Trauma: An Independent Risk Factor for Cardiovascular Disease in Sexual Minority Women

According to several population-based studies, sexual minority women (those who are lesbian, gay, and bisexual) have higher rates of modifiable risk factors for cardiovascular disease—such as stress, tobacco use, heavy drinking, and obesity—compared to heterosexual women.

In a recent study presented at the American Heart Association (AHA) Scientific Sessions 2018, held November 10—12, 2018, in Chicago, Illinois, investigators shared data indicating that trauma is as an independent risk factor for cardiovascular disease in sexual minority women, suggesting it should be screened for as a cardiovascular disease risk factor.

“This study emerged from an interest in understanding potential factors that contribute to the excess cardiovascular disease risk observed in sexual minority women,” lead investigator Billy A. Caceres, PhD, RN, AGPCNP-BC, said in an interview with MD Magazine®.

Caceres went on to explain that although recent studies suggest interpersonal trauma, such as abuse and neglect, are associated with higher cardiovascular disease risk in the general population, few studies have examined the cardiovascular effects of interpersonal trauma in sexual minority women.

For the study, Caceres and his team analyzed data from the longest-running study of the sexual minority women’s health, Wave 3 of the Chicago Health and Life Experiences of Women study, on a traumatic stress model of cardiovascular disease.

Multiple logistic regression models were used to study the associations of different forms of trauma throughout the lifespan—childhood, adulthood, and lifetime. Psychosocial and behavioral risk factors for cardiovascular disease and self-reported obesity, hypertension, and diabetes in sexual minority women were adjusted for relevant covariates.

From the sample consisting of 547 sexual minority women, a probable diagnosis of posttraumatic stress disorder and lower perceived social support were associated with all forms of trauma.

Anxiety was associated with adult trauma (adjusted odds ratio [aOR] 1.30, 95% CI 1.05-1.60), while higher odds of depression were associated with other forms of trauma (childhood trauma aOR 1.41, 95% CI 1.11-1.81; lifetime trauma aOR 1.22, 95% CI 1.06-1.40). Childhood trauma was associated with higher odds of past-3-month overeating (aOR 1.44, 95% CI 1.07-1.92), and no significant associations between trauma and behavioral risk factors were noted.

Furthermore, childhood trauma was revealed as an independent risk factor for diabetes in logistic regression models (aOR 1.58, 95% CI=1.02-2.44).

According to the study authors, “adulthood and lifetime trauma were independently associated with obesity (adulthood trauma aOR 1.22, 95% CI 1.01-1.49; lifetime trauma aOR 1.16, 95% CI 1.01-1.33) and hypertension (adulthood trauma aOR 1.30, 95% CI 1.01-1.68; lifetime trauma aOR 1.22, 95% CI 1.01-1.46).”

“Among the most significant findings of this study was that different forms of trauma across the lifespan (childhood trauma, adulthood trauma, and lifetime trauma) were associated with cardiovascular disease risk,” Caceres said. “Among psychosocial risk factors, we found that childhood and lifetime trauma increased the risk for depression. All forms of trauma were associated with higher rates of probable diagnosis of post-traumatic stress disorder and lower rates of social support.

“We [also] identified that childhood trauma was linked with higher rates of diabetes,” Caceres continued. “Whereas adulthood and lifetime trauma were associated with higher rates of both obesity and hypertension even after accounting for traditional risk factors.”

From the results, the study authors concluded that an independent risk factor for cardiovascular disease in sexual minority women is trauma. Consequently, trauma as a cardiovascular disease risk factor should be screened for in sexual minority women by nurses and other clinicians.

Looking forward, Caceres outlined what he and his team plan to do with the data.

“Our next steps are to first, replicate these findings in other samples, specifically to compare the association of interpersonal trauma and cardiovascular disease risk between sexual minority and heterosexual women; second, examine these associations longitudinally to assess differences in the impact of recent and lifetime trauma on cardiovascular disease; and third, investigate whether the associations of interpersonal trauma observed with self-reported cardiovascular disease risk remain consistent with objectively measured obesity, hypertension, and diabetes.”