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Cardiac risk factors and prevention
Original research
Sex differences in the association between childhood maltreatment and cardiovascular disease in the UK Biobank
  1. Ana Luiza Gonçalves Soares1,2,
  2. Gemma Hammerton1,2,
  3. Laura D Howe1,2,
  4. Janet Rich-Edwards3,4,
  5. Sarah Halligan5,6,
  6. Abigail Fraser1,2
  1. 1 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
  2. 2 MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
  3. 3 Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
  4. 4 Brigham and Women’s Hospital and Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
  5. 5 Department of Psychology, University of Bath, Bath, UK
  6. 6 Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
  1. Correspondence to Dr Ana Luiza Gonçalves Soares, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2BN, UK; analuiza.soares{at}bristol.ac.uk

Abstract

Objectives To assess and compare associations between childhood maltreatment and cardiovascular disease (CVD) in men and women in the UK. In secondary analyses, we also explored possible age differences and associations with early onset CVD (<50 years).

Methods We included 157 311 participants from the UK Biobank who had information on physical, sexual or emotional abuse, emotional or physical neglect. CVD outcomes were defined as any CVD, hypertensive disease, ischaemic heart disease (IHD) and cerebrovascular disease. These were extracted from self-report, blood pressure measurements, hospital register and death register. The associations between maltreatment and CVD were assessed using Poisson regression with robust variance to estimate risk ratios, stratified by sex and adjusted for socioeconomic and demographic factors.

Results All types of maltreatment were associated with increased risk of CVD and IHD in both sexes. Additionally, in women all types of maltreatment were associated with higher risk of hypertensive disease, and all, except emotional neglect, were associated with cerebrovascular disease. In men, all but sexual abuse, were associated with higher risk of hypertensive disease, and all, except physical and sexual abuse, were associated with cerebrovascular disease. Associations were generally stronger in women, and individuals who were younger at baseline had stronger associations of childhood maltreatment with any CVD and IHD, but age differences were less evident when only early onset CVD was considered.

Conclusions Childhood maltreatment was consistently associated with CVD and stronger associations were generally observed in women and seemed to be stronger for early onset CVD.

  • cardiac risk factors and prevention
  • heart disease
  • epidemiology
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/heartjnl-2019-316320

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    Footnotes

    • Twitter @ana_lg_soares

    • Contributors AF and ALGS designed the study. ALGS analysed the data and with AF drafted the manuscript. ALGS, GH, LDH, JR-E, SH and AF interpreted the data. All authors contributed to revising the manuscript critically for important intellectual content. All authors approved the version of the manuscript to be published. ALGS and AF are the guarantors. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

    • Funding ALGS, GH, LDH and AF work in a Unit that receives support from the University of Bristol and UK Medical Research Council (MC_UU_00011/6). AF and ALGS are funded by UK Medical Research Council fellowship to AF (MR/M009351/1). GH is funded by a Sir Henry Wellcome Postdoctoral Fellowship (209138/Z/17/Z). LDH is funded by a UK Medical Research Council fellowship (MR/M020894/1).

    • Disclaimer The study funders had no role in the study design, collection, analysis, and interpretation of data or report writing. The corresponding author had full access to the data and the final responsibility to submit for publication.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval The UK Biobank received ethical approval from the National Health Service National Research Ethics Service (11/ NW/0382).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available. All data relevant to the study are included in the article or uploaded as supplementary information. The UK Biobank is an open access resource, and the data reported in this study are available via application to the UK Biobank.

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