Childhood abuse or neglect can elevate risk for CVD in adulthood
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Childhood physical, sexual or emotional abuse or emotional or physical neglect were each associated with greater risk for early-onset CVD and ischemic heart disease, researchers reported.
According to results published in Heart, these associations were consistently stronger among women and participants who were younger at baseline.
“The association between childhood maltreatment and CVD is well known, but most studies rely on individual’s report of CVD and very few studies have used medically confirmed cases and although this association might differ in men and women, this has not been explored,” Ana Luiza Goncalves Soares, BSc, MSc, senior research associate in the Bristol Population Health Science Institute at the University of Bristol Medical School, U.K., told Healio. “Our study shows that there is higher risk of CVD in both men and women who suffered maltreatment in early life (ie, physical abuse, sexual abuse, emotional abuse, physical neglect or emotional neglect), and that this risk is higher in women.”
For this analysis, investigators assessed 157,311 participants (mean age, 56 years) who completed a UK Biobank mental health questionnaire and answered at least one question about childhood maltreatment. Outcomes included development of CVD, hypertension, ischemic heart disease and cerebrovascular disease.
The most common form of childhood maltreatment was emotional neglect (22.5%), followed by physical abuse among men (21.1%) and emotional abuse among women (17.9%).
Childhood maltreatment and later CVD
The occurrence of any type of CVD was 54.3% among men and 40.3% among women. According to the study, all CVD types were more prevalent among men.
Researchers observed that all forms of childhood maltreatment conferred elevated risk for any CVD and ischemic heart disease among both men and women, even after adjustment for confounders.
Among women, all types of maltreatment conferred a higher risk for hypertension. All types were associated with greater risk for cerebrovascular disease, apart from emotional neglect (RR = 0.95; 95% CI, 0.77-1.17).
Moreover, the association between physical abuse and ischemic heart disease was greater among women (RR = 1.48; 95% CI, 1.34-1.63) compared with men (RR = 1.2; 95% CI, 1.13-1.27).
“Possible mechanisms include health-related behavioral factors (ie, smoking, overeating, physical inactivity), mental health (ie, depression, anxiety) and biological factors (ie, altered stress response, chronic inflammation and metabolic changes),” the researchers wrote. “These potential mediators are by no means mutually exclusive and may be part of the same pathways, for example, maltreatment causing depression, physical inactivity, greater adiposity and inflammation, resulting in CVD.”
After an age-stratified analysis, researchers found that the relationship between childhood maltreatment and any CVD or ischemic heart disease was stronger among younger men compared with older men. Men aged 40 to 49 years who experienced emotional abuse as a child had a greater risk for ischemic heart disease (RR = 1.82; 95% CI, 1.41-2.36) than men aged 50 to 59 years (RR = 1.43; 95% CI, 1.26-1.63) or men aged at least 60 years (RR = 1.18; 95% CI, 1.08-1.3).
“The risk might be particularly stronger for early-onset CVD (occurring before age 50 years), but this needs to be further explored in other studies,” Soares said in an interview. “Our results highlight the need for interventions to reduce the risk of cardiovascular disease associated with childhood maltreatment, especially in women.
“There is still need to understand when the cardiovascular consequences of childhood maltreatment start to emerge and how childhood maltreatment affects CVD risk later in life,” Soares told Healio. “Our future work will be to investigate these pathways to better understand how we might improve the health of people who have suffered maltreatment.
Findings may inform childhood intervention
“This current study adds important knowledge to the so-far limited literature on gender difference in the life course influence of childhood maltreatment on cardiometabolic health,” Leah Li, MS, BS, PhD, of the population, policy and practice research and teaching department at University College London Great Ormond Street Institute of Child Health, and Rebecca E. Lacey, PhD, of the department of epidemiology and public health at University College London, wrote in a related editorial. “If the association indeed differs by gender, it will be crucial to further explore the mechanisms and life course pathways that may contribute to the gender-specific associations and also the timing of their emergence. This may indicate the sensitive period during which intervention could lead to improvements in adult cardiometabolic health, especially for women.”
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For more information:
Ana Luiza Goncalves Soares, BSc, MSc, can be reached at analuiza.soares@bristol.ac.uk.
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