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December 2, 2020

Association of Adverse Childhood Experiences With Cardiovascular Disease Later in Life: A Review

Author Affiliations
  • 1Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada
  • 2Instituto do Coracao (InCor), Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
  • 3Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  • 4Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
  • 5Centre for Headache, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
  • 6Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
JAMA Cardiol. 2021;6(2):228-235. doi:10.1001/jamacardio.2020.6050

Importance  Adverse childhood experiences (ACEs) are potentially harmful events that occur during childhood, spanning neglect, physical or sexual abuse, parental separation, or death, among others. At least 50% of the US adult population has experienced 1 or more ACEs before the age of 18 years, but in clinical practice, ACEs remain underrecognized. Adults who have experienced ACEs are at increased risk of developing health risk behaviors and, ultimately, cardiovascular disease (CVD). This review summarizes the evidence regarding the association of ACEs with CVD and the accompanying diagnostic and therapeutic approaches in the adult population.

Observations  ACEs are commonly classified into 3 domains: abuse (psychological, physical, or sexual), household dysfunction (eg, substance use by household members, mental illness, parental separation), and neglect. These experiences elicit chronic activation of the stress response system, leading to autonomic, neuroendocrine, and inflammatory dysfunction. The subsequent development of traditional risk factors, such as diabetes, hypertension, smoking, and obesity, results in the onset of CVD and premature mortality. Adults with 4 or more ACEs compared with those with none have a more than 2-fold higher risk of developing CVD and an almost 2-fold higher risk of premature mortality.

Conclusions and Relevance  Identifying methods of mitigating the health consequences of ACEs may lead to better cardiovascular outcomes. Inquiry into ACE exposure during clinical encounters and subsequent referral to psychological services when appropriate may be helpful, but strategies aimed at CVD prevention via management of ACEs in adults continue to lack adequate evidence.

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