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. 2021 Mar 1;6(3):336-340.
doi: 10.1001/jamacardio.2020.5749.

Association of Early-Life Trauma and Risk of Adverse Cardiovascular Outcomes in Young and Middle-aged Individuals With a History of Myocardial Infarction

Zakaria Almuwaqqat  1   2 , Matthew Wittbrodt  3 , An Young  1   2 , Bruno B Lima  1 , Muhammad Hammadah  1 , Mariana Garcia  1   2 , Lisa Elon  4 , Bradley Pearce  2 , Yingtian Hu  4 , Samaah Sullivan  2 , Puja K Mehta  1 , Emily Driggers  2 , Ye Ji Kim  2 , Tene T Lewis  2 , Shakira F Suglia  2 , Amit J Shah  1   2   5 , J Douglas Bremner  3   5 , Arshed A Quyyumi  1 , Viola Vaccarino  1   2
Affiliations

Association of Early-Life Trauma and Risk of Adverse Cardiovascular Outcomes in Young and Middle-aged Individuals With a History of Myocardial Infarction

Zakaria Almuwaqqat et al. JAMA Cardiol. .

Abstract

Importance: Compared with older patients, young adults with a history of myocardial infarction (MI) tend to have a higher burden of psychosocial adversity. Exposure to early-life stressors may contribute to the risk of adverse outcomes in this patient population, potentially through inflammatory pathways.

Objective: To investigate the association of early-life trauma with adverse events and examine whether inflammation plays a role.

Design, setting, and participants: This cohort study included patients aged 18 to 60 years with a verified history of MI in the past 8 months from a university-affiliated hospital network. Baseline data were collected from June 2011 to March 2016, and follow-up data were obtained through July 2019. Analysis began September 2019.

Exposures: Early-life trauma was assessed using the Early Trauma Inventory-Self Report short form (ETI-SR-SF), both as a continuous and as a binary variable at the threshold of a score of 7 or higher. Inflammatory biomarkers, interleukin 6, and C-reactive protein were obtained at baseline.

Main outcomes and measures: A composite end point of recurrent MI, stroke, heart failure hospitalization, and cardiovascular death over a median 3-year follow-up.

Results: Of 300 patients, the mean (SD) age was 51 (7) years, 198 (66%) were African American, and 150 (50%) were women. Compared with participants with MI with an ETI-SR-SF score less than 7, those with a score of 7 or higher had higher levels of interleukin 6 and C-reactive protein at baseline. Compared with participants with an ETI-SR-SF score less than 7, those with a score of 7 or higher were at a greater risk for adverse outcomes, with a hazards ratio of 2.3 (95% CI, 1.3-3.9). Results remained consistent in multivariable analysis. Further adjustment for C-reactive protein rendered the results no longer statistically significant. Early-life trauma displayed a dose-dependent response when analyzed as a continuous variable and by quartiles.

Conclusions and relevance: Early-life trauma is an independent risk factor for adverse outcomes in young and middle-aged individuals with a history of MI. Neurobiological mechanisms leading to lifetime activation of systemic inflammatory cascades may be implicated.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure.
Figure.. Cardiovascular (CV) Outcomes Associated With Early-Life Trauma
A, Frequency of CV outcomes in participants with Early Trauma Inventory–Self Report short form (ETI-SR-SF) score less than 7 and 7 or more. P = .004 comparing the frequency of the composite end point between patients with ETI-SR-SF score less than 7 and those with ETI-SR-SF score of 7 or more. B, Kaplan-Meier survival curves for event-free survival after myocardial infarction by quartiles of ETI-SR-SF. Adverse CV events were defined as CV death, myocardial infarction (MI), stroke, or hospitalization for heart failure. P value from log-rank test = .001 (n = 297). HR indicates hazard ratio.
See this image and copyright information in PMC

References

    1. Suglia SF, Campo RA, Brown AGM, et al. . Social determinants of cardiovascular health: early life adversity as a contributor to disparities in cardiovascular diseases. J Pediatr. 2020;219:267-273. doi:10.1016/j.jpeds.2019.12.063 - DOI - PMC - PubMed
    1. Saleh A, Potter GG, McQuoid DR, et al. . Effects of early life stress on depression, cognitive performance and brain morphology. Psychol Med. 2017;47(1):171-181. doi:10.1017/S0033291716002403 - DOI - PMC - PubMed
    1. Danese A, Pariante CM, Caspi A, Taylor A, Poulton R. Childhood maltreatment predicts adult inflammation in a life-course study. Proc Natl Acad Sci U S A. 2007;104(4):1319-1324. doi:10.1073/pnas.0610362104 - DOI - PMC - PubMed
    1. Vaccarino V, Bremner JD. Behavioral, emotional and neurobiological determinants of coronary heart disease risk in women. Neurosci Biobehav Rev. 2017;74(pt B):297-309. doi:10.1016/j.neubiorev.2016.04.023 - DOI - PMC - PubMed
    1. Vaccarino V, Sullivan S, Hammadah M, et al. . Mental stress-induced-myocardial ischemia in young patients with recent myocardial infarction: sex differences and mechanisms. Circulation. 2018;137(8):794-805. doi:10.1161/CIRCULATIONAHA.117.030849 - DOI - PMC - PubMed