Adverse childhood and adulthood experiences and risk of new-onset cardiovascular disease with consideration of social support: a prospective cohort study
Abstract Background The relationship between adverse childhood experiences (ACEs) and adverse adulthood experiences (AAEs) and their association with incident cardiovascular disease (CVD) have not been extensively studied. Considering social support, we evaluated the complex relations of ACEs and AA...
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BMC
2023-08-01
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| Series: | BMC Medicine |
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| Online Access: | https://doi.org/10.1186/s12916-023-03015-1 |
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| author | Wanxin Wang Yifeng Liu Yuwei Yang Weiqing Jiang Yanyan Ni Xue Han Ciyong Lu Lan Guo |
| author_facet | Wanxin Wang Yifeng Liu Yuwei Yang Weiqing Jiang Yanyan Ni Xue Han Ciyong Lu Lan Guo |
| author_sort | Wanxin Wang |
| collection | DOAJ |
| description | Abstract Background The relationship between adverse childhood experiences (ACEs) and adverse adulthood experiences (AAEs) and their association with incident cardiovascular disease (CVD) have not been extensively studied. Considering social support, we evaluated the complex relations of ACEs and AAEs with incident CVD. Methods This prospective cohort study used data from the 2014 life course survey and the 2015 and 2018 surveys of the China Health and Retirement Longitudinal Study, a national survey of Chinese adults aged ≥ 45 years from 28 provinces across China. The study population included 5836 individuals (mean [SD] age, 59.59 [8.22] years, 49.7% were males). Information on ACEs, AAEs, young adulthood social support, health behavior factors, health status factors, and demographics was measured. Cox regression models, the difference method to estimate the mediation proportion, and the additive and multiplicative interactions were performed. Subgroup and sensitivity analyses were also conducted. Results During follow-up, 789 incident cases of CVD occurred. The fully adjusted model, including demographics, health behaviors, health status factors (e.g., depressive symptoms), and social support as control variables, demonstrated that the overall number of ACEs (Hazard ratio [HR]: 1.11, 95% CI: 1.08 to 1.14) and AAEs (HR: 1.19, 95% CI: 1.16 to 1.22) were associated with an increased risk of incident CVD. A dose–response relationship existed between the number of ACEs or AAEs and incident CVD risk. The overall AAEs were found to mediate 17.7% (95% CI: 8.2 to 34.2%) of the association between ACEs and incident CVD. Moreover, a significant additive interaction between ACEs and AAEs was detected (RERI [95% CI]: 0.32 [0.09 to 0.56]). Compared with adults without exposure to both ACE and AAE, those with exposure to both at least one ACE and one AAE indicator had the highest risk of incident CVD (HR: 1.96, 95% CI: 1.72 to 2.23). Conclusions Exposure to ACEs or AAEs was independently associated with an increased risk of incident CVD among Chinese middle-aged and older adults in a dose–response manner, and the overall AAEs partially mediated the association between ACEs and incident CVD. Preventive measures aimed at addressing either ACEs or AAEs alone may not significantly reduce the risk of CVD later in life. The necessity of a comprehensive life-course health strategy targeting the prevention of adversity merits increased attention. |
| first_indexed | 2024-03-10T17:41:47Z |
| format | Article |
| id | doaj.art-74465fb7145c4e2c899f29dba3263ee4 |
| institution | Directory Open Access Journal |
| issn | 1741-7015 |
| language | English |
| last_indexed | 2024-03-10T17:41:47Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
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| series | BMC Medicine |
| spelling | doaj.art-74465fb7145c4e2c899f29dba3263ee42023-11-20T09:41:10ZengBMCBMC Medicine1741-70152023-08-0121111410.1186/s12916-023-03015-1Adverse childhood and adulthood experiences and risk of new-onset cardiovascular disease with consideration of social support: a prospective cohort studyWanxin Wang0Yifeng Liu1Yuwei Yang2Weiqing Jiang3Yanyan Ni4Xue Han5Ciyong Lu6Lan Guo7Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen UniversityDepartment of Psychiatry, Shenzhen Nanshan Center for Chronic Disease ControlGuangdong Provincial Center for Disease Control and PreventionDepartment of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen UniversitySchool of Public Health, The University of Hong KongDepartment of Psychiatry, Shenzhen Nanshan Center for Chronic Disease ControlDepartment of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen UniversityDepartment of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen UniversityAbstract Background The relationship between adverse childhood experiences (ACEs) and adverse adulthood experiences (AAEs) and their association with incident cardiovascular disease (CVD) have not been extensively studied. Considering social support, we evaluated the complex relations of ACEs and AAEs with incident CVD. Methods This prospective cohort study used data from the 2014 life course survey and the 2015 and 2018 surveys of the China Health and Retirement Longitudinal Study, a national survey of Chinese adults aged ≥ 45 years from 28 provinces across China. The study population included 5836 individuals (mean [SD] age, 59.59 [8.22] years, 49.7% were males). Information on ACEs, AAEs, young adulthood social support, health behavior factors, health status factors, and demographics was measured. Cox regression models, the difference method to estimate the mediation proportion, and the additive and multiplicative interactions were performed. Subgroup and sensitivity analyses were also conducted. Results During follow-up, 789 incident cases of CVD occurred. The fully adjusted model, including demographics, health behaviors, health status factors (e.g., depressive symptoms), and social support as control variables, demonstrated that the overall number of ACEs (Hazard ratio [HR]: 1.11, 95% CI: 1.08 to 1.14) and AAEs (HR: 1.19, 95% CI: 1.16 to 1.22) were associated with an increased risk of incident CVD. A dose–response relationship existed between the number of ACEs or AAEs and incident CVD risk. The overall AAEs were found to mediate 17.7% (95% CI: 8.2 to 34.2%) of the association between ACEs and incident CVD. Moreover, a significant additive interaction between ACEs and AAEs was detected (RERI [95% CI]: 0.32 [0.09 to 0.56]). Compared with adults without exposure to both ACE and AAE, those with exposure to both at least one ACE and one AAE indicator had the highest risk of incident CVD (HR: 1.96, 95% CI: 1.72 to 2.23). Conclusions Exposure to ACEs or AAEs was independently associated with an increased risk of incident CVD among Chinese middle-aged and older adults in a dose–response manner, and the overall AAEs partially mediated the association between ACEs and incident CVD. Preventive measures aimed at addressing either ACEs or AAEs alone may not significantly reduce the risk of CVD later in life. The necessity of a comprehensive life-course health strategy targeting the prevention of adversity merits increased attention.https://doi.org/10.1186/s12916-023-03015-1Adverse childhood experienceAdverse adulthood experienceNew-onset cardiovascular diseaseCohort study |
| spellingShingle | Wanxin Wang Yifeng Liu Yuwei Yang Weiqing Jiang Yanyan Ni Xue Han Ciyong Lu Lan Guo Adverse childhood and adulthood experiences and risk of new-onset cardiovascular disease with consideration of social support: a prospective cohort study BMC Medicine Adverse childhood experience Adverse adulthood experience New-onset cardiovascular disease Cohort study |
| title | Adverse childhood and adulthood experiences and risk of new-onset cardiovascular disease with consideration of social support: a prospective cohort study |
| title_full | Adverse childhood and adulthood experiences and risk of new-onset cardiovascular disease with consideration of social support: a prospective cohort study |
| title_fullStr | Adverse childhood and adulthood experiences and risk of new-onset cardiovascular disease with consideration of social support: a prospective cohort study |
| title_full_unstemmed | Adverse childhood and adulthood experiences and risk of new-onset cardiovascular disease with consideration of social support: a prospective cohort study |
| title_short | Adverse childhood and adulthood experiences and risk of new-onset cardiovascular disease with consideration of social support: a prospective cohort study |
| title_sort | adverse childhood and adulthood experiences and risk of new onset cardiovascular disease with consideration of social support a prospective cohort study |
| topic | Adverse childhood experience Adverse adulthood experience New-onset cardiovascular disease Cohort study |
| url | https://doi.org/10.1186/s12916-023-03015-1 |
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