The Interplay between Child Maltreatment and Stressful Life Events during Adulthood and Cardiovascular Problems-A Representative Study.

Vera Clemens,Jörg M Fegert,Markus Huber-Lang,David Bürgin,Elmar Brähler,Paul L Plener

doi:10.3390/jcm10173937

Abstract

Psychological stress is a major risk factor for cardiovascular diseases. While the relevance of early life stress, such as that which is due to child maltreatment (CM), is well known to impact individual stress responses in the long-term, and data on the interplay between CM and stressful events in adulthood on cardiovascular health are sparse. Here, we aimed to assess how stressful life events in adulthood are associated with cardiovascular health infarction in later life and whether this association is independent of CM. In a cross-sectional design, a probability sample of the German population above the age of 14 was drawn using different sampling steps. The final sample included 2510 persons (53.3% women, mean age: 48.4 years). Participants were asked about sociodemographic factors, adult life events, CM, and health conditions in adulthood. Results indicate that the number of experienced adverse life events in adulthood is associated with significantly increased odds for obesity (Odds Ration (OR)women = 1.6 [1.3; 2.0], ORmen = 1.4 [1.1; 1.9]), diabetes (ORwomen = 1.5 [1.1; 2.1], ORmen = 1.5 [1.1; 2.3]) and myocardial infarction (ORwomen = 2.1 [1.0; 4.3], ORmen = 1.8 [1.1; 2.8]). This association is not moderated by the experience of CM, which is associated with cardiovascular problems independently. Taken together, adult stressful life events and CM are significantly and independently associated with cardiovascular health in men and women in the German population in a dose-dependent manner. General practitioners, cardiologists and health policy-makers should be aware of this association between psychosocial stressors during childhood and adulthood and cardiovascular health.

Highlights

Psychological stress is a major risk factor for cardiovascular diseases [1]
In a representative sample of the German population, we have shown that the risk for obesity, diabetes, hypertension, and myocardial infarction is associated with each single subtype of child maltreatment (CM) and that growing intensity of each CM subtype is associated with higher rates of these conditions [15]
In the second step of our study, we aimed to assess whether the association between adult stressful life events and later cardiovascular health is independent of CM

Summary

Introduction

Psychological stress is a major risk factor for cardiovascular diseases [1]. Stress leads to an activation of the hypothalamus, and, to the activation of the two main stress systems of the human body: the hypothalamic–pituitary–adrenal (HPA)axis and the sympathetic nervous system (SNS). HPA axis activation results in cortisol secretion in the adrenal cortex and increased intravascular volume and reduced inflammation, while the SNS leads to secretion of catecholamines in the adrenal medullar with consecutive increased heart rate, cytokines and reduced heart rate variability. Both HPA axis and SNS activation can lead to insulin resistance, increased blood pressure and increased coagulation [2]. There are numerous publications including cohort studies, adjusting for socioeconomic and psychosocial factors, showing the devastating impact of CM on adult health [4,5,6,7,8,9,10], leading to a reduction of lifespan up to 20 years [11]

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