Adverse Childhood Experiences and Cardiovascular Disease Risk in Childhood: A Pilot Study Anastasia Wass 1 , Jeffrey Garofano 1 , Carisa Parrish 1 , Tammy Brady 1 1 Johns Hopkins University, Baltimore, MD Background: Adverse childhood experiences (ACE) are associated with increased cardiovascular disease (CVD) risk in adults. We aimed to determine if ACE associate with CVD risk factors among youth with obesity and elevated blood pressure (EBP). Methods: This was a cross-sectional pilot study of 25 youth aged 5-22 yrs with obesity and EBP who completed ACE questionnaires. Triplicate manual BPs and 24-hr ambulatory BPs were obtained and BP indexes were calculated (measured BP/age-sex-height specific 95 th %ile BP; values ≥1 are elevated). Students t-tests, Wilcoxon rank sum, Chi-squared analyses compared characteristics between youth with ACE≥4 vs<4. Regression analyses determined associations of ACE with CVD risk factors, adjusting for age, sex, race, BMI z-score. Results: Overall mean age was 14.8 yrs, 56% were female, 84% were Black. 28% reported ≥4 ACE. Those with ACE≥4 had higher resting systolic BP (SBP), resting SBP index, and non-HDL cholesterol than those with ACE<4 (Table). Having ≥4 ACE was independently associated with resting SBP [β 11.0, 95% confidence interval (CI) 4, 18.1, p=0.004) and resting SPB index (β 0.09, 95% CI 0.03, 0.14; p= 0.004). No ABPM measures or other CVD risk factors were associated with ACE. Conclusion: In this pilot study of youth with obesity and EBP, ACE were associated with higher resting SBP. Further research in larger cohorts are needed to better elucidate how ACE associate with CVD risk in children and adolescents.