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Brief Report
November 13, 2020

Association of Early-Life Trauma and Risk of Adverse Cardiovascular Outcomes in Young and Middle-aged Individuals With a History of Myocardial Infarction

Author Affiliations
  • 1Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
  • 2Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, Georgia
  • 3Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
  • 4Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
  • 5Atlanta VA Medical Center, Decatur, Georgia
JAMA Cardiol. 2021;6(3):336-340. doi:10.1001/jamacardio.2020.5749
Key Points

Question  Among individuals with a history of acute myocardial infarction, are those who had a past exposure to adverse childhood experiences at higher risk of adverse outcomes than those without such exposure?

Findings  In this cohort study of 300 individuals with a history of myocardial infarction and exposure to higher levels of early-life trauma, there was a 2-fold increased incidence of adverse cardiovascular outcomes compared with those with lower exposure. The association was independent of other risk factors and was dose dependent.

Meaning  Individuals with a history of myocardial infarction and early-life trauma may be at increased long-term risk of adverse cardiovascular outcomes.


Importance  Compared with older patients, young adults with a history of myocardial infarction (MI) tend to have a higher burden of psychosocial adversity. Exposure to early-life stressors may contribute to the risk of adverse outcomes in this patient population, potentially through inflammatory pathways.

Objective  To investigate the association of early-life trauma with adverse events and examine whether inflammation plays a role.

Design, Setting, and Participants  This cohort study included patients aged 18 to 60 years with a verified history of MI in the past 8 months from a university-affiliated hospital network. Baseline data were collected from June 2011 to March 2016, and follow-up data were obtained through July 2019. Analysis began September 2019.

Exposures  Early-life trauma was assessed using the Early Trauma Inventory–Self Report short form (ETI-SR-SF), both as a continuous and as a binary variable at the threshold of a score of 7 or higher. Inflammatory biomarkers, interleukin 6, and C-reactive protein were obtained at baseline.

Main Outcomes and Measures  A composite end point of recurrent MI, stroke, heart failure hospitalization, and cardiovascular death over a median 3-year follow-up.

Results  Of 300 patients, the mean (SD) age was 51 (7) years, 198 (66%) were African American, and 150 (50%) were women. Compared with participants with MI with an ETI-SR-SF score less than 7, those with a score of 7 or higher had higher levels of interleukin 6 and C-reactive protein at baseline. Compared with participants with an ETI-SR-SF score less than 7, those with a score of 7 or higher were at a greater risk for adverse outcomes, with a hazards ratio of 2.3 (95% CI, 1.3-3.9). Results remained consistent in multivariable analysis. Further adjustment for C-reactive protein rendered the results no longer statistically significant. Early-life trauma displayed a dose-dependent response when analyzed as a continuous variable and by quartiles.

Conclusions and Relevance  Early-life trauma is an independent risk factor for adverse outcomes in young and middle-aged individuals with a history of MI. Neurobiological mechanisms leading to lifetime activation of systemic inflammatory cascades may be implicated.