Association of Adverse Childhood Experiences With Cardiovascular Disease Later in Life

Abstract

xposure to adversity early in life has been linked to negative long-term health outcomes. The consequences in late life of these adverse childhood experiences (ACEs), which include different forms of abuse, household dysfunction, and neglect, are now recognized. 1,2 ACEs have been traditionally related to an increased risk of psychological disturbances and substance use disorders. 3 The landmark Adverse Childhood Experiences study, authored by Felitti and colleagues 2 20 years ago, was the first study to propose that ACEs are also associated with the development of chronic physical conditions in adulthood, including cardiovascular disease (CVD). Since then, multiple studies have shown that traumatic events in childhood are associated with an increased likelihood of developing risk factors for CVD (eg, obesity, smoking, hypertension, diabetes) as well as CVD during the lifetime. 4 Interventions that mitigate the negative consequences of ACEs or prevent their initial onset may reduce the incidence of CVD. This narrative review summarizes the current literature regarding the association of ACEs with CVD and discusses possible pathophysiological mechanisms along with management approaches. ACE DefinitionACEs encapsulate a broad spectrum of traumatic and distressing events that threaten a child's physical, familial, or social safety and security before the age of 18 years. 4 These events may include direct mistreatment and neglect, exposure to household dysfunction, physical or sexual abuse, or violence. There are several methods of assessing ACEs. The initial Adverse Childhood Experiences study 2 introduced a 10-category ACE questionnaire to identify abuse, household dysfunction, or neglect up to age 18 years that is still used in its original and expanded versions. 5 Recently, additional factors, such as bullying, economic hardship, and loss of or severe disease in close persons, have also been recognized as ACEs (Table ). 6 ACEs tend to occur in clusters, such that individuals who experience at least 1 ACE are more likely to experience others, putting them at an even higher risk of poor future health. 7 Multiple ACEs may suggest a chaotic family environment that places not only individuals at risk but also family members, eliciting a potentially vicious cycle of intergenerational risk. 8 IMPORTANCE Adverse childhood experiences (ACEs) are potentially harmful events that occur during childhood, spanning neglect, physical or sexual abuse, parental separation, or death, among others. At least 50% of the US adult population has experienced 1 or more ACEs before the age of 18 years, but in clinical practice, ACEs remain underrecognized. Adults who have experienced ACEs are at increased risk of developing health risk behaviors and, ultimately, cardiovascular disease (CVD). This review summarizes the evidence regarding the association of ACEs with CVD and the accompanying diagnostic and therapeutic approaches in the adult population.OBSERVATIONS ACEs are commonly classified into 3 domains: abuse (psychological, phys...

Adverse childhood experiences and adult cardiometabolic risk factors and disease outcomes: Cross-sectional, population-based study of adults in rural Uganda

“…A number of reasons may explain the null relationships between ACEs and adverse cardiometabolic and cardiovascular outcomes in this sample. First, our models may have excluded the role of protective factors that may buffer adults from the long-term cardiometabolic and cardiovascular effects of early trauma exposure, such as the positive effects of psychological resources [ 37 ], social support [ 38 ] and cultural integration [ 39 ]. Second, the psychological and physiological impacts of certain forms of childhood trauma do not necessarily have a deterministic effect on future elevated disease risk or adversely affect the stress physiological pathways understood to underlie these long-term effects.…”

Extracellular Vesicles in Premature Aging and Diseases in Adulthood Due to Developmental Exposures

“…Additionally, there is an increased risk of hypertension and obesity in children prenatally exposed to smoking [132], and secondhand smoking in childhood is also associated with subsequent obesity, dyslipidemia, and insulin resistance [133]. Similar outcomes have been attributed to adverse childhood events and maternal stress during pregnancy [134,135].…”

“…Another means by which prenatal and early life exposures may contribute to CVD in adulthood is by increasing the predisposition for additional contributory risk factors, such as obesity, insulin resistance, hypertension, abnormal cholesterol, and an increased risk for clotting [55,[132][133][134][135]. For example, impaired glucose homeostasis as well as dyslipidemia has been identified in adult animals prenatally exposed to ethanol [55].…”

The Interplay between Child Maltreatment and Stressful Life Events during Adulthood and Cardiovascular Problems—A Representative Study

“…Early life stress has been shown to affect long-term HPA axis functioning [20]. Consequently, cortisol metabolism [21] and autonomic, neuroendocrine, and inflammatory systems [22] are altered with potential long-term implications for hemodynamic and autonomic dysfunction [23]. This may be one explanation for why stress during childhood is associated with cardiovascular health impairments across the life span [22].…”

“…Consequently, cortisol metabolism [21] and autonomic, neuroendocrine, and inflammatory systems [22] are altered with potential long-term implications for hemodynamic and autonomic dysfunction [23]. This may be one explanation for why stress during childhood is associated with cardiovascular health impairments across the life span [22]. In a recent systematic review, CM was associated with cardiovascular diseases (myocardial infarction, stroke, ischemic heart disease, coronary heart disease) in 91.7% of the 24 included studies [24].…”