title: Insights into causal pathways for ischemic heart disease: adverse childhood experiences study.
abstract: BACKGROUND
  The purpose of this study was to assess the relation of adverse childhood experiences (ACEs), including abuse, neglect, and household dysfunction, to the risk of ischemic heart disease (IHD) and to examine the mediating impact on this relation of both traditional IHD risk factors and psychological factors that are associated with ACEs.
  
  
  RESULTS
  Retrospective cohort survey data were collected from 17,337 adult health plan members from 1995 to 1997. Logistic regression adjusted for age, sex, race, and education was used to estimate the strength of the ACE-IHD relation and the mediating impact of IHD risk factors in this relation. Nine of 10 categories of ACEs significantly increased the risk of IHD by 1.3- to 1.7-fold versus persons with no ACEs. The adjusted odds ratios for IHD among persons with > or =7 ACEs was 3.6 (95% CI, 2.4 to 5.3). The ACE-IHD relation was mediated more strongly by individual psychological risk factors commonly associated with ACEs than by traditional IHD risk factors. We observed significant association between increased likelihood of reported IHD (adjusted ORs) and depressed affect (2.1, 1.9 to 2.4) and anger (2.5, 2.1 to 3.0) as well as traditional risk factors (smoking, physical inactivity, obesity, diabetes and hypertension), with ORs ranging from 1.2 to 2.7.
  
  
  CONCLUSIONS
  We found a dose-response relation of ACEs to IHD and a relation between almost all individual ACEs and IHD. Psychological factors appear to be more important than traditional risk factors in mediating the relation of ACEs to the risk of IHD. These findings provide further insights into the potential pathways by which stressful childhood experiences may increase the risk of IHD in adulthood.
authors.affiliation: National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga 30341, USA. mfd7@cdc.gov
authors.forename: Maxia
authors.initials: M
authors.lastname: Dong
authors.forename: Wayne H
authors.initials: WH
authors.lastname: Giles
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Felitti
authors.forename: Shanta R
authors.initials: SR
authors.lastname: Dube
authors.forename: Janice E
authors.initials: JE
authors.lastname: Williams
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Chapman
authors.forename: Robert F
authors.initials: RF
authors.lastname: Anda
mesh_terms: D000786:Anger; D002140:California / Q000453:epidemiology; D002648:Child; D002649:Child Abuse / Q000145:classification; D015331:Cohort Studies; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D017579:Domestic Violence; D005006:Ethnicity; D005192:Family Health; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008019:Life Style; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D009765:Obesity / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires