Physical and Sexual Abuse in Childhood as Predictors of Early-Onset Cardiovascular Events in Women
ABSTRACT Although child abuse is widespread and has been associated with cardiovascular disease (CVD) risk factors, its association with CVD events is not established.
We examined associations of child abuse with CVD events among 66 798 women in the Nurses' Health Study 2. Proportional hazards models estimated hazard ratios and 95% confidence intervals (CIs) for myocardial infarction (n=262), stroke (n=251), and total CVD (n=513). Severe physical abuse was reported by 9% and forced sex by 11% of participants. After adjustment for age, race, childhood body type, parental education, and family CVD history, the hazard ratios for CVD events were 0.91 (95% CI, 0.70-1.17) 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. Compared with women without childhood sexual abuse, the hazard ratio was 1.10 (95% CI, 0.88-1.35) for unwanted sexual touching and 1.56 (95% CI, 1.23-1.99) for forced sex. After adjustment for adult lifestyle and medical risk factors, the hazard ratio for severe physical abuse was 1.13 (95% CI, 0.85-1.51) and that for forced sex was 1.25 (95% CI, 0.98-1.60); these intermediates accounted for much of the association of severe child abuse with CVD. Associations were similar for retrospectively and prospectively reported events. Women with abuse were less likely to release medical records. The associations were stronger for unconfirmed self-reported events than end points that were corroborated with additional information or medical record review.
Severe child abuse is a prevalent risk for early adult CVD that is partially mediated by preventable risk factors.
- [Show abstract] [Hide abstract]
ABSTRACT: Abuse in childhood and adolescence may affect risks of diabetes and cardiovascular disease later in life. Although mechanisms underlying these relationships are unclear, chronic stress may lead to dysregulation of immune function and chronic inflammation. To evaluate associations between early-life physical and sexual abuse and blood levels of inflammatory markers in adulthood among 702 members of the Nurses' Health Study II. Abuse in childhood (before age 11 years) and adolescence (ages 11-17 years) was self-reported in 2001. Plasma samples collected in 1996-1999 were assayed for C-reactive protein (CRP); interleukin (IL)-6; and the soluble fraction of tumor necrosis factor alpha receptor 2 in 2001, 2009, and 2010. Mean age at blood collection was 43.9 years. Moderate or severe physical abuse was reported by 35.3% of participants; 22.7% reported unwanted sexual touching and 9.8% reported forced sex. Plasma levels of CRP and IL-6 were higher in women reporting sexual abuse in adolescence compared to those reporting no abuse (p=0.04 and 0.03, respectively) in analyses adjusted for confounders including age and childhood adiposity. Inflammatory marker levels similarly were elevated in women reporting sexual abuse during childhood, but results were not significant. Relationships largely persisted after further adjustment for potential mediators such as adult BMI and smoking. Physical abuse during childhood and/or adolescence was not consistently associated with inflammatory marker levels. Chronic inflammation may be one mechanism through which sexual abuse may affect future risk of physical and psychological disorders.American journal of preventive medicine 12/2012; 43(6):611-20. DOI:10.1016/j.amepre.2012.08.014 · 4.53 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Objective: To determine whether greater childhood adversity relates to younger menarcheal age; whether younger menarcheal age relates to increased CVD risk; and whether greater childhood adversity relates to increased CVD risk, directly or indirectly (mediated by menarcheal age). Methods: Among 650 pre-menopausal women (ages 25-45; M=34.9[5.6]), SEM was performed to estimate relations between childhood adversity, menarcheal age, and CVD risk. Results: Results supported a covariate-adjusted model (RMSEA=0.035; CFI=0.983) in which greater childhood adversity was related to younger menarcheal age (β=-.13, p<.01) and younger menarcheal age was related to greater CVD risk (β=-.18, p<.05). Direct and indirect effects of childhood adversity on CVD risk were non-significant. Re-evaluation of the same model with additional covariate-adjustment for adulthood body composition showed the relation between menarcheal age and CVD risk attenuated (β=-.03, p=.376). Conclusions: Cross-sectional evidence suggests family-related adversity experiences in childhood confer risk for earlier menarche which, in turn, relates to increased CVD risk in adulthood, possibly via post-pubertal body size.Biological psychology 02/2013; 93(1). DOI:10.1016/j.biopsycho.2013.02.005 · 3.40 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Elevated inflammation biomarkers are associated with incident cardiovascular disease. Several studies suggest that childhood abuse may be associated with inflammation later in life. This study examined whether childhood abuse predicted elevated levels of C reactive protein (CRP) and whether the association was due to body size. Participants were 326 (104 Black, 222 White) women from the Pittsburgh site of the Study of Women's Health Across the Nation (SWAN). SWAN included a baseline assessment of premenopausal or early perimenopausal women in midlife (mean age = 45.7), and CRP, depressive symptoms, body mass index (BMI), and other covariates were measured over 7 annual follow-up visits. The Childhood Trauma Questionnaire, a standardized measure that retrospectively assesses abuse and neglect in childhood and adolescence, was administered at year 8 or 9 of follow-up. Approximately 37% of the participants reported a history of abuse or neglect. Generalized estimating equations showed that sexual and emotional abuse, emotional and physical neglect, and the total number of types of abuse were associated with higher CRP levels over 7 years, adjusting for race, age, education, smoking status, use of hormone therapy, depressive symptoms, occurrence of heart attack or stroke, and medications for hypertension. The coefficients for indirect effects for emotional and sexual abuse, physical neglect, and total number of types of abuse on CRP levels through BMI were significant. A history of emotional abuse and neglect was related to percent change in CRP over the 7 years but not through percent change in BMI over the 7 years. A history of childhood abuse and neglect retrospectively reported is related to overall elevated inflammation in mid-life women, perhaps through obesity. A history of some types of abuse and neglect (emotional) may be related to change in inflammation, independent of simultaneously measured change in BMI.Brain Behavior and Immunity 09/2013; 36. DOI:10.1016/j.bbi.2013.09.013 · 5.89 Impact Factor