Childhood Trauma, Neglect Linked to Increased Risk of Cardiovascular Disease

Joseph Feinglass, PhD

While most ongoing research into the impact of mental stress focuses on current stress, a new analysis of the CARDIA study suggests a dysfunctional childhood could be linked to increased risk of cardiovascular disease 30 years later.

Results of the analysis indicate children who experienced childhood dysfunction, such as family dysfunction, abuse, and neglect, were more likely to experience cardiovascular disease and all-cause mortality, even after adjusting for risk factors.

"Early childhood experiences have a lasting effect on adult mental and physical well-being, and a large number of American kids continue to suffer abuse and dysfunction that will leave a toll of health and social functioning issues throughout their lives," said lead investigator Joseph Feinglass, PhD, a research professor of medicine and of preventive medicine at Northwestern University Feinberg School of Medicine, in a statement.

To learn more about the impact of an adverse childhood environment on the risk of cardiovascular disease through middle adulthood, Feinglass and colleagues designed a review to evaluate the topic using data from the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Briefly, CARDIA included more than 5000 patients aged 18-30 years at enrollment—for the current analysis, investigators focused on a cohort of patients that completed the Childhood Family Environment (CFE) questionnaire in year 15 of the study.

Using this and other inclusion criteria, investigators identified a cohort of 3646 participants for the current study. Additional inclusion criteria included complete information related to mortality, cardiovascular disease outcome, and not being pregnant at enrollment.

The CFE questionnaire used in CARDIA was an adapted version of the Adverse Childhood Experiences questionnaire called the Risky Families questionnaire. The questionnaire evaluated the presence of 7 factors: parental love and support, verbal abuse, physical affection, physical abuse, presence of alcohol/drug abuser in the home, how well‐organized and well‐managed a household was, and parental/guardian knowledge of what participant’s activities during childhood.

Of note, investigators grouped participants by the sum of questions to assess overall CFE adversity. Scores could range from a minimum of 0 to a maximum of 7—a score of 0-3 was classified as low, 2-3 was classified as moderate, and 4 or more was classified as high.

The mean age of participants included in the current analysis at enrollment was 25.1±3.6 years old, 47% were black, 56% were female, and the mean CFE adversity score was 1.7 (0.8). A total of 198 participants (17.9 per 10,000 person-years) would eventually develop cardiovascular disease during the follow-up period, which lasted a mean of 30.9 years.

Investigators pointed out a significant trend towards lower socioeconomic status, higher rates of smoking, lower systolic blood pressure, and higher rates of depressive symptoms was observed with individuals who had higher CFE adversity scores.

Based on the results of their analysis, investigators determined incidence of cardiovascular disease was greater among those with moderate (20.1 events per 10,000-person years) and high (22.2 events per 10,000 person-years) CFE adversity scores compared to those with low CFE adversity scores (14.7 per 10,000 person-years). Results of fully adjusted models indicated patients with high CFE adversity scores were at a 68% (aHR, 1.68; 95% CI, 1.17—2.41) increased risk of all-cause mortality and patients with moderate CFE adversity scores were at a 55% (aHR, 1.55; 95% CI, 1.11-2.17) increased risk.

This study, “Association of Childhood Psychosocial Environment With 30‐Year Cardiovascular Disease Incidence and Mortality in Middle Age,” was published in the Journal of the American Heart Association.