While both sexes affected, women pay the higher price

Child abuse takes its toll on many levels — along with psychological sequelae, its aftereffects may also set the stage for cardiovascular disease (CVD), according to a recent observational study.

“All types of maltreatment were associated with higher risk of CVD in both men and women, with stronger associations in the latter and in younger participants, but some age differences disappeared when only early-onset CVD was considered,” wrote Ana Luiza Gonçalves Soares, BSc, a population health researcher with Bristol Medical School in the United Kingdom, and colleagues, in the BMJ journal Heart.

Previous data have shown childhood maltreatment — comprising physical abuse, sexual abuse, emotional abuse, emotional neglect, and physical neglect — to be associated with CVD, which includes myocardial infarction, stroke, ischemic heart disease, and coronary heart disease. According to Soares and colleagues, their study went a step further by exploring potential sex- or age-related associations between CVD and maltreatment.

“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,” Soares and colleagues wrote. “We use data from a large cohort in the U.K. to assess the association between childhood maltreatment and CVD, and to examine sex differences in this relationship. Given the wide age range of the participants (40-69 years at baseline) and the possibility of age differences in the associations, we also tested whether the associations were stable across different age groups.”

Soares and colleagues used data from 157,366 survey respondents who answered questions on a range of topics including childhood maltreatment. Emotional neglect was the most common type of maltreatment (22.5%) reported, followed by physical abuse in men (21.1%) and emotional abuse in women (17.9%).

Overall, women were more likely to experience childhood maltreatment than men, with all categories of maltreatment except physical abuse being more common in women. Further, 4.6% of women experienced 4 or more types of maltreatment compared with 2.7% of men. Younger study respondents, particularly women, reported experiencing a higher number of maltreatment types.

There were several direct connections between women who suffered maltreatment and specific CVD risk. For example, the association between physical abuse and ischemic heart disease was RR 1.48 (95% CI 1.34-1.63) for women and RR 1.20 (95% CI 1.13-1.27) for men (P<0.001).

Following age-stratified analysis, associations between CVD and childhood maltreatment were stronger in younger men versus older. For example, the RR for emotional abuse and ischemic heart disease was 1.82 (95% CI 1.41-2.36) in men 40-49 years of age, 1.43 (95% CI 1.26-1.63) in men 50-59 years of age, and 1.18 (95% CI 1.08-1.30) in men 60 years of age or older. When limited to early-onset CVD, stronger associations between the two emerged among men who suffered physical neglect and women who suffered physical or emotional neglect.

Study limitations identified by the authors included the possibility of selection bias because the cohort had a low response rate and does not represent the full UK population.

In an accompanying editorial, Leah Li, PhD, a policy and practice researcher, and Rebecca Lacey, PhD, an epidemiologist, both of University College London and neither of whom were affiliated with the study, wrote that the associations found in the study by Soares and colleagues — and other studies like it — could have several potential explanations.

“Several mechanisms by which child maltreatment confers risk for CVD later in life have been postulated,” Li and Lacey wrote. “First, maltreatment may lead to unhealthy behaviors, which impact on the risk of CVD. Second, the influence of maltreatment on mental health problems could link to CVD via increased physiological response to stressors or unhealthy behaviors. Third, maltreatment may influence adult socioeconomic position, which in turn affects adult cardiometabolic health. Fourth, childhood maltreatment is associated with dysregulation of biological stress response systems such as the hypothalamus-pituitary adrenal axis, and elevated inflammatory markers, which have been shown to link to CVD risk.”

Moving forward, Soares and colleagues suggested more study into potential factors, including age and sex, that might help better illuminate the link between maltreatment and CVD.

“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 CVD types,” Soares and colleagues wrote.

Li and Lacey wrote that the findings were a significant step forward and that a still-greater examination of “life course pathways” could help advance clinical knowledge of maltreatment’s downstream effects on cardiovascular health.

“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,” Li and Lacey wrote. “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.”

  1. All types of childhood maltreatment were associated with higher risk of CVD in both men and women, with stronger associations in the latter and in younger participants.

  2. Be aware that some age differences disappeared when only early-onset CVD was considered.

Scott Harris, Contributing Writer, BreakingMED™

No source appearing in this article disclosed any relevant financial relationships with industry.

Cat ID: 513

Topic ID: 85,513,285,730,914,513,192,925