Sexual, physical abuse ups CVD risk for women

AHA Scientific Sessions 2011

ORLANDO, Fla. — Women who experienced repeated episodes of sexual abuse during childhood or adolescence appear to have a 56% greater risk for CVD. Further, severe physical abuse was also associated with a 46% increased risk for CV events, according to data presented here.

“We were aware of the very high prevalence of physical and sexual abuse of girls in the United States, and we were also aware of vast literature indicating an association between psychosocial stress and CV risk, which really makes abuse the elephant in the room that we’re failing to talk about,” Janet Rich-Edwards, ScD, MPH, associate professor in the department of medicine at Brigham and Women’s Hospital in Boston, told Cardiology Today. “We’ve also seen in earlier studies that women with a history of abuse were at an increased risk for hypertension and diabetes, particularly if that abuse occurred in childhood. Therefore, the natural next step was to look at CV events.”

Rich-Edwards and colleagues analyzed associations between child abuse and confirmed CV events, such as MI and stroke, from 1989 to 2007 using data from 67,102 women in the Nurses’ Health Study II. Overall, 9% reported severe physical abuse and 11% reported forced sexual activity during childhood or adolescence.

After adjusting for age, race/ethnicity, body type at age 5 years, parental education and family history, the HRs for CV events were 0.91 (95% CI, 0.7-1.17) for mild physical abuse; 1.02 (95% CI, 0.82-1.26) for moderate physical abuse; and 1.46 (95% CI, 1.11-1.92) for severe physical abuse compared with no abuse during childhood or adolescence. Severe abuse also appeared to be more strongly associated with stroke than with MI, the researchers found.

Compared with those who did not report sexual abuse, the HRs for CV events were 1.1 (95% CI, 0.88-1.35) for unwanted sexual touching; 1.56 (95% CI, 1.14-2.15) for one episode of forced sexual activity; and 1.56 (95% CI, 1.23-1.99) for repeated forced sex in childhood or adolescence, according to study results.

Data also showed that risk factors such as adult BMI, smoking, alcohol use, hypertension and diabetes accounted for 47% of the association between severe physical abuse and 38% of the association between forced sex and CVD.

“The primary message here is prevention,” Rich-Edwards said. “If we can identify the girls and young women who are being abused and help them avoid the traditional CV risk factors, such as smoking and weight gain in late adolescence — all things that we see among women with a history of abuse — then we would be way ahead of the game. We could probably knock out maybe even half of this risk associated with early abuse.”

This study’s findings, however, cannot just help with preventing abuse. Even as adults, women may benefit from physicians’ awareness of these issues, according to Rich-Edwards.

“If primary care physicians begin to ask these questions in their offices, explain that abuse is an incredibly widespread exposure and that emerging science indicates that it may have long-term health impact, then maybe we can get women to begin to talk about what their experiences [and how it is] impacting their health behavior.

“In addition, our data suggest that women with a history of abuse may be good candidates for early CV risk screening. As the science progresses, we will begin to understand the particular physiologic mechanisms that underlie early abuse and later CV risk. Then, maybe we will get new, tailored interventions,” she said.

Because the study primarily included white nurses, exploring the link between abuse and CVD in different socio-demographic groups would be beneficial, Rich-Edwards said. – by Melissa Foster

For more information:

• Rich-Edwards J. #16865. Presented at: American Heart Association Scientific Sessions 2011; Nov. 12-16, 2011; Orlando, Fla.

Disclosure: Dr. Rich-Edwards reports no relevant financial disclosures.

This is an important and timely area. What is clear is that the prevalence of childhood physical abuse and sexual abuse is higher than the public thinks. Because the CV risks associated with [abuse] are very high, it is time to address this in girls and young children.

– Donna Arnett, PhD

President-Elect, American Heart Association
Epidemiologist, School of Public Health
University of Alabama at Birmingham

Disclosure: Dr. Arnett reports no relevant financial disclosures.

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