Psychological and biological mechanisms linking trauma with cardiovascular disease risk

Sumner, Jennifer A.; Cleveland, Shiloh; Chen, Tiffany; Gradus, Jaimie L.

doi:10.1038/s41398-023-02330-8

Cited by 21 publications

(12 citation statements)

References 247 publications

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“…This outcome-wide study does not allow for the investigation of mechanisms underlying these associations. Prior evidence suggests that psychological (e.g., post-traumatic stress disorder), behavioral (e.g., physical activity), and biological (e.g., immune dysregulation) pathways are likely at play [ 96 – 100 ].…”

Section: Discussionmentioning

confidence: 99%

Childhood maltreatment and health in the UK Biobank: triangulation of outcome-wide and polygenic risk score analyses

Espinosa Dice,

Lawn,

Ratanatharathorn

et al. 2024

BMC Med

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Background Childhood maltreatment is common globally and impacts morbidity, mortality, and well-being. Our understanding of its impact is constrained by key substantive and methodological limitations of extant research, including understudied physical health outcomes and bias due to unmeasured confounding. We address these limitations through a large-scale outcome-wide triangulation study. Methods We performed two outcome-wide analyses (OWAs) in the UK Biobank. First, we examined the relationship between self-reported maltreatment exposure (number of maltreatment types, via Childhood Trauma Screener) and 414 outcomes in a sub-sample of 157,316 individuals using generalized linear models (“observational OWA”). Outcomes covered a broad range of health themes including health behaviors, cardiovascular disease, digestive health, socioeconomic status, and pain. Second, we examined the relationship between a polygenic risk score for maltreatment and 298 outcomes in a non-overlapping sample of 243,006 individuals (“genetic OWA”). We triangulated results across OWAs based on differing sources of bias. Results Overall, 23.8% of the analytic sample for the observational OWA reported at least one maltreatment type. Of 298 outcomes examined in both OWAs, 25% were significant in both OWAs and concordant in the direction of association. Most of these were considered robust in the observational OWA according to sensitivity analyses and included outcomes such as marital separation (OR from observational OWA, ORo = 1.25 (95% CI: 1.21, 1.29); OR from genetic OWA, ORg = 1.06 (1.03, 1.08)), major diet changes due to illness (ORo = 1.27 (1.24, 1.29); ORg = 1.01 (1.00, 1.03)), certain intestinal diseases (ORo = 1.14 (1.10, 1.18); ORg = 1.03 (1.01, 1.06)), hearing difficulty with background noise (ORo = 1.11 (1.11, 1.12); ORg = 1.01 (1.00, 1.01)), knee arthrosis (ORo = 1.13 (1.09, 1.18); ORg = 1.03 (1.01, 1.05)), frequent sleeplessness (ORo = 1.21 (1.20, 1.23); ORg = 1.02 (1.01, 1.03)), and low household income (ORo = 1.28 (1.26, 1.31); ORg = 1.02 (1.01, 1.03)). Approximately 62% of results were significant in the observational OWA but not the genetic OWA, including numerous cardiovascular outcomes. Only 6 outcomes were significant in the genetic OWA and null in the observational OWA; these included diastolic blood pressure and glaucoma. No outcomes were statistically significant in opposite directions in the two analyses, and 11% were not significant in either OWA. Conclusions Our findings underscore the far-reaching negative effects of childhood maltreatment in later life and the utility of an outcome-wide triangulation design with sensitivity analyses for improving causal inference.

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Section: Discussionmentioning

confidence: 99%

Childhood maltreatment and health in the UK Biobank: triangulation of outcome-wide and polygenic risk score analyses

Espinosa Dice,

Lawn,

Ratanatharathorn

et al. 2024

BMC Med

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“…However, studies on children in different contexts have highlighted that severe deprivation or neglect produces negative outputs. For example, it disrupts how children’s brains develop and process information, increasing the risk of behavioral disorders [ 11 ]; it modifies biological stress response systems, leading to a greater risk of anxiety, depression, cardiovascular problems, and other chronic health impairments over a person’s lifetime [ 12 ]; and it is linked to a significant risk of learning disabilities and poor school achievement [ 13 ]…”

Section: Consequences Of Child Neglectmentioning

confidence: 99%

Improving the Early Assessment of Child Neglect Signs—A New Technique for Professionals

2023

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This paper grants some considerations on a critical phenomenon for child health: child neglect. It is an omission-type form of childhood maltreatment, which is widespread but very hard to intercept. For the assessment of child neglect, the Italian Society of Pediatric Psychology (S.I.P.Ped.) has developed and validated a specific assessment technique (the C.N.A. technique). It is supposed to be for parents of children between 3 and 9 years old. It is based on a paradigm that identifies the dysregulation of parental competence as the cause of neglect. It can occur in hypo- or hyperactivation of three fundamental factors (recognition, stimulation, and care). The child neglect assessment technique (C.N.A.) differs from the retrospective tools available in the literature since it allows for interception of the “signs” of possible child neglect when negligence occurs.

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“…substance abuse, obesity, sleep disturbance) and/or psychosocial (e.g. social isolation) factors (extensively reviewed in [9] and [10]). Conversely, it may also be possible that a diagnosis or experience of life-threatening CVD could provoke PTSD [4].…”

Section: Introductionmentioning

confidence: 99%

A genetic exploration of the relationship between Posttraumatic Stress Disorder and cardiovascular diseases

Lukas,

Veeneman,

Smit

et al. 2024

Preprint

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Background and Aims Experiencing a traumatic event may lead to Posttraumatic Stress Disorder (PTSD), including symptoms such as flashbacks and hyperarousal. Individuals suffering from PTSD are at increased risk of cardiovascu- lar disease (CVD), but it is unclear why. This study assesses shared genetic liability and potential causal pathways between PTSD and CVD. Methods We leveraged summary-level data of genome-wide association studies (PTSD: N= 1,222,882; atrial fibril- lation (AF): N=482,409; coronary artery disease (CAD): N=1,165,690; hypertension: N=458,554; heart failure (HF): N=977,323). First, we estimated genetic correlations and utilized genomic structural equation modeling to identify a common genetic factor for PTSD and CVD. Next, we assessed biological, behavioural, and psychosocial factors as potential mediators. Finally, we employed multivariable Mendelian randomiza- tion to examine causal pathways between PTSD and CVD, incorporating the same potential mediators. Results Significant genetic correlations were found between PTSD and CAD, HT, and HF (rg =0.21-0.32, p < 3.08 x 10−16), but not between PTSD and AF. Insomnia, smoking, alcohol dependence, waist-to-hip ratio, and inflammation (IL6, C-reactive protein) partly mediated these associations. Mendelian randomization indicated that PTSD causally increases CAD (IVW OR=1.53, 95% CIs=1.19-1.96, p=0.001), HF (OR=1.44, CIs=1.08-1.92, p=0.012), and to a lesser degree hypertension (OR=1.25, CIs=1.05-1.49, p=0.012). While insomnia, smoking, alcohol, and inflammation were important mediators, independent causal effects also remained. Conclusions In addition to shared genetic liability between PTSD and CVD, we present strong evidence for causal effects of PTSD on CVD. Crucially, we implicate specific lifestyle and biological mediators (insomnia, substance use, inflammation) which has important implications for interventions to prevent CVD in PTSD patients.

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Psychological and biological mechanisms linking trauma with cardiovascular disease risk

Cited by 21 publications

References 247 publications

Childhood maltreatment and health in the UK Biobank: triangulation of outcome-wide and polygenic risk score analyses

Childhood maltreatment and health in the UK Biobank: triangulation of outcome-wide and polygenic risk score analyses

Improving the Early Assessment of Child Neglect Signs—A New Technique for Professionals

A genetic exploration of the relationship between Posttraumatic Stress Disorder and cardiovascular diseases

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