Abstract 17807: Gender Differences in the Association of Adverse Childhood Events with Cardiovascular Disease
Background: Prevention strategies of conventional cardiovascular disease (CVD) risk factors have largely focused on modification in the adult, however many of these processes have their origins in childhood and adolescence. It is postulated that early stressors such as adverse childhood experiences (ACE), including bad home environment, physical, emotional and sexual abuse, can lead to changes in adulthood that negatively impact behaviours throughout life and these processes may vary by gender.
Objectives: To determine: 1) the prevalence and socio-demographic characteristics of CVD, ACE and risk factors among a nationally represented population and 2) the association of ACE with CVD adjusted for behavioural and clinical risk factors.
Methods: The 2009 and 2011 BRFSS includes a nationally representative survey of participants ages 18-99 years that provided information on CVD, ACE, health behaviours and risk factors. We captured distributions via frequency and percentage counts and ACE categories as an ordinal variable of cumulative burden. Logistic regression models tested the association of ACE categories with CVD, adjusted for CVD risk factors in univariable and multivariable analyses, stratified by gender.
Results: Amongst 45,277 study participants, 12% reported CVD, 52% reported at least one ACE, 25% reported at least two ACE categories. Among ACE, women reported Bad home (39.4% vs. 34.5%) and Sexual abuse (15.4% vs. 6.5%) more often than men where Direct abuse was reported higher among men (35.0% vs. 32.4%). ACE burden was strongly associated with CVD in a dose-response relationship (p for trend <0.001) with more pronounced effects among women compared to men (i.e. 3 ACE OR=2.3 95%CI 2.0-2.7 vs. OR=1.5 95%C 1.2-1.9). Attenuation of ACE burden was low between univariable model compared to multivariable model adjusted for all CVD risk factors.
Conclusions: The prevalence of ACE in this nationally represented population is high and we found that the presence of even one ACE is strongly associated with CVD, independent of conventional CVD risk factors. While ACE in itself may be non-modifiable, future studies need to determine how to effectively implement prevention strategies among this high-risk group.
Author Disclosures: C. Kreatsoulas: None. E.W. Fleegler: None. S.V. Subramanian: None.
- © 2014 by American Heart Association, Inc.