Childhood Abuse, Neglect May Be Linked to a Greater Incidence of Heart Disease

Childhood maltreatment—in the form of physical, sexual, and emotional abuse and emotional and physical neglect—was linked to a greater incidence of heart disease, both cardiovascular (CVD) and ischemic (IHD), among women and men in a recent UK study, according to results published online Monday in the journal Heart.

Most previous studies linking an adversity-filled childhood and adult-onset heart disease have relied upon self-reported data. The authors of the present study used medically verified cases. In addition to women, they sought a greater understanding of the link between childhood maltreatment and later heart disease in men. The mean (SD) age of the women was 55.5 (7.7) years, and the men, 56.6 (7.8) years.

“We set out to assess and compare associations between childhood maltreatment and cardiovascular disease in men and women in the UK as well as possible age differences and associations with early onset CVD,” the authors stated in a press release announcing their findings.

Following dissemination of an online mental health questionnaire to 157,311 persons in the UK Biobank that asked about physical, sexual, and emotional abuse, results showed that most respondents experienced childhood emotional neglect (22.5% overall), physical abuse (21.1% of men), or emotional abuse (17.9% of women). Women were also shown to have experienced 4 or more types of maltreatment compared with men, 4.6% vs 2.7%, as were those whose abuse happened at a younger age.

Overall, 54.3% of men and 40.3% of women who experienced childhood maltreatment developed some form of heart disease. There was a family history of CVD in 72.5% and 77.7%, respectively.

Additional study results show that the women had higher risks of hypertensive disease if they endured all forms of the maltreatment accounted for in the study and that among the men, emotional neglect was the only form of abuse not linked to a greater risk of cerebrovascular disease.

Also, there was a stronger association between physical abuse and development of adult-onset IHD in women (relative risk [RR], 1.48; 95% CI, 1.34-1.63) compared with men (RR, 1.20; 95% CI, 1.13-1.27; P < .001), and there was a greater link between emotional abuse and IHD in men aged 40 to 49 years (RR, 1.82; 95% CI, 1.41-2.36) vs age 50 to 59 years (RR, 1.18; 95% CI, 1.08-1.30).

An editorial on the study noted that “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.” These authors cited possible links between childhood maltreatment and risk of CVD due to unhealthy behaviors, increased physiological response, and socioeconomic status.

The authors highlight that widespread applicability of their findings may be difficult due to selection bias and that most study respondents were white, lived in better neighborhoods, and had lower overall disease rates than the general British population.

One of their suggestions to investigate their findings further is to study gene—environment interactions to see if there is variation in a genetic predisposition to CVD among men and women who suffered abuse and neglect as children. Additional studies could be carried out among those who have not experienced abuse to see if the links from the present study persist.

“To our knowledge, this is the largest study assessing the association between childhood maltreatment and CVD in both men and women and exploring different types of maltreatment and different types of CVD,” the authors conclude. “All types of maltreatment were associated with higher risk of CVD in both men and women.”

Reference

Soares ALG, Hammerton G, Howe LD, Rich-Edwards J, Halligan S, Fraser A. Sex differences in the association between childhood maltreatment and cardiovascular disease in the UK Biobank. Heart. Published online July 13, 2020. doi:10.1136/heartjnl-2019-316320