Table:

Early Life Adversity (ELA) and Cardiovascular Disease Disparities: Research Gaps and Research Recommendations

IDENTIFIED RESEARCH GAPS	RESEARCH RECOMMENDATIONS
Developmental Timing	Understand how ELA may differentially impact or imprint physiological systems at developmental time points, from the prenatal to late adulthood period, to influence CVD risk.
Interdisciplinary Approach	Engage interdisciplinary approaches to examine the impact of ELA across multiple, related biological systems (genomic, neuroendocrine, cardiovascular, etc.), rather than examining individual systems using a silo-based approach. Utilize an interdisciplinary approach that recognizes other SDoH factors (e.g., adverse physical environment) often co-occur with ELA exposure and can compound CVD risk.
Critical Populations	Examine differential ELA impact and intersectionality considerations for racial and ethnic minorities, sexual minorities, and children with special health care needs as these populations may experience multiple and chronic forms of ELA and differential risk due to social and structural conditions.
Inclusion of Resilience	Explore modifiable resilience factors in early life and investigate their impact on CVD. Examine psychological, behavioral, neurological, genetic, biochemical or physiological factors that characterize the resilience pathway among persons with ELA histories who do not develop CVD.
STUDY DESIGN CONSIDERATIONS
Prospective Cohort Studies	Design studies staring in pregnancy or infancy to understand mechanisms by which ELA impacts cardiovascular health across the lifecourse as well as understand risk and protective factors which may inform intervention starting earlier in the lifecourse.
Natural Experiments	Promote research studies that occur in traumatic and stressful environments settings, such as foster care, community-based resilience programs, home visiting programs, or after natural disasters as natural experiments for prospective data.
Intervention Studies	Encourage studies aimed at prevention or reducing the impact of ELA to examine their impact on cardiometabolic health and health behaviors.. Conduct intervention research studies on ELA that focus on multiple levels of analyses; i.e., individual or family levels, school/community levels, or at home.
Multi-level Studies	Consider study designs that capture cumulative risk across all levels of the ecosystem (interpersonal, familial, community, and structural exposures).