BackgroundViolence against women has become a global public health threat. Data on the potential impact of exposure to violence on cardiovascular disease are scarce.Methods and ResultsWe evaluated the association between exposure to violence and subclinical cardiovascular disease in 634 disease‐free women from the Mexican Teachers' Cohort who responded to violence‐related items from the Life Stressor Checklist and underwent measures of carotid artery intima‐media thickness in 2012 and 2013. We defined exposure to violence as having ever been exposed to physical and/or sexual violence. Intima‐media thickness was log‐transformed, and subclinical carotid atherosclerosis was defined as intima‐media thickness ≥0.8 mm or plaque. We used multivariable linear and logistic regression models adjusted for several potential confounders. Mean age was 48.9±4.3 years. Close to 40% of women reported past exposure to violence. The lifetime prevalence of sexual violence was 7.1%, and prevalence of physical violence was 23.5% (7.7% reported both sexual and physical violence). Relative to women with no history of violence, exposure to violence was associated with higher intima‐media thickness (adjusted mean percentage difference=2.4%; 95% confidence interval 0.5, 4.3) and subclinical atherosclerosis (adjusted odds ratio=1.60; 95% confidence interval 1.10, 2.32). The association was stronger for exposure to physical violence, especially by mugging or physical assault by a stranger (adjusted mean % difference=4.6%; 95% confidence interval 1.8, 7.5, and odds ratio of subclinical carotid atherosclerosis=2.06; 95% confidence interval 1.22, 3.49).ConclusionsExposure to violence, and in particular assault by a stranger, was strongly associated with subclinical cardiovascular disease in Mexican middle‐aged women.

Hair cortisol concentration (HCC) represent a potential biomarker of chronic psychological stress. Previous studies exploring the association between perceived stress and HCC have been limited to relatively small and selected populations. We collected hair samples from 881 women from the Mexican Teachers’ Cohort (MTC) and 398 women from the Icelandic SAGA pilot-cohort following identical protocols. HCC was quantified using liquid chromatography coupled with tandem mass spectrometry. The self-reported Perceived Stress Scale (PSS, 10 and 4 item, range 0–40 and 0–16) was used to assess psychological stress. We conducted multivariable linear regression analyses to assess the association between perceived stress and log-transformed HCC in the combined sample and in each cohort separately. MTC participants had slightly higher HCC and PSS scores than SAGA participants (median HCC 6.0pg/mg vs. 4.7pg/mg and mean PSS-10 score 12.4 vs. 11.7, respectively). After adjusting for sociodemographic factors and health behaviors, we observed a 1.4% (95% CI 0.6, 2.1) increase in HCC for each unit increase in the PSS-10 score in the combined sample. Furthermore, PSS-10 quintiles were associated with a 24.3% (95% CI 8.4, 42.6, mean logHCC 1.8 vs 1.6) increase in HCC when comparing the highest to the lowest quintile, after multivariable adjustment. Similar results were obtained when we analyzed each cohort separately and when using the PSS-4. Despite relatively small absolute differences, an association between perceived stress and HCC was found in a sample of women from two diverse geographical and cultural backgrounds supporting the hypothesis that HCC is a viable biomarker in studies of chronic psychological stress.

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Introduction: Violence against women remains globally one of the most important human rights violations and public health threats. Yet, data on the potential impact of lifetime exposure to violence, an important stressor, on cardiovascular disease (CVD) are scarce. Hypothesis: Adult women with a history of childhood and/or adult exposure to violence are at increased risk of subclinical CVD compared to women without this history. Methods: We evaluated the association of childhood and adult exposure to violence and carotid artery intima-media thickness (IMT) in 634 disease-free women from the Mexican Teachers’ Cohort. In 2012-13, study participants retrospectively responded to 12 violence-related items from the Life Stressor Checklist questionnaire. We categorized violence as neglect, and observed, physical and sexual violence, in childhood and adulthood. IMT was measured by standardized neurologists through ultrasound and log-transformed. We defined carotid atherosclerosis as IMT ≥0.8mm or plaque. We used multivariable linear and logistic regression models to assess the association between violence, IMT and carotid atherosclerosis. Results: In childhood, the prevalence of neglect was 8.2%, observed violence 22.2%, sexual violence 6.9% and physical violence 8.2%. In adulthood, neglect was present in 17.4% participants, observed violence in 21.6%, sexual violence in 10.4% and physical violence in 27.4%. Childhood exposure to sexual violence appeared to be associated to IMT in midlife but remained non-significant. In adulthood, we observed an association between exposure to physical violence and IMT when comparing exposed to unexposed women (multivariable-adjusted mean % difference=2.3%; 95%CI 0.1, 4.6). The multivariable-adjusted odds ratio for carotid atherosclerosis was 1.69 (95%CI 1.07, 2.69) comparing women who reported physical violence relative to those who did not. Conclusions: Exposure to certain types of violence may be associated with increased subclinical CVD in middle-aged women.

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