Adverse Childhood Experiences Are Associated with Cardiovascular Risk Factors and Cardiovascular Disease Among Adults: US 2019 BRFSS Data

Background

Adverse Childhood Experiences (ACEs) are potentially traumatic events occurring during childhood that may have long-term effects on health. Previous research suggests that ACEs may contribute to cardiovascular (CV) risk factors and cardiovascular disease later in life. This study assessed the association between ACEs and cardiovascular disease among adults in the United States and explored potential modifiable factors that may mediate this relationship.

Methods

We analyzed data from 62,503 adults aged 18–80 years who participated in the 2019 Behavioral Risk Factor Surveillance System (BRFSS). Cardiovascular disease was defined as a self-reported history of coronary artery disease, myocardial infarction, or stroke. ACEs included three measures of childhood abuse and five measures of household dysfunction, generating a cumulative score ranging from 0 to 8. Participants were categorized as having 0–1 ACEs or ≥2 ACEs (poly-ACEs). Weighted logistic regression models were used to assess the association between ACE exposure and cardiovascular disease while accounting for cardiovascular risk factors. Potential mediators of the association between ACEs and cardiovascular disease were also explored.

Results / Findings

Participants had a mean age of 50.3 years; 51.4% were female, 9.8% reported cardiovascular disease, and 42.6% reported ≥2 ACEs. Among individual ACEs, living with someone who had been incarcerated, experiencing sexual abuse, and living with a household member with mental illness were associated with higher odds of cardiovascular disease. In multivariable analyses, participants with ≥2 ACEs had significantly higher odds of cardiovascular disease compared with those reporting 0–1 ACEs (OR 1.18, 95% CI 1.08–1.28). Poor self-rated health, depression, and smoking showed the largest proportions of mediation in the relationship between ACE exposure and cardiovascular disease.

Discussion & Conclusion

Exposure to multiple ACEs was associated with increased odds of cardiovascular disease among U.S. adults. These findings support the potential long-term cardiovascular consequences of adverse experiences occurring early in life and highlight the importance of a life-course approach to cardiovascular health. Depression, smoking, and poor self-rated health may represent important pathways linking childhood adversity with cardiovascular disease. Clinicians assessing cardiovascular risk may benefit from considering the broader effects of childhood adversity while addressing modifiable factors, particularly smoking and depression.