How are adverse childhood events and less than ideal cardiovascular health in adulthood associated?

In a recent study published in Preventive Medicine, researchers evaluated associations between adverse childhood events (ACEs) and cardiovascular health (CVH).

Background

In the United States of America (USA), nearly 900,000 people die each year due to poor CVH. Accordingly, in 2010, the American Heart Association (AHA) promoted seven healthy behaviors, Life's Simple 7, to promote good CVH among US citizens. If adopted, these behaviors helped people maintain normal body weight, cholesterol, blood pressure, and blood glucose; however, they needed to consume a healthy diet, exercise regularly, and quit smoking.

Since its inception, multiple studies have explored the effect(s) of adoption or non-adoption of Life's Simple 7 on CVH among US population. A systematic review of prospective cohort studies by Fang et al. found that achieving an ideal CVH lowered the risk of all-cause and cardiovascular deaths. Likewise, another systematic review and meta-analysis highlighted the low level of ideal CVH (overall) in all 21 studies, highlighting the need for national-level efforts to improve this situation.

ACEs are traumatic events experienced by children/adolescents aged zero to 17, e.g., witnessing or experiencing violence. Being raised in a household with financial instability, mental health issues, drug abuse, and the death/separation of parents could also undermine a child’s sense of safety. Multiple studies have associated ACEs with a heightened risk of early death due to excessive smoking, drug and alcohol intake, obesity, and hypertension.

About the study

In the present study, researchers analyzed data from the 2019 telephonic survey, Behavioral Risk Factor Surveillance System (BRFSS), which interviewed all civilian US adults. This survey had a core component, state-added queries, and optional modules.

A total of 20 US states implemented the ACEs optional module in 2019 and received an average response rate of 51%. Thus, compared to other surveys, BRFSS fetched acceptable data for multiple chronic disease risk factors.

The team gave each participant a CVH score/rating of poor, intermediate, or ideal, ranging between zero and seven. In the primary analysis, the team compared poor and intermediate CVH scores (zero to two and three to five) to ideal scores (six to seven).

They categorized seven CVH metrics by various BRFSS questions using definitions based on the AHA standards. For instance, they considered a moderate-intensity aerobic exercise of at least 150 minutes/week or vigorous exercise of 75 minutes/week adequate.

Results

Survey respondents who completed the ACEs module ranged between 4,040 and 16,101 (average 7032). However, information on CVH status was available for 95,941 respondents. After excluding participants whose data was missing, the final study sample comprised 86,289 adults.

Nearly 51% of adult survey respondents were females, and based on age, 35.6%, 37.7%, and 21.2% of these adults were 18 to 44, 45 to 64, and 65 to 79 years old, respectively. The authors noted wide variation in the components of ACEs, with 19.3% of participants reporting four or more ACEs.

Despite extensive promotions to improve CVH by the AHA, the study results showed that one in nine adults had ideal CVH while one in six had poor CHV; however, the majority, i.e., 78.5%, reported having intermediate CVH. Also, the CVH estimates varied by the number of ACEs or adverse childhood experiences, highlighting the need to promote positive experiences during childhood and support programs for children experiencing adversity.

In an adjusted generalized logit model, those with one, two, three, and ≥4 ACEs were more prone to have poor CVH than those with zero ACEs. Similarly, people of advanced age were at a higher risk of poor CVH than those aged 18 to 44 years. Compared to White adults, Black adults reported experiencing four or more ACEs. Also, they were more prone to poor and intermediate CVH, highlighting the complexity of social interactions determining health.

Note that the Centers for Disease and Prevention (CDC) runs many programs and initiatives to prevent exposure to ACEs to address the long-term health impact of such events. They also offer economic support for families to ensure a good life for children. Remarkably, the Million Hearts®initiative, co-led by the CDC, tries to prevent one million heart attacks over five years to improve the cardiovascular health of children and adolescents.

Conclusions

Overall, the study results showed that having four or more ACEs increased the likelihood of poorer health and socioeconomic outcomes. An increase in ACEs score translated to more pronounced adverse effects on CVH. Thus, there is an urgent need for more research on ACEs screening, including the assessment of protocols for trauma-informed healthcare systems. Early guidance could help those who have experienced ACEs adopt healthy behaviors and improve CVH throughout their life course.

Written by

Neha Mathur

Neha is a digital marketing professional based in Gurugram, India. She has a Master’s degree from the University of Rajasthan with a specialization in Biotechnology in 2008. She has experience in pre-clinical research as part of her research project in The Department of Toxicology at the prestigious Central Drug Research Institute (CDRI), Lucknow, India. She also holds a certification in C++ programming.