Abstract 16865: Severe Physical and Sexual Abuse in Childhood and Adolescence Predicts Cardiovascular Events in Women

Abstract

Context: Although physical and sexual abuse of girls is widespread and has been associated with increased risks of obesity, hypertension, and diabetes, no study has investigated the extent to which early abuse increases risk of confirmed cardiovascular disease (CVD) events in women. Hypothesis: Child and adolescent abuse has a dose-response association with risk of CVD events. Design, Setting, and Participants: We examined associations of child and adolescent abuse reported in 2001 with confirmed CVD events from 1989-2007 among 67,102 women in the Nurses' Health Study II. Main Outcome Measures: Proportional hazards models were used to estimate hazard ratios and 95% confidence intervals for myocardial infarction (MI, n=263), stroke (n=251), and total CVD events (n=514). Results: Nine percent of participants reported severe physical abuse and 11% reported forced sex during childhood or adolescence. With adjustment for age, race, body type at age five, parental education and family history, the hazards ratio (HR) for cardiovascular events was 0.91 (95% confidence interval: 0.70-1.17) for mild physical abuse, 1.03 (0.83-1.27) for moderate physical abuse, and 1.45 (1.10-1.90) for severe physical abuse compared to no physical abuse in childhood or adolescence. Compared with women reporting no sexual abuse in childhood or adolescence, the HR was 1.10 (0.89-1.36) for unwanted sexual touching, 1.56 (1.14-2.15) for one episode of forced sexual activity, and 1.62 (1.17-2.22) for repeated forced sex in childhood or adolescence. Associations of severe abuse with stroke were somewhat stronger for stroke than for MI. Adult body mass index, smoking, alcohol use, hypertension, and diabetes accounted for 41% (21% - 66%) of the association of severe physical abuse and 37% (22% - 55%) of the association of forced sex with CVD events. Conclusions: Severe physical and sexual abuse in childhood and adolescence are prevalent risk factors for heightened CVD risk in adult women. Mild and moderate abuse were not associated with increased CVD risk. The excess risk associated with severe abuse is mediated by elevated adult CVD risk factors in women with a history of early abuse.