family environment includes not just adverse experiences, however, but also positive experiences, which have been understudied. Positive experiences do not simply reflect the absence of risk factors, but instead are independent attributes or assets that enhance health and resilience over time. For example, the absence of abuse in the household does not necessary imply optimal parenting. The Health Outcomes from Positive Experiences (HOPE) is a complimentary framework to childhood adversity that organises positive childhood experiences into four broad categories: Being in nurturing, supportive relationships; Living, developing, playing, and learning in safe, stable, protective, and equitable environments; Having opportunities for constructive social engagement and to develop a sense of connectedness; and Learning social and emotional competencies.

Emerging evidence suggests that positive childhood experiences – variably defined – are associated with better adult cardiovascular health. These studies are suggestive that positive experiences in childhood also have relevance for cardiovascular health. To fully understand children’s experiences in the early years and how environments can be optimised to promote cardiovascular health in later life, however, we need to capture both adverse and positive experiences in childhood; otherwise, we just look at half the picture. For example, no previous studies have examined whether the effect of positive experiences was evident over and above that of adverse experiences in childhood. While adverse and positive experiences are not the inverse of one another, they are negatively correlated. Do positive experiences actually matter for cardiovascular health, or are they just a proxy indicator for the absence of adverse experiences? If they do matter, can they help to promote resilience in the presence of childhood adversity; that is, good health despite the presence of adversity?