Abstract
Background
Childhood maltreatment has been consistently associated with cardiovascular disease (CVD). However, the mechanisms of this relationship are not yet fully understood. We explored the relative contribution of anxiety/depression, smoking, body mass index (BMI) and inflammation (C-reactive protein, CRP) to the association between childhood maltreatment and CVD in men and women aged 40–69 years in the UK.
Methods
We used data from 40 596 men and 59 511 women from UK Biobank. To estimate the indirect effects of childhood maltreatment (physical, sexual and emotional abuse, and emotional and physical neglect) on incident CVD via each of the mediators, we applied a sequential mediation approach.
Results
All forms of maltreatment were associated with increased CVD risk [hazard ratios (HRs) ranging from 1.09 to 1.27]. Together, anxiety/depression, smoking, BMI and inflammation (indexed by CRP) mediated 26–90% of the association between childhood maltreatment and CVD, and the contribution of these mediators differed by type of maltreatment and sex. Anxiety/depression mediated the largest proportion of the association of sexual abuse, emotional abuse and emotional neglect with CVD (accounting for 16–43% of the total effect), especially in women. In men, BMI contributed the most to the indirect effect of associations of physical abuse and physical neglect with CVD; in women, anxiety/depression and BMI had similar contributions.
Conclusions
These findings add to the understanding of how childhood maltreatment affects CVD risk and identify modifiable mediating factors that could potentially reduce the burden of CVD in people exposed to maltreatment in early life.
Childhood maltreatment has been consistently associated with cardiovascular disease (CVD). However, the mechanisms of this relationship are not yet fully understood. We explored the relative contribution of anxiety/depression, smoking, body mass index (BMI) and inflammation (C-reactive protein, CRP) to the association between childhood maltreatment and CVD in men and women aged 40–69 years in the UK.
Methods
We used data from 40 596 men and 59 511 women from UK Biobank. To estimate the indirect effects of childhood maltreatment (physical, sexual and emotional abuse, and emotional and physical neglect) on incident CVD via each of the mediators, we applied a sequential mediation approach.
Results
All forms of maltreatment were associated with increased CVD risk [hazard ratios (HRs) ranging from 1.09 to 1.27]. Together, anxiety/depression, smoking, BMI and inflammation (indexed by CRP) mediated 26–90% of the association between childhood maltreatment and CVD, and the contribution of these mediators differed by type of maltreatment and sex. Anxiety/depression mediated the largest proportion of the association of sexual abuse, emotional abuse and emotional neglect with CVD (accounting for 16–43% of the total effect), especially in women. In men, BMI contributed the most to the indirect effect of associations of physical abuse and physical neglect with CVD; in women, anxiety/depression and BMI had similar contributions.
Conclusions
These findings add to the understanding of how childhood maltreatment affects CVD risk and identify modifiable mediating factors that could potentially reduce the burden of CVD in people exposed to maltreatment in early life.
| Original language | English |
|---|---|
| Article number | dyab085 |
| Pages (from-to) | 555-566 |
| Number of pages | 12 |
| Journal | International Journal of Epidemiology |
| Volume | 51 |
| Issue number | 2 |
| Early online date | 26 May 2021 |
| DOIs | |
| Publication status | Published - 30 Apr 2022 |
Bibliographical note
FundingA.L.G.S., G.H., L.D.H. and A.F. work in a unit that receives support from the University of Bristol and UK Medical Research Council [MC_UU_00011/6]. A.F. and A.L.G.S. are funded by the UK Medical Research Council fellowship to A.F. [MR/M009351/1]. A.L.G.S. is supported by the study of Dynamic longitudinal exposome trajectories in cardiovascular and metabolic non-communicable diseases [H2020-SC1-2019-Single-Stage-RTD, project ID 874739]. G.H. is funded by a Sir Henry Wellcome Postdoctoral Fellowship [209138/Z/17/Z]. L.D.H. is funded by a UK Medical Research Council fellowship [MR/M020894/1]. M.C.M. works at the Centre for Fertility and Health supported by the Research Council of Norway through its Centres of Excellence funding scheme [project number 262700].
This research was funded in whole, or in part, by the Wellcome Trust [209138/Z/17/Z]. For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. The study funders had no role in the study design, collection, analysis and interpretation of the data or report writing. The corresponding author had full access to the data and the final responsibility to submit for publication.
Data availability
The UK Biobank is an open-access resource and the data reported in this study are available via application to the UK Biobank.
Keywords
- Childhood maltreatment
- UK Biobank
- cardiovascular disease
- intermediate confounding
- sequential mediation analysis
ASJC Scopus subject areas
- Epidemiology
