Abuse and Heart Disease
Abuse and Heart Disease: Exposure to trauma and abuse leads to increased cardiovascular disease
Dr. Donna Zfat-Zwas
As we move to the next stages of the COVID-19 pandemic, we will need to assess the long-term effects of the pandemic on women’s health. One of the most frightening aspects of the lock downs and closures was the increase in reports of domestic violence and abuse. Exposure to trauma and abuse in childhood and in adulthood leads to increased cardiovascular disease down the road.
Studies of the effects of adverse childhood experiences, including physical, emotional and sexual abuse, have shown an increase in the risk of heart disease, stroke and early mortality. Some of this is mediated by risk factors, including smoking, alcohol and drug abuse, and depression, which are all more common in victims of abuse. Similarly, individuals who were abused, particularly sexually abused, are more like to be obese and/or diabetic. In addition, those who suffered from abuse are more likely to have problems maintaining gainful employment, which is yet another risk factor for heart disease. Women’s health, in particular, is likely to be adversely affected by low socio-economic status. All told, individuals who report sexual abuse as a child have a 40% increased risk of heart disease, victims of emotional abuse have a 50% increased risk and those who report sustained physical abuse have a 70% increased risk of heart disease.
The data in adults is less extensive. Studies in women who reported sexual abuse during service in the military found an increased risk of heart failure, stroke, obesity and chronic pain. A study of women in England compared more than 18,000 women who reported a history of sexual abuse to more than 70,000 who did not. Over just two years of follow-up, victims of abuse had a 40% higher risk of heart attack, a 29% increased risk of stroke, and a 30% increased risk of death. The nurses’ health study, which follows more than 60,000 nurses, has reported increased risk of diabetes, obesity and hypertension and markers of inflammation. It is often difficult to separate out those with the experience of abuse as an adult, as the leading risk factor for abuse as an adult is abuse as a child.
Analyses of outcomes in patients who reported abuse have found that ~60% of the increased risk is explained by the increased prevalence of risk factors in victims of abuse, such as smoking, obesity, hypertension and diabetes. But this certainly does not explain all the increased risk. Chronically increased levels of stress hormones may have long term adverse effects on the health of the arteries. Similarly, high levels of total-body inflammation seen in victims of abuse may also lead to acceleration of atherosclerosis of the vessels of the heart and brain, leading to heart attacks and strokes. Childhood exposure may be a more powerful harbinger of changes in inflammation. Recent studies looking at epigenetics, the study of how behaviors and experiences can cause changes that affect the way our genes work, may also shed light on how those who have experienced abuse may be more likely to develop heart disease.
By identifying women with a history of abuse and helping them address their risk factors for heart disease, we may be able to reduce their future risk. Increasing awareness can help us get the right treatment to the women who need it most.