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von Känel R, Princip M, Holzgang SA, Giannopoulos AA, Kaufmann PA, Buechel RR, Zuccarella-Hackl C, Pazhenkottil AP. Cross-sectional study on the impact of adverse childhood experiences on coronary flow reserve in male physicians with and without occupational burnout. J Psychosom Res 2024; 181:111672. [PMID: 38636300 DOI: 10.1016/j.jpsychores.2024.111672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/13/2024] [Accepted: 04/13/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE Physicians face documented challenges to their mental and physical well-being, particularly in the forms of occupational burnout and cardiovascular disease. This study examined the previously under-researched intersection of early life stressors, prolonged occupational stress, and cardiovascular health in physicians. METHODS Participants were 60 practicing male physicians, 30 with clinical burnout, defined by the Maslach Burnout Inventory, and 30 non-burnout controls. They completed the Adverse Childhood Experiences (ACE) Questionnaire asking about abuse, neglect and household dysfunctions before the age of 18, and the Perceived Stress Scale to rate thoughts and feelings about stress in the past month. Endothelium-independent (adenosine challenge) coronary flow reserve (CFR) and endothelium-dependent CFR (cold pressor test) were assessed by positron emission tomography-computed tomography. The segment stenosis score was determined by coronary computed tomography angiography. RESULTS Twenty-six (43%) participants reported at least one ACE and five (8%) reported ≥4 ACEs. A higher ACEs sum score was associated with lower endothelium-independent CFR (r partial (rp) = -0.347, p = .01) and endothelium-dependent CFR (rp = -0.278, p = .04), adjusting for age, body mass index, perceived stress and segment stenosis score. In exploratory analyses, participants with ≥4 ACEs had lower endothelium-independent CFR (rp = -0.419, p = .001) and endothelium-dependent CFR (rp = -0.278, p = .04), than those with <4 ACEs. Endothelium-dependent CFR was higher in physicians with burnout than in controls (rp = 0.277, p = .04). No significant interaction emerged between burnout and ACEs for CFR. CONCLUSION The findings suggest an independent association between ACEs and CFR in male physicians and emphasize the nuanced relationship between early life stressors, professional stress, and cardiovascular health.
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Affiliation(s)
- Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Mary Princip
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sarah A Holzgang
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andreas A Giannopoulos
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ronny R Buechel
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Claudia Zuccarella-Hackl
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Bremner JD, Piccinelli M, Garcia EV, Moncayo VM, Elon L, Nye JA, Cooke CD, Washington BP, Ortega RA, Desai SR, Okoh AK, Cheung B, Soyebo BO, Shallenberger LH, Raggi P, Shah AJ, Daaboul O, Jajeh MN, Ziegler C, Driggers EG, Murrah N, De Cecco CN, van Assen M, Krafty RT, Quyyumi AA, Vaccarino V. A Pilot Study of Neurobiological Mechanisms of Stress and Cardiovascular Risk. MEDICAL RESEARCH ARCHIVES 2023; 11:3787. [PMID: 37484871 PMCID: PMC10361343 DOI: 10.18103/mra.v11i4.3787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Objective Coronary heart disease is a leading cause of death and disability. Although psychological stress has been identified as an important potential contributor, mechanisms by which stress increases risk of heart disease and mortality are not fully understood. The purpose of this study was to assess mechanisms by which stress acts through the brain and heart to confer increased CHD risk. Methods Coronary Heart Disease patients (N=10) underwent cardiac imaging with [Tc-99m] sestamibi single photon emission tomography at rest and during a public speaking mental stress task. Patients returned for a second day and underwent positron emission tomography imaging of the brain, heart, bone marrow, aorta (indicating inflammation) and subcutaneous adipose tissue, after injection of [18F]2-fluoro-2-deoxyglucose for assessment of glucose uptake followed mental stress. Patients with (N=4) and without (N=6) mental stress-induced myocardial ischemia were compared for glucose uptake in brain, heart, adipose tissue and aorta with mental stress. Results Patients with mental stress-induced ischemia showed a pattern of increased uptake in the heart, medial prefrontal cortex, and adipose tissue with stress. In the heart disease group as a whole, activity increase with stress in the medial prefrontal brain and amygdala correlated with stress-induced increases in spleen (r=0.69, p=0.038; and r=0.69, p=0.04 respectfully). Stress-induced frontal lobe increased uptake correlated with stress-induced aorta uptake (r=0.71, p=0.016). Activity in insula and medial prefrontal cortex was correlated with post-stress activity in bone marrow and adipose tissue. Activity in other brain areas not implicated in stress did not show similar correlations. Increases in medial prefrontal activity with stress correlated with increased cardiac glucose uptake with stress, suggestive of myocardial ischemia (r=0.85, p=0.004). Conclusions These findings suggest a link between brain response to stress in key areas mediating emotion and peripheral organs involved in inflammation and hematopoietic activity, as well as myocardial ischemia, in Coronary Heart Disease patients.
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Affiliation(s)
- J. Douglas Bremner
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - Marina Piccinelli
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Ernest V. Garcia
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Valeria M. Moncayo
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Lisa Elon
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Jonathon A. Nye
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - C. David Cooke
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Brianna P. Washington
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Rebeca Alvarado Ortega
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Shivang R. Desai
- Department Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
| | - Alexis K. Okoh
- Department Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
| | - Brian Cheung
- Department Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
| | - Britt O. Soyebo
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | | | - Paolo Raggi
- Mazankowski Alberta Heart Institute and the Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Amit J. Shah
- Department Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
- Department of Epidemiology, Emory University, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - Obada Daaboul
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | | | - Carrie Ziegler
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | | | - Nancy Murrah
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Carlo N. De Cecco
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
- Department Biomedical Informatics, Emory University School of Medicine, Atlanta, GA
| | - Marly van Assen
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Robert T. Krafty
- Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Arshed A. Quyyumi
- Department Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
| | - Viola Vaccarino
- Department Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
- Department of Epidemiology, Emory University, Atlanta, GA, USA
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Jacquet-Smailovic M, Brennstuhl MJ, Tarquinio CL, Tarquinio C. Relationship Between Cumulative Adverse Childhood Experiences and Myocardial Infarction in Adulthood: a Systematic Review and Meta-analysis. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:701-714. [PMID: 35958714 PMCID: PMC9360358 DOI: 10.1007/s40653-021-00404-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/10/2021] [Indexed: 06/15/2023]
Abstract
The aim of this systematic review and meta-analysis was to estimate the relationship between cumulative adverse childhood experiences (ACEs) and myocardial infarction (MI) in adulthood and to examine the role of potential confounding factors that may have contributed to the association. Studies examining the association of cumulative ACEs with MI among adults were identified by searching PubMed/MEDLINE, PsycINFO, ScienceDirect, and ProQuest Dissertations and Thesis. Individual estimates of odds ratios were pooled using random effects meta-analysis. Articles were pooled separately according to whether findings were adjusted for sociodemographic factors, cardiovascular disease (CVD) risk factors, and psychological factors. Several moderators were also examined: age, gender, race/ethnicity, type of MI assessment, type of cumulative ACEs assessment, and quality assessment of included studies. A total of 10 eligible studies met our inclusion criteria. The pooled ORs for the magnitude of the relationship between ACEs and MI were OR = 1.88; 95% CI, 1.40-2.53, before adjustment for CVD risk factors, and OR = 1.78; 95% CI, 1.24-2.57, after adjustment for CVD risk factors. The association between ACEs and MI was OR = 2.09; 95% CI, 1.43-3.06, after further adjustment for psychological factors. Effect sizes were larger when studies included participants predominantly over 55 years of age than younger participants. Cumulative ACEs is associated with an increased risk of MI in adulthood. However, further prospective studies are needed to better understand potential moderators that attenuate or amplify observed relations. Supplementary Information The online version contains supplementary material available at 10.1007/s40653-021-00404-7.
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Affiliation(s)
- Murielle Jacquet-Smailovic
- Department of Health Psychology, University of Lorraine, APEMAC/EPSAM EA 4360, Île du Saulcy, 57000 Metz, France
- Centre Hospitalier d’Avesnes, Unité de Réadaptation Cardiaque Et Vasculaire, Route de Haut-Lieu, 59363 Avesnes-sur-Helpe, France
| | - Marie-Jo Brennstuhl
- Department of Health Psychology, University of Lorraine, APEMAC/EPSAM EA 4360, Île du Saulcy, 57000 Metz, France
| | - Camille Louise Tarquinio
- Department of Health Psychology, University of Lorraine, APEMAC/EPSAM EA 4360, Île du Saulcy, 57000 Metz, France
| | - Cyril Tarquinio
- Department of Health Psychology, University of Lorraine, APEMAC/EPSAM EA 4360, Île du Saulcy, 57000 Metz, France
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Engemann L, Aweimer A, Ewers A, Afshari F, Maiß C, Kern K, Lücke T, Mügge A, Brüne M. Altered Left Ventricular Myocardial Deformation in Young Women With Borderline Personality Disorder: An Echocardiographic Study. Psychosom Med 2022; 84:581-587. [PMID: 35412514 DOI: 10.1097/psy.0000000000001084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Borderline personality disorder (BPD) is characterized by intense mood swings, impulsivity, self-injurious behavior, poor anger control, fear of abandonment, and unstable interpersonal relationships. BPD is also associated with a heightened risk of cardiovascular disease, whereby the underlying mechanisms are insufficiently understood. Accordingly, the present study set out to examine whether individuals with BPD would show abnormal myocardial deformation and to explore the role of potential risk factors, including maladaptive stress responsivity, childhood trauma, and current stress exposure. METHODS Fifty female patients diagnosed with BPD and 50 controls matched for sex and age underwent echocardiography to determine the global longitudinal strain (GLS) of the left ventricle. In addition, childhood trauma, chronic stress, and "allostatic load" were determined, as well as borderline symptom severity and common risk factors for cardiovascular disease. RESULTS Aside from a significantly greater GLS in BPD patients, a multivariable regression analysis revealed that allostatic load (β = 0.225, p = .048) was significantly associated with GLS, with childhood trauma (β = 0.279, p = .062) approaching significance. Conversely, smoking (p = .867), chronic stress (p = .193), and borderline symptom severity (p = .342) were not associated with GLS, even though bivariate correlations were significant. CONCLUSIONS Somatically healthy women with BPD display subtle signs of increased GLS, which is associated with allostatic load as an indicator of the "wear-and-tear" of the body. The association between childhood trauma with GLS was of similar strength but did not reach the threshold for statistical significance. This finding may support the need for primary prevention of somatic consequences of maladaptive stress responsivity in psychiatric patients.
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Affiliation(s)
- Luisa Engemann
- From the LWL University Hospital Bochum, Department of Psychiatry, Psychotherapy and Preventive Medicine, Division of Social Neuropsychiatry and Evolutionary Medicine (Engemann, Maiß, Kern, Brüne); Bergmannsheil Bochum, Medical Clinic II, Department of Cardiology and Angiology (Aweimer, Ewers, Afshari, Mügge), and St. Josef-Hospital, University Hospital of Pediatrics and Adolescent Medicine, Department of Neuropediatrics and Social Pediatrics (Lücke), Ruhr University Bochum, Bochum, NRW, Germany
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Shah AJ, Weeks V, Lampert R, Bremner JD, Kutner M, Raggi P, Sun YV, Lewis TT, Levantsevych O, Kim YJ, Hammadah M, Alkhoder A, Wittbrodt M, Pearce BD, Ward L, Sheps D, Quyyumi AA, Vaccarino V. Early Life Trauma Is Associated With Increased Microvolt T-Wave Alternans During Mental Stress Challenge: A Substudy of Mental Stress Ischemia: Prognosis and Genetic Influences. J Am Heart Assoc 2022; 11:e021582. [PMID: 35167312 PMCID: PMC9075061 DOI: 10.1161/jaha.121.021582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Early life trauma has been associated with increased cardiovascular risk, but the arrhythmic implications are unclear. We hypothesized that in patients with coronary artery disease, early life trauma predicts increased arrhythmic risk during mental stress, measured by elevated microvolt T‐wave alternans (TWA), a measure of repolarization heterogeneity and sudden cardiac death risk. Methods and Results In a cohort with stable coronary artery disease (NCT04123197), we examined early life trauma with the Early Trauma Inventory Self Report‐Short Form. Participants underwent a laboratory‐based mental stress speech task with Holter monitoring, as well as a structured psychiatric interview. We measured TWA during rest, mental stress, and recovery with ambulatory electrocardiographic monitoring. We adjusted for sociodemographic factors, cardiac history, psychiatric comorbidity, and hemodynamic stress reactivity with multivariable linear regression models. We examined 320 participants with noise‐ and arrhythmia‐free ECGs. The mean (SD) age was 63.8 (8.7) years, 27% were women, and 27% reported significant childhood trauma (Early Trauma Inventory Self Report‐Short Form ≥10). High childhood trauma was associated with a multivariable‐adjusted 17% increase in TWA (P=0.04) during stress, and each unit increase in the Early Trauma Inventory Self Report‐Short Form total score was associated with a 1.7% higher stress TWA (P=0.02). The largest effect sizes were found with the emotional trauma subtype. Conclusions In a cohort with stable coronary artery disease, early life trauma, and in particular emotional trauma, is associated with increased TWA, a marker of increased arrhythmic risk, during mental stress. This association suggests that early trauma exposures may affect long‐term sudden cardiac death risk during emotional triggers, although more studies are warranted.
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Affiliation(s)
- Amit J Shah
- Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA.,Division of Cardiology Department of Medicine Emory University Atlanta GA.,Atlanta Veterans Affairs Healthcare System Decatur GA
| | | | - Rachel Lampert
- Division of Cardiology Department of Medicine Yale University School of Medicine New Haven CT
| | - J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences School of Medicine Emory University Atlanta GA.,Department of Psychiatry and Department of Radiology Emory University, School of MedicineEmory University Atlanta GA
| | - Michael Kutner
- Department of Biostatistics Rollins School of Public Health Emory University Atlanta GA
| | - Paolo Raggi
- Department of Medicine Mazankowski Alberta Heart InstituteUniversity of Alberta Edmonton Alberta Canada
| | - Yan V Sun
- Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Tené T Lewis
- Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Oleksiy Levantsevych
- Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Ye Ji Kim
- Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Muhammad Hammadah
- Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA.,Division of Cardiology Department of Medicine Emory University Atlanta GA
| | - Ayman Alkhoder
- Division of Cardiology Department of Medicine Emory University Atlanta GA
| | - Matthew Wittbrodt
- Department of Psychiatry and Behavioral Sciences School of Medicine Emory University Atlanta GA
| | - Brad D Pearce
- Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Laura Ward
- Department of Biostatistics Rollins School of Public Health Emory University Atlanta GA
| | - David Sheps
- Department of Epidemiology University of Florida Gainesville FL
| | - Arshed A Quyyumi
- Division of Cardiology Department of Medicine Emory University Atlanta GA
| | - Viola Vaccarino
- Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA.,Division of Cardiology Department of Medicine Emory University Atlanta GA
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Homocysteine as a potential indicator of endothelial dysfunction and cardiovascular risk in female patients with borderline personality disorder. Borderline Personal Disord Emot Dysregul 2022; 9:11. [PMID: 35255991 PMCID: PMC8900342 DOI: 10.1186/s40479-021-00171-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is increasing evidence suggesting that patients with Borderline Personality Disorder (BPD) are at greater risk of developing cardiovascular diseases (CVD) compared to the general population. Homocysteine (Hcy) has been discussed as a serum marker for endothelial dysfunction as a mechanism involved in CVD and has been shown to be associated with numerous psychiatric conditions. Pathophysiologically, there seems to be a link between Hcy and psychological stress mediated by abnormal activity of the autonomic nervous system. Accordingly, the present study sought to examine Hcy in BPD and to explore possible associations with clinical parameters. METHODS Plasma Hcy levels as well as conventional cardiovascular risk factors, such as blood pressure, BMI, smoking habits, HbA1c, HDL, LDL, and cholesterol, were examined in 49 young female in-patients diagnosed with BPD and 50 psychologically healthy control subjects matched for age and sex. Assessment of borderline symptom severity, childhood trauma, exposure to chronic stress, and quality of sleep was performed using self-reported questionnaires. RESULTS BPD patients showed significantly higher mean plasma Hcy concentrations compared to controls, though below ranges considered pathological. Moreover, Hcy correlated significantly with the severity of childhood trauma, chronic stress, and subjective sleep disturbances. In a regression model BPD diagnosis was found to predict Hcy levels best. CONCLUSION In conclusion, young female BPD patients with no history of CVD show higher, though non-pathological, Hcy levels compared to healthy controls. Our findings seem to support the assumption that BPD is associated with increased risk of CVD, and that Hcy could serve as potential marker for risk evaluation of midlife CVD in BPD patients.
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Traumatismes psychiques, trouble de stress posttraumatique et syndrome coronarien aigu : une synthèse des données de la littérature. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2020. [DOI: 10.1016/j.ejtd.2019.100123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Jakubowski KP, Cundiff JM, Matthews KA. Cumulative childhood adversity and adult cardiometabolic disease: A meta-analysis. Health Psychol 2018; 37:701-715. [PMID: 30024227 PMCID: PMC6109976 DOI: 10.1037/hea0000637] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Adverse childhood experiences may be associated with cardiometabolic morbidity and mortality in adulthood. There is heterogeneity in this literature regarding the type of items in cumulative adversity indices, sample sizes, demographics, and covariates. The present review used quantitative meta-analysis to examine this association and potential moderators. METHOD Included studies had a measure of cumulative adversity (an index of at least 2 adverse childhood experiences from age 0 to 18) and a measure of cardiometabolic disease: cardiovascular disease (CVD) clinical outcomes (hypertension, coronary heart disease, ischemic heart disease, myocardial infarction, stroke, cerebrovascular disease) and metabolic outcomes (diabetes, metabolic syndrome) at age 18 or older. Given different interpretations of odds ratios (OR) versus hazard ratios (HR), effects were pooled separately. Overall, 9 HR studies (15 effects) based on 179,612 participants and 29 OR studies (62 effects) based on 247,393 participants were included. RESULTS On the basis of retrospectively assessed adversity, combined studies showed a significant estimated effect of cumulative childhood adversity on adult cardiometabolic disease (HR = 1.42, 95% CI [1.20, 1.67]; OR = 1.36 [1.27, 1.46]). Results varied somewhat by type of cardiometabolic disease, analytic strategy, and number and type of covariates. CONCLUSIONS The literature suggests that cumulative childhood adversity is modestly related to adult cardiometabolic disease, with effects somewhat stronger for CVD clinical outcomes. The absence of a consistent operational and conceptual definition of adversity and paucity of prospective designs temper the conclusions. It is time for further evaluation of the types and timing of childhood events that have maximal impact on adult cardiometabolic disease. (PsycINFO Database Record
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Basu A, McLaughlin KA, Misra S, Koenen KC. Childhood Maltreatment and Health Impact: The Examples of Cardiovascular Disease and Type 2 Diabetes Mellitus in Adults. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2017; 24:125-139. [PMID: 28867878 DOI: 10.1111/cpsp.12191] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Child maltreatment is associated with increased risk for an array of mental and physical health problems. We reviewed studies examining associations of child maltreatment, assessed either alone or in combination with other adversities, with cardiovascular disease (CVD) and Type 2 Diabetes. PubMed was searched for relevant studies until December, 2015. Forty publications met inclusion criteria. Consistent positive associations were noted across a range of childhood adversities. Child maltreatment was associated with CVD (myocardial infarction, stroke, ischemic heart disease, coronary heart disease) in 91.7% of studies, with diabetes in 88.2% of studies, and with blood pressure/hypertension in 61.5% of studies. Inclusion of mental disorders tended to attenuate associations. Sex-related differences were under-examined. Implications for future research and intervention efforts are discussed.
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Affiliation(s)
- Archana Basu
- Harvard T. H. Chan School of Public Health, Massachusetts General Hospital
| | | | | | - Karestan C Koenen
- Harvard T. H. Chan School of Public Health, Massachusetts General Hospital
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