Citation

Kreatsoulas C, Fleegler EW, Kubzansky LD, McGorrian CM, Subramanian SV. Am. J. Med. 2019; 132(5): 605-613.

Affiliation

Professor of Population Health and Geography, Harvard T.H. Chan School of Public Health, Department of Social and Behavioural Sciences, 677 Huntington Avenue, Kresge Building Rm 716, Boston, Massachusetts 02115.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.amjmed.2018.12.022

PMID

30639555

Abstract

INTRODUCTION: While cardiovascular disease is the leading cause of death, its determinants include unhealthy behaviours and clinical risk factors and are recognised as the "actual causes" of death. Risk likely accumulates over the life course and adverse childhood experiences may increase the risk of "actual causes" of death. To determine the prevalence and test the association of adverse childhood experiences among unhealthy behaviours and risk factors as a primordial risk factor among young adults.

METHODS: Data were extracted from the 2009&2011 Behavioural Risk Factor Surveillance System. Individuals 18-99 years provided complete information on adverse childhood experiences, health behaviours and risk factors. Adverse childhood experiences were categorized and evaluated as cumulative burden. Multivariable logistic models, including stratified analysis for young adults, tested the association of adverse childhood experiences burden with unhealthy behaviours and risk factors.

RESULTS: Among 45,482 study participants, 52% report one adverse childhood experiences and 25% report two adverse childhood experiences categories. Among total study population, 37% report violence/emotional abuse, 34% report neglect and 12% report sexual abuse. Even one adverse childhood experience is strongly associated with hypertension, dyslipidemia and diabetes, and while the association increases in a dose-response (p trend <0.001) for all, it is especially more pronounced among the younger adults with minimal attenuation of effects in the fully adjusted models.

CONCLUSION: The prevalence of adverse childhood experiences in this study population is high. Even one adverse childhood experience is strongly and independently associated with cardiovascular risk factors, with implications for primordial prevention. Future studies are needed to develop screening and treatment strategies targeted to this high-risk group, especially among young adults.

Copyright © 2019. Published by Elsevier Inc.

Language: en

Keywords

adverse childhood experiences/events; cardiovascular disease; diabetes; dyslipidemia; hypertension; life course; risk factor; young adults