OBJECTIVE: Adult survivors of congenital heart disease (CHD) have increased risk for cardiovascular complications, but few adults with CHD are in optimal cardiovascular health. Executive function deficits, which are elevated among CHD survivors, may contribute to engagement in behaviors that increase cardiovascular risk. The aim of the present study was to identify the association between executive function and (1) tobacco use, (2) saturated fat intake, and (3) moderate-to-strenuous physical activity among adults with CHD.

METHODS: Adults with CHD (N=137) completed the Behavior Rating Inventory of Executive Function – Adult Version (BRIEF-A). The BRIEF-A yields scores for nine domains of executive function (e.g., inhibition, working memory, emotional control), as well as an overall composite score. Participants also completed self-report measures of tobacco use, saturated fat intake, and moderate-to-strenuous physical activity. In separate analyses, tobacco use, saturated fat intake, and moderate-to-strenuous physical activity were regressed on domains of executive function. Demographic and clinical covariates included in the models were age, sex, race, income, functional status, and emotional distress.

RESULTS: Problems with overall executive function were associated with greater tobacco use (β=0.27, p=.018) and increased saturated fat intake (β=0.30, p=.012) but not moderate-to-strenuous physical activity (β=0.05, p=.463). With respect to individual domains of executive function, difficulties with inhibition (e.g., ability to resist impulses) were related to greater tobacco use (β=0.30, p=.002) and increased saturated fat intake (β=0.32, p=.002), and difficulties with self-monitoring (e.g., social and interpersonal awareness) were associated with greater tobacco use (β=0.23, p=.019).

CONCLUSIONS: Executive function problems are associated with self-reported engagement in health risk behaviors among adults with CHD. Future research should obtain objective measurements of executive function and health risk behaviors. Health behavior interventions for adult CHD survivors may require additional modifications that consider executive function problems, particularly difficulties with inhibition.