ADVERSE CHILDHOOD EVENTS INCREASE THE RISK OF BEHAVIOURAL AND CLINICAL CARDIOVASCULAR RISK FACTORS

Abstract

While cardiovascular disease (CVD) is the leading cause of mortality, the “actual” leading causes of death include behaviours such as smoking, poor diet and physical inactivity. Prevention focuses on the modification of these adult risk factors, however many of these processes have their origins in childhood and adolescence. It is postulated that adverse childhood experiences (ACE), which includes a negative home environment, physical, emotional and sexual abuse, can lead to stress-response changes that negatively impact behaviours throughout life. Objectives: To determine: 1) the prevalence and socio-demographic characteristics of ACE among a nationally represented population and 2) the association of ACE categories with behavioural and clinical risk factors. We used the 2009 and 2011 Behavioural Risk Factor Surveillance System, a nationally representative survey of participants ages 18-99 years. Data included individuals that provided information on ACE, health behaviours and CVD risk factors. We captured distributions via frequency and percentage counts and ACE categories as an ordinal variable of cumulative burden. Multivariable logistic regression models tested the association of the burden of ACE categories with outcome variables of behavioural and clinical risk factors. Amongst 45,644 study participants, 52% reported at least one ACE, 25% reported at least two ACE categories. Among the ACE, 37% reported a Bad home, 34% reported Direct abuse and 12% reported Sexual abuse. A strong association exists between even one ACE and the behavioural and clinical risk factors including obesity (OR=1.3 95%CI 1.2-1.4), physical inactivity (OR=1.1, 95%CI 1.0-1.1), heavy drinking (OR=1.3, 95%CI 1.2-1.5), current smoking (OR=1.7, 95%CI 1.6-1.8), hypertension (OR=1.1, 95%CI 1.1-1.2), dyslipidemia (OR=1.3, 95%CI 1.3-1.4) and diabetes (OR=1.2, 95%CI 1.1-1.3). Further, the number of ACE categories was strongly associated with each risk factor in a dose-response relationship (p for trend, all p<0.001). More than half of this nationally represented population experienced an adverse childhood event and we found that the presence of even one ACE is strongly associated with behavioural and clinical CVD risk factors, identifying key childhood risk factors that increase CVD risk factors. While ACE in itself may be non-modifiable, future studies need to determine how to effectively implement prevention strategies among this high-risk group.