Child Abuse and Neglect and Subclinical Cardiovascular Disease Among Midlife Women

Abstract

Objective: A childhood history of abuse or neglect may be associated with elevated adult cardiovascular disease (CVD) risk. No studies have examined associations between child abuse/neglect and subclinical CVD using a validated measure of abuse and neglect. We hypothesized that midlife women with a history of childhood abuse or neglect would have increased subclinical CVD beyond standard CVD risk factors. We tested moderation of associations by sleep, hot flashes, and race/ethnicity.

Methods: Two hundred ninety-five midlife women completed the Child Trauma Questionnaire, physiologic hot flash and actigraphic sleep monitoring, blood draw, and carotid ultrasound (intima media thickness [IMT]; plaque). Relations between abuse/neglect and outcomes were tested in linear regression models adjusting for demographic, psychosocial, and CVD risk factors. Interactions with sleep, hot flashes, and race/ethnicity were tested.

Results: Forty-five percent of women reported a history of child abuse or neglect. Women with any child abuse or neglect had higher IMT [b(SE) = .039 (.011), p = .001] and carotid plaque [odds ratio (95% [CI] = 1.95 [1.15-3.33]); p = .014] than nonabused/neglected women. Furthermore, physical abuse, emotional abuse, and emotional neglect were associated with higher subclinical CVD. Sexual abuse was associated with higher IMT among nonwhite women. Interactions with sleep time and sleep hot flashes (p values < .05) indicated that higher subclinical CVD with an abuse/neglect history was observed primarily among women sleeping less than 6 hours/night or with sleep hot flashes.

Conclusions: A history of child abuse or neglect is associated with higher subclinical CVD in women, particularly when paired with short sleep or hot flashes. Findings underscore the importance of childhood adversity in midlife women's CVD risk.

Figure 1. Adjusted mean IMT by abuse or neglect history

*p<.05; **p<.01; Means adjusted for age, race, education, BMI, SBP, DBP, HOMA, LDL, HDL, triglycerides, shiftwork, medication use (BP-lowering, anti-diabetic, lipid-lowering, antidepressants, anxiolytics, sleep); Error bars represent standard errors

Figure 2. Adjusted mean IMT by abuse or neglect history and sleep time

*p<.05; **p<.001; ***p<.0001 relative to no abuse ≥6 hours sleep Means adjusted for age, race, education, BMI, SBP, DBP, HOMA, LDL, HDL, triglycerides, shiftwork, medication use (BP-lowering, anti-diabetic, lipid-lowering, antidepressants, anxiolytics, sleep); Error bars represent standard errors Subgroup sample sizes ranged from N=27 (<6 hours sleep/emotional abuse) to N=134 (≥6 hours sleep/no physical abuse). Please see Supplemental Digital Content 1 for sample sizes of each subgroup.

Figure 3. Adjusted mean IMT by abuse or neglect history and sleep hot flashes

*p<.05, **p<.01, ***p<.001, relative to no abuse/neglect sleep hot flashes Means adjusted for age, race, education, BMI, SBP, DBP, HOMA, LDL, HDL, triglycerides, shiftwork, medication use (BP-lowering, anti-diabetic, lipid-lowering, antidepressants, anxiolytics, sleep); Error bars represent standard errors Subgroup sample sizes ranged from N=22 (no sleep hot flashes/emotional neglect) to N=147 (sleep hot flashes/no emotional neglect). Please see Supplemental Digital Content for sample sizes of each subgroup.