Abused or neglected children are more likely to develop heart disease as adults

Sep 22 2004

An abused or neglected child is much more likely to develop ischemic heart disease as an adult, according to a study published in Circulation: Journal of the American Heart Association.

The study is the first to suggest that ischemic heart disease in adulthood may be a possible long-term consequence of childhood trauma.

Adults who reported that they experienced emotional, physical or sexual abuse, emotional or physical neglect, or household dysfunction including incarceration, substance abuse, mental illness, or domestic violence had a 30 percent to 70 percent higher risk of developing ischemic heart disease than people who did not report these adverse childhood experiences (ACE). Of the 10 childhood experiences investigated, only marital discord – divorce or separation of parents – had no impact on heart disease risk.

Adults who reported seven or more types of adverse childhood experiences “were more than three times as likely as persons with no ACEs to report an ischemic heart disease,” said the study’s lead author Maxia Dong, M.D., Ph.D., a medical epidemiologist at the Centers for Disease Control and Prevention (CDC) in Atlanta.

As the number of ACEs increased so did the risk of heart disease, suggesting “a dose-response relationship,” she said. A stressful childhood also increased the likelihood of adult adverse risk behaviors such as smoking, drug abuse, and inactivity as well as a greater likelihood of diabetes, obesity and hypertension. Those adverse risk behaviors may also contribute to the increased risk of heart disease.

“Notably, the prevalence of depression and anger was increased two- to three-fold among people with four or more ACEs compared to those with no ACEs,” she said. “This was similar for diabetes and hypertension.”

The relationship between childhood trauma and heart disease is mediated substantially by both traditional and psychological factors. When traditional and psychological risk factors were included in the analysis, the influence of ACE weakened by 50 percent to 100 percent, yet “graded relation between the ACE score and the likelihood of ischemic heart disease remained significant.”

The study, a joint effort of Kaiser Permanente’s Health Appraisal Center in San Diego, Calif. and the CDC, used data collected between 1995 and 1997 in surveys of 9,367 women and 7,970 men who were members of the Kaiser health plan. Participants were average age 56, 75 percent were white; and 39 percent were college graduates. The questionnaire was mailed to plan members two weeks after their annual physical exams. The survey included detailed questions about childhood abuse, neglect and dysfunction as well as questions about adult health-related behaviors. A total of 10.6 percent of the participants had a history of heart disease, with the prevalence higher in men (11.3 percent) than women (9.9 percent), blacks (13 percent) and persons 65 or older (15 percent).

Dong said the study results suggest “child abuse and neglect are important risk factors for heart disease.”

Previous research found that multiple childhood traumas indicate “a disordered social environment, and stressful exposures that can negatively affect the developing brain as well as emotional and social well-being,” the researchers write. “The chain of events begins with childhood exposure to abuse, neglect and household dysfunction, which lead to development of unpleasant affective states, depression, anger/hostility, as a result of long-term effect of physiological response to stress. Attempts to cope with these stresses may also lead to the adoption of risk behaviors, such as smoking, overeating and physical inactivity.”

Dong said, “Only about half of the variance in ischemic heart disease can be explained by traditional risk factors such as smoking, diabetes and physical inactivity. We have to recognize adverse childhood experience as a very important component of adult health.

“We need to encourage physicians to include questions about childhood experience as part of any medical examination since these factors not only impact disease risk, but may also play a role in adult lifestyle. For example, a history of ACEs may make it more difficult to quit smoking.”