Childhood maltreatment tied to CVD, more so in women

Adults who suffered maltreatment during their childhood are more likely to develop cardiovascular disease (CVD), with stronger associations observed in women, a UK study has shown.

“This study contributes to the growing body of evidence demonstrating an association between childhood maltreatment and CVD. The magnitude of the associations with the different types* of CVD was similar across all the types of childhood maltreatment,” said the researchers.

After adjusting for potential confounders**, all types of maltreatment were associated with a greater risk of any CVD in women (adjusted risk ratios [adjRRs], 1.11, 1.07, 1.09, 1.08, and 1.07 for physical abuse, sexual abuse, emotional abuse, emotional neglect, and physical neglect, respectively). [Heart 2020;106:1310-1316]

While the CVD risks were similarly found in men who reported a history of maltreatment, the associations between childhood maltreatment and CVD outcomes were stronger among women, noted the researchers.

Specifically, for ischaemic heart disease (IHD), the risk was significantly higher among women vs men who reported physical abuse (adjRR, 1.48 vs 1.20) and emotional neglect (adjRR, 1.41 vs 1.18; p_{sex interaction}<0.001 for both).

“[These findings suggest that] individuals who suffered maltreatment in childhood have higher risk of CVD, especially women, and might benefit from early screening and interventions to prevent CV consequences,” they said.

Why women?

“Sex differences are evident in the hypothalamic-pituitary-adrenal axis dysregulation in response to stress, and women might be more vulnerable to the consequences of psychosocial stress, such as childhood maltreatment,” explained the researchers. [Front Neuroendocrinol 2014;35:285-302; Endocrinology 2017;158:4017-4037; Lancet 2009;373:68-81; Circulation 2018;137:E15-E28]

“Understanding such sex differences might help to identify sex-specific protective or maladaptive mechanisms by which childhood maltreatment might affect CVD [and] inform interventions to reduce the burden of CVD in those who suffered maltreatment,” they added.

Understanding underlying mechanisms

From the large UK Biobank (n=502,524), the researchers extracted data from 157,311 participants who responded to at least one question relating to childhood maltreatment. The most common type of childhood maltreatment reported was emotional neglect (22.5 percent), followed by physical abuse in men (21.1 percent) and emotional abuse in women (17.9 percent).

Despite the large sample size, the use of self-reported retrospective measures could have been influenced by recall bias and/or measurement errors, noted the researchers. Also, as the UK Biobank primarily includes healthy and less socio-economically deprived individuals, the odds of experiencing childhood maltreatment appear to be lower. [Am J Epidemiol 2017;186:1026-1034]

“[Nonetheless, the study calls for] interventions that ameliorate the negative effects of childhood maltreatment … as well as more understanding of the pathways*** that link childhood maltreatment to CVD and whether they differ by sex, types of maltreatment, and CVD types,” the researchers pointed out.

Looking into possible gene-environment interactions between CVD and childhood maltreatment would also help to establish the role of sex in this association and determine whether genetic heritability of CVD differs in individuals who did and did not suffer maltreatment, they added.