Adverse childhood experiences and adult cardiometabolic risk factors and disease outcomes: Cross-sectional, population-based study of adults in rural Uganda

Abstract

Background Cardiovascular diseases (CVD) pose a major threat to public health in sub-Saharan African communities, where the burden of these classes of illnesses is expected to double by 2030. Growing research suggests that past developmental experiences and early life conditions may also elevate CVD risk throughout the life course. Greater childhood stress and adversity are consistently associated with a range of adult CVDs and associated risk factors, yet little research exists on the long-term effects of early life stress on adult physical health outcomes, especially CVD risk, in sub-Saharan African contexts. This study aims to evaluate the associations between adverse childhood experiences and adult cardiometabolic risk factors and health outcomes in a population-based study of adults living in Mbarara, a rural region of southwestern Uganda. Methods Data come from an ongoing, whole-population social network cohort study of adults living in the eight villages of Nyakabare Parish, Mbarara. A modified version of the Adverse Childhood Experiences-International Questionnaire (ACEs) assessed past exposure to physical, emotional, and sexual adversity. Participants also took part in a health fair where medical histories on cardiometabolic risk factors and cardiovascular diseases were gathered. Multiple logistic regression models estimated the associations between ACEs and cardiometabolic risk factors and health outcomes. Results Data were available on 545 adults. The average number of ACEs was 4.9 out of a possible 16. The cumulative number of ACEs were associated with having a history of heart attack and/or heart failure (adjusted odds ratio (AOR) = 1.11, 95% confidence interval (CI) = 0.999-1.234, P = 0.051), but the estimated association was not statistically significant. ACEs did not have statistically significant associations with any others measures of adult cardiometabolic risk and CVD. Conclusions Adverse childhood experiences are not associated with a range of adult cardiometabolic risk factors and health outcomes in this sample of rural Ugandan adults. Further research in this sample is necessary to identify the pathways that may motivate these null relationship and possibly protect against adverse cardiometabolic and cardiovascular health outcomes.

Associations of Childhood Maltreatment and Genetic Risks With Incident Heart Failure in Later Life

“… 4 , 6 , 7 Our study extends the literature by showing that childhood maltreatment also accounted for an increased hazard of incident heart failure, an end‐stage condition of multiple cardiovascular diseases. Compared with previous studies showing a trend of association between childhood maltreatment and heart failure, 9 , 10 our study offers more compelling evidence supporting such association by comprehensively considering confounding factors and genetic modulation, bearing a longer follow‐up period, and having a large sample size. In addition, we put forward these studies by delineating that such association was in dose‐dependent and type‐specific patterns, with a stronger effect from physical abuse.…”

“…To our knowledge, several previous studies have demonstrated a trend of association between a higher burden of childhood maltreatment and an increased risk of heart failure. 8 , 9 , 10 However, a recent longitudinal study observed a lack of such a gradient association between childhood maltreatment and incident heart failure among young patients with myocardial infarction. 11 These conflicting findings may result from the limitations of the existing studies, such as cross‐sectional design, small sample size, and/or a small number of events.…”

“… 11 These conflicting findings may result from the limitations of the existing studies, such as cross‐sectional design, small sample size, and/or a small number of events. 8 , 9 , 11 In addition, there is evidence indicating the specific effect of each type of childhood maltreatment on the risk of mental disorders. 12 However, it remains unknown whether childhood maltreatment yields such a type‐specific association with incident heart failure.…”