Adverse childhood experiences and myocardial infarction: Analysis of United States Behavioral Risk Factor Surveillance System (BRFSS) data

Abstract

Adverse childhood experiences (ACEs) have been linked to an increased risk of disease in adulthood and a range of other negative health outcomes, including cardiovascular disease (CVD). This study aims to build on previous research on ACEs and CVD by investigating the association between ACEs and heart attack or myocardial infarction diagnosis. Our analysis used cross-sectional data from the 2021 Behavioral Risk Factor Surveillance System (BRFSS) annual survey and ACE Module questionnaires. Responses included data from a national sample of 52,492 adults aged 18 years or older in the United States. ACEs value is a composite score of physical, emotional and sexual abuse, household dysfunction, neglect, and other childhood traumas. The study population had a mean number of 1.75 ACEs (SD 2.25), with 61% experiencing at least one ACE and 17% experiencing four or more ACEs. Almost 6% of adults in the sample reported a previous myocardial infarction (5.7%). Multiple logistic regression analysis demonstrated that, after adjusting for a variety of sociodemographic and health covariates, every one-event increase in the number of ACEs was significantly associated with 6% increased odds of myocardial infarction in adulthood (adjusted odds ratio [aOR] = 1.06, 95% confidence interval [CI] = 1.04 - 1.09, p <0.001). Efforts to decrease the incidence of myocardial infarction and reduce cardiac-related mortality in the U.S. should include policies that reduce the occurrence of ACEs and provide resources for adults to address their childhood traumas.

Keywords

Adverse childhood experiences / Trauma / Abuse / Neglect / Heart attack / Myocardial infarction / Family / Parent

References

[1] Anda R.F., Porter L.E., & Brown D.W. (2020). Inside the adverse childhood experience score: Strengths, limitations, and misapplications. American Journal of Preventive Medicine, 59(2):293-295. https://doi.org/10.1016/j.amepre.2020.01.009

[2] Bellis M.A., Hughes K., Ford K., Ramos Rodriguez G., Sethi D., & Passmore J. (2019). Life course health consequences and associated annual costs of adverse childhood experiences across Europe and North America: A systematic review and meta-analysis. The Lancet Public Health, 4(10):e517-e528. https://doi.org/10.1016/S2468-2667(19)30145-8

[3] Bertele S., Heitland I., Fraccarollo D., Stapel B., Bauersachs J., Westhoff-Bleck M., et al. (2022). Behavioral pathway to a broken heart: The link between adverse childhood experiences, depression, physical exercise and cardiovascular health. Frontiers in Psychiatry, 13:1002143. https://doi.org/10.3389/fpsyt.2022.1002143

[4] CDC. (2018). BRFSS Frequently Asked Questions (FAQs). Available from: https://www.cdc.gov/brfss/about/brfss_faq.htm [Last accessed on 2024 May 26].

[5] CDC. (2023a). Heart Disease Facts. Heart Disease. Available from: https://www.cdc.gov/heartdisease/facts.htm [Last accessed on 2024 May 26].

[6] CDC. (2023b). BRFSS - Questionnaires. Available from: https://www.cdc.gov/brfss/questionnaires/index.htm [Last accessed on 2024 May 26].

[7] Deschênes S.S., Kivimaki M., & Schmitz N. (2021). Adverse childhood experiences and the risk of coronary heart disease in adulthood: Examining potential psychological, biological, and behavioral mediators in the Whitehall II cohort study. Journal of the American Heart Association, 10(10):e019013. https://doi.org/10.1161/JAHA.120.019013

[8] Felitti V.J., Anda R.F., Nordenberg D., Williamson D.F., Spitz A.M., Edwards V., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine, 14(4):245-258. https://doi.org/10.1016/S0749-3797(98)00017-8

[9] Finkelhor D. (2020). Trends in adverse childhood experiences (ACEs) in the United States. Child Abuse and Neglect, 108:104641. https://doi.org/10.1016/j.chiabu.2020.104641

[10] Ford K., Kelly S., Evans J., Newbury A., Meredith Z., & Roderick J. (2017). Adverse Childhood Experiences: Breaking the Generational Cycle of Crime: Turning Understanding into Action: Summary Report. Public Health Wales NHS Trust.

[11] Giano Z., Wheeler D.L., & Hubach R.D. (2020). The frequencies and disparities of adverse childhood experiences in the U.S. BMC Public Health, 20(1):1327. https://doi.org/10.1186/s12889-020-09411-z

[12] Goddard A. (2021). Adverse childhood experiences and trauma-informed care. Journal of Pediatric Health Care, 35(2):145-155. https://doi.org/10.1016/j.pedhc.2020.09.001

[13] Hughes K., Bellis M.A., Hardcastle K.A., Sethi D., Butchart A., Mikton C., et al. (2017). The effect of multiple adverse childhood experiences on health: A systematic review and meta-analysis. The Lancet Public Health, 2(8):e356-e366. https://doi.org/10.1016/S2468-2667(17)30118-4

[14] Iniguez K.C., & Stankowski R.V. (2016). Adverse childhood experiences and health in adulthood in a rural population-based sample. Clinical Medicine and Research, 14(3-4):126-137. https://doi.org/10.3121/cmr.2016.1306

[15] Jiang S., Postovit L., Cattaneo A., Binder E.B., & Aitchison K.J. (2019). Epigenetic modifications in stress response genes associated with childhood trauma. Frontiers in Psychiatry, 10:808. https://doi.org/10.3389/fpsyt.2019.00808

[16] Lee C., Cao J., Eagen-Torkko M., & Mohammed S.A. (2023). Network analysis of adverse childhood experiences and cardiovascular diseases. SSM - Population Health, 22:101358. https://doi.org/10.1016/j.ssmph.2023.101358

[17] Lin I.C., McKenny M., & Elkbuli A. (2021). Broken bones, broken minds, and broken hearts: Psychotrauma resources for pediatric non-accidental trauma survivors - Editorial. Annals of Medicine and Surgery, 67:102512. https://doi.org/10.1016/j.amsu.2021.102512

[18] Martín-Higarza Y., Fontanil Y., Méndez M.D., & Ezama E. (2020). The direct and indirect influences of adverse childhood experiences on physical health: A cross-sectional study. International Journal of Environmental Research and Public Health, 17(22):8507. https://doi.org/10.3390/ijerph17228507

[19] Mayo Clinic Staff. (2023). Heart Attack. Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/heart-attack/symptoms-causes/syc-20373106 [Last accessed on 2024 May 26].

[20] Metzler M., Merrick M.T., Klevens J., Ports K.A., & Ford D.C. (2017). Adverse childhood experiences and life opportunities: Shifting the narrative. Children and Youth Services Review, 72:141-149. https://doi.org/10.1016/j.childyouth.2016.10.021

[21] Morton P.M., Turiano N.A., Mroczek D.K., & Ferraro K.F. (2018). Childhood misfortune, personality, and heart attack: Does personality mediate risk of myocardial infarction? The Journals of Gerontology: Series B, 73(5):825-835. https://doi.org/10.1093/geronb/gbw021

[22] National Center for Health Statistics. (2023). National Health Interview Survey 2022. Available from: https://www.cdc.gov/nchs/nhis/2022nhis.htm [Last accessed on 2024 May 26].

[23] National Center for Injury Prevention and Control, Division of Violence Prevention. (2023). Behavioral Risk Factor Surveillance System ACE Data. CDC: Violence Prevention. Available from: https://www.cdc.gov/violenceprevention/aces/ace-brfss.html [Last accessed on 2024 May 26].

[24] National Children’s Alliance. (2023). National Statistics on Child Abuse. Available from: https://www.nationalchildrensalliance.org/media-room/national-statistics-on-child-abuse [Last accessed on 2024 May 26].

[25] Racine N., Killam T., & Madigan S. (2020). Trauma-informed care as a universal precaution: beyond the adverse childhood experiences questionnaire. JAMA Pediatrics, 174(1):5. https://doi.org/10.1001/jamapediatrics.2019.3866

[26] Rafiq T., O’Leary D.D., Dempster K.S., Cairney J., & Wade T.J. (2020). Adverse childhood experiences (ACEs) predict increased arterial stiffness from childhood to early adulthood: Pilot analysis of the Niagara longitudinal heart study. Journal of Child and Adolescent Trauma, 13(4):505-514. https://doi.org/10.1007/s40653-020-00311-3

[27] Sonu S., Post S., & Feinglass J. (2019). Adverse childhood experiences and the onset of chronic disease in young adulthood. Preventive Medicine, 123:163-170. https://doi.org/10.1016/j.ypmed.2019.03.032

[28] Wade T.J., O’Leary D.D., Dempster K.S., MacNeil A.J., Molnar D.S., McGrath J., et al. (2019). Adverse childhood experiences (ACEs) and cardiovascular development from childhood to early adulthood: Study protocol of the Niagara Longitudinal Heart Study. BMJ Open, 9(7):e030339. https://doi.org/10.1136/bmjopen-2019-030339

[29] Whitfield C.L. (1998). Adverse childhood experiences and Trauma. American Journal of Preventive Medicine, 14(4):361-364.