Adverse Childhood Experiences Associated With CVD Later in Life

Exposure to adverse childhood experiences (ACEs), such as different forms of abuse, household dysfunction, and neglect, have been linked to negative long-term health outcomes, including cardiovascular disease (CVD). A recent study published in JAMA Cardiology reviewed the available literature linking ACEs to CVD in order to determine possible pathophysiological mechanisms and potential management approaches.

ACEs were found to be quite prevalent. The authors discovered in one study that 52% of the more than 13,000 participants reported at least 1 ACE and 6.2% reported more than 4. The most common category was exposure to substance abuse in the household (25.6%), followed by sexual abuse (22.0%). In another study that looked at a more ethnically diverse population, 82.8% of the participants reported an ACE.

Additionally, in the Behavioral Risk Factor Surveillance System—a telephone survey conducted across 23 US states that surveyed 214,157 people—62% were shown to have experienced at least 1 ACE, and 16% had 4 or more ACEs. Participants who reported a lower socioeconomic status, lower education background, lack of employment, or a lesbian, gay, bisexual, transgender, or queer identity or who were of a racial/ethnic minority were considerably more likely to have been exposed to childhood adversity. Notably, this survey also discovered that among adult primary care patients with CVD or its risk factors (eg, obesity, smoking, hypertension, diabetes) the prevalence of at least 1 ACE was 61%.

Several of the studies reviewed by the authors investigated the association of ACEs with the onset of diabetes. In one study, participants who reported having experienced 4 or more ACEs was associated with an increased risk of diabetes (HR, 1.6; 95% CI, 1.0-2.5). Furthermore, a meta-analysis of 7 studies comprising 87,251 participants reported increased chances of adults with a history of ACEs developing diabetes (odds ratio [OR] 1.32; 95% CI, 1.16-1.51).

Likewise, the relationship between ACEs and obesity has been identified as quite strong. In one study, children aged 11 to 14 years, having experienced 4 or more ACEs was linked with increased body mass index (BMI), waist circumference, and clinical obesity. In another study, children who had experienced at least 2 ACEs were associated with a 40% increase in the odds of severe obesity, or having a BMI of 35 or greater (HR, 1.4; 95% CI, 1.1-1.9).

Although several of the studies reviewed identified an association of ACEs with the subsequent development of CVD later, it is also important to note the overlap between ACEs and other social determinants of health. ACEs are associated with poor food security, and adults who may have experienced them may live in neighborhoods exposed to higher levels of air pollution.

In one study, a trend was identified between a higher burden of ACEs and the incidence of cardiovascular events in 3646 young adults in the United States. Another study found that compared with individuals who reported no ACEs, individuals who experienced 4 or more had higher odds of sedentarism (OR, 1.25; 95% CI, 1.03-1.52), being overweight or obese (OR, 1.39; 95% CI, 1.13-1.71), diabetes (OR, 1.52; 95% CI, 1.23-1.89), smoking (OR, 2.82, 95% CI, 2.38-3.34), and CVD (OR, 2.07; 95% CI, 1.66-2.59).

Overall, ACEs are a well-established risk factor for the development of CVD and its causes. Screening for ACEs may raise awareness that these experiences might be relevant to a patient’s health and medical care. In patients already being treated for CVD and cardiovascular risk factors, reducing the ACE burden may assist in mitigating the effects of ACEs in adults.

Reference

Godoy LC, Frankfurter C, Cooper M, Lay C, Maunder R, Farkouh ME. Association of childhood experiences with cardiovascular disease later in life, a review. JAMA Cardiol. Published online December 2, 2020. doi:10.1001/jamacardio.2020.6050