Sexual assault, harassment may up hypertension risk in women

Experiencing sexual assault, sexual harassment at work, or both appear to increase a woman’s risk of developing hypertension over a long-term period, according to an analysis of the Nurses’ Health Study II.

“Our results showed that women who reported experiencing both sexual assault and workplace sexual harassment had the highest risk of hypertension, suggesting potential compounding effects of multiple sexual violence exposures on women’s cardiovascular (CV) health,” said study lead author Dr Rebecca Lawn from the Harvard T. H. Chan School of Public Health, Boston, Massachusetts, US.

The study population comprised 33,127 women aged 43–64 years enrolled in a 2008 substudy of the Nurses’ Health Study II (mean age 53.1 years at follow-up onset). The participants did not have hypertension (self-reported physician-diagnosed hypertension or use of antihypertensive medication) during the assessment for sexual assault or workplace sexual harassment conducted in 2008. Diagnosis of hypertension was assessed biennially until 2015. Women with pre-existing CV or cerebrovascular disease were excluded.

Lifetime history of sexual violence or exposure to other trauma was determined through the modified Brief Trauma Questionnaire. Twenty-three percent of women had experienced sexual assault in their lifetime and 12 percent workplace sexual harassment, with 6 percent having experienced both.

A total of 7,096 women (21 percent) developed hypertension during the 7-year follow-up period.

The risk of hypertension was greatest among women who experienced both sexual assault and workplace sexual harassment compared with those who had not experienced any type of trauma* (adjusted** hazard ratio [adjHR], 1.21, 95 percent confidence interval [CI], 1.09–1.35; p=0.0003). [J Am Heart Assoc 2022;11:e023015]

The risk of hypertension was still elevated among women who either experienced sexual assault (adjHR, 1.11, 95 percent CI, 1.03–1.19; p=0.004) or workplace sexual harassment (adjHR, 1.15, 95 percent CI, 1.05–1.25; p=0.001) compared with those with no exposure to trauma.

Additional adjustment for BMI, alcohol use, smoking status, physical activity, and diet quality attenuated the association between history of sexual assault and hypertension (HR, 1.06; p=0.12) but not between workplace sexual harassment (HR, 1.12; p=0.01) or both assault and harassment (HR, 1.17; p=0.004) and hypertension.

The results of the primary analysis were consistent (mildly attenuated) after additional adjustment for psychological distress (post-traumatic stress disorder and depression) and sociodemographic, childhood, and family factors.

“We did not find any association of increased risk for hypertension among women who had a history of other types of trauma and who did not experience sexual violence, suggesting that increased hypertension risk does not appear to be associated with all trauma exposure,” Lawn pointed out.

Sexual violence history: A key measure of CV health?

“We know that experiences of sexual violence in the form of sexual assault and workplace sexual harassment are common, and that women are disproportionately victims of such violence, with 13–44 percent of women reporting sexual assault and up to 80 percent of women reporting workplace sexual harassment,” said Lawn.

“However, exposure to sexual violence is not widely recognized as a contributor to women’s CV health. [Identifying the link between sexual violence and hypertension risk] could help in the early identification of factors that influence women’s long-term CV health,” Lawn said.

According to the authors, prior research has shown an association between sexual violence and psychological distress and between psychological distress and the risk of CV disease. “It is therefore likely that psychological distress lies on the sexual violence–hypertension pathway,” they said.

Nonetheless, this could not be examined in detail as timing between trauma and distress was unavailable. Other limitations included the observational study design, retrospective assessment of sexual violence which could have led to bias, self-report of hypertension, a largely Caucasian population comprising healthcare workers, and lack of information on timing and severity of sexual violence.

“These results suggest that screening for a broader range of experiences of sexual violence in routine healthcare, including sexual harassment in the workplace, as well as verbal harassment or assault, and being aware of and treating potential CV health consequences may be beneficial for women’s long-term health,” noted Lawn. “Reducing sexual violence against women, which is important in its own right, may also provide a strategy for improving women’s lifetime CV health.”