People who were abused or neglected as children at greater risk of heart disease, especially women: Study
Adults who experience various forms of maltreatment such as abuse and neglect in their childhood have a higher risk of cardiovascular disease. A team of international researchers has found that women especially are more likely to have heart disease following a childhood that involved ill-treatment, including physical abuse, sexual abuse or neglect.
In particular, the associations of physical abuse with ischemic heart disease (relative risk 1.48 for women versus 1.20 for men) and with any cardiovascular disease (1.14 versus 1.07), and emotional neglect with ischemic heart disease (1.41 versus 1.18) were significantly stronger in women. Ischemic Heart Disease (IHD) is characterized by reduced blood supply to the heart, which prevents the heart muscle from receiving enough oxygen. The team says individuals who suffer maltreatment in childhood might benefit from early screening and interventions to prevent cardiovascular consequences.
It includes experts from the University of Bristol, UK, Harvard Medical School, US, Harvard University T H Chan School of Public Health, US, University of Bath, Bath, UK, and University of Cape Town, Africa. "Childhood maltreatment was consistently associated with CVD and stronger associations were generally observed in women and seemed to be stronger for early-onset CVD," say researchers in their findings in the journal Heart, which is published by BMJ.
Childhood maltreatment is a preventable risk factor associated with a range of health outcomes. Previous studies have suggested that childhood maltreatment is associated with an increased risk for many adverse mental and physical health outcomes, including cardiovascular diseases (CVD) in adulthood. But most studies assessed self-reported CVD, and few have used medically verified cases and/or investigated different types of CVD. There is also little evidence of how the association between maltreatment in childhood and CVD differs by sex and age, write authors.
Accordingly, researchers led by Dr Ana Gonçalves Soares from the University of Bristol's Medical School examined and compared associations between childhood maltreatment and cardiovascular disease in men and women as well as possible age differences and associations with early-onset cardiovascular disease. The authors analyzed responses to an online mental health questionnaire completed by 157,311 participants from the UK Biobank, which is an international health database designed to improve the prevention, diagnosis, and treatment of a wide range of serious and life-threatening illnesses. The people selected had information on physical, sexual or emotional abuse, or emotional or physical neglect.
Cardiovascular disease outcomes — defined as any cardiovascular disease, hypertensive disease, ischemic heart disease, and cerebrovascular disease — were extracted from self-report, blood pressure measurements, hospital registers, and death registers. The researchers found that emotional neglect was the most common type of childhood maltreatment (22.5%), followed by physical abuse in men (21.1%) and emotional abuse in women (17.9%).
Analysis of the results showed that all types of maltreatment were associated with increased risk of cardiovascular disease and ischemic heart disease in both sexes. All forms of maltreatment were more prevalent in women except for physical abuse, which was more prevalent in men. Women were also more likely to experience a higher number of types of childhood maltreatment: 4.6% of women experienced four or more types of maltreatment, while 2.7% of men experienced the same number.
"In women, all types of maltreatment were associated with a greater risk of hypertensive disease, and all, except emotional neglect, were associated with a greater risk of cerebrovascular disease. In men, all types of maltreatment but sexual abuse were also associated with hypertensive disease and all, except physical and sexual abuse, were associated with a greater risk of cerebrovascular disease. Associations between childhood maltreatment and CVD outcomes were generally stronger in women. For instance, the association between physical abuse and IHD was 1.48 (risk ratio) in women and 1.20 (risk ratio) in men," the findings state.
The prevalence of childhood maltreatment decreased with increasing age, except for sexual abuse in men, which did not vary, and physical neglect, which increased across age categories. Younger participants also reported a higher number of maltreatment types, especially women. The occurrence of any CVD was 54.3% in men and 40.3% in women and all CVD types were more common in men.
When only medical records and measured blood pressure were considered, the occurrence of CVD was lower, but the same sex and age patterns were observed. "Interventions that ameliorate the negative effects of childhood maltreatment are needed, as well as more understanding of the pathways that link childhood maltreatment to CVD and whether they differ by sex, types of maltreatment, and cardiovascular disease types," says the team.
In an accompanying editorial, Dr Leah Li and Dr Rebecca Lacey from University College London, UK, say that the 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.
"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," write experts.