Are adverse childhood experiences linked to ischemic heart disease in adulthood?

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The study assessed the relationship between adverse childhood experiences (ACEs)—including abuse, neglect, and household dysfunction—and the risk of ischemic heart disease (IHD). It also examined the mediating roles of traditional IHD risk factors and psychological factors associated with ACEs.

Researchers collected retrospective cohort survey data from 17,337 adult health plan members between 1995 and 1997. They used logistic regression adjusted for age, sex, race, and education to estimate the strength of the ACE–IHD relationship and the mediating impact of IHD risk factors.

Nine of 10 ACE categories were associated with a significantly higher IHD risk, 1.3 to 1.7 times that of people with no ACEs. For people with seven or more ACEs, the adjusted odds ratio for IHD was 3.6 (95% confidence interval: 2.4–5.3).

Individual psychological risk factors commonly associated with ACEs appeared to mediate the ACE–IHD relationship more strongly than traditional IHD risk factors. A higher likelihood of reported IHD was significantly associated with depressed affect (adjusted odds ratio 2.1; 95% confidence interval: 1.9–2.4) and anger (2.5; 2.1–3.0), as well as with traditional risk factors—smoking, physical inactivity, obesity, diabetes, and hypertension—for which odds ratios ranged from 1.2 to 2.7.

The researchers found a dose-response relationship between ACEs and IHD, as well as a relationship between almost all individual ACE categories and IHD. They concluded that psychological factors appeared more important than traditional risk factors in mediating the relationship. The findings offer insight into potential pathways by which stressful childhood experiences may increase IHD risk in adulthood.