Child Abuse and Neglect and Subclinical Cardiovascular Disease Among Midlife Women.
Child Abuse and Neglect and Subclinical Cardiovascular Disease Among Midlife Women.
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DOI：
10.1097/psy.0000000000000400
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发表时间：
2017-05
影响因子：
3.3
通讯作者：
Matthews KA
中科院分区：
文献类型：
--
作者：
Thurston RC;Chang Y;Barinas-Mitchell E;von Känel R;Jennings JR;Santoro N;Landsittel DP;Matthews KA
儿童期虐待或忽视史可能与成人心血管疾病（CVD）风险升高有关。没有研究使用有效的虐待和忽视措施来检查儿童虐待/忽视与亚临床CVD之间的关联。我们假设有童年虐待或忽视史的中年妇女会增加亚临床CVD超过标准CVD危险因素。我们通过睡眠、潮热和种族/民族测试了关联的适度性。295名中年女性完成了儿童创伤问卷、生理性潮热和活动记录睡眠监测、抽血和颈动脉超声（内膜中层厚度、IMT;斑块）。虐待/忽视和结果之间的关系进行了测试的线性回归模型调整人口，心理和心血管疾病的风险因素。测试了与睡眠、潮热和种族/民族的相互作用。45%的女性报告有虐待或忽视儿童的历史。有任何儿童虐待或忽视的妇女与未受虐待/忽视的妇女相比，IMT [B（SE）= 0.039（0.011），p<0.01]和颈动脉斑块[OR（95%CI= 1.95（1.15-3.33），p<0.05]更高。此外，身体虐待、情感虐待或情感忽视与较高的亚临床CVD相关。性虐待与非白人女性IMT升高相关。与睡眠时间和睡眠潮热的相互作用（p值<.05）表明，有虐待/忽视史的亚临床CVD较高，主要见于睡眠<6小时/夜或睡眠潮热的女性。儿童虐待或忽视史与女性亚临床CVD较高相关，特别是与睡眠不足或潮热配对时。研究结果强调了童年逆境在中年女性CVD风险中的重要性。
A childhood history of abuse or neglect may be associated with elevated adult cardiovascular disease (CVD) risk. No studies have examined associations between child abuse/neglect and subclinical CVD using a validated measure of abuse and neglect. We hypothesized that midlife women with a childhood abuse or neglect history would have increased subclinical CVD beyond standard CVD risk factors. We tested moderation of associations by sleep, hot flashes, and race/ethnicity. 295 midlife women completed the Child Trauma Questionnaire, physiologic hot flash and actigraphic sleep monitoring, blood draw, and carotid ultrasound (intima media thickness, IMT; plaque). Relations between abuse/neglect and outcomes were tested in linear regression models adjusting for demographic, psychosocial, and CVD risk factors. Interactions with sleep, hot flashes, and race/ethnicity were tested. 45% of women reported a history of child abuse or neglect. Women with any child abuse or neglect had higher IMT [b(SE)=.039(.011), p<.01] and carotid plaque [OR(95%CI= 1.95 (1.15–3.33), p<.05] than non-abused/neglected women. Further, physical abuse, emotional abuse, or emotional neglect were associated with higher subclinical CVD. Sexual abuse was associated with higher IMT among nonwhite women. Interactions with sleep time and sleep hot flashes (p values <.05) indicated that higher subclinical CVD with an abuse/neglect history was observed primarily among women sleeping <6 hours/night or with sleep hot flashes. A history of child abuse or neglect is associated with higher subclinical CVD in women, particularly when paired with short sleep or hot flashes. Findings underscore the importance of childhood adversity in midlife women’s CVD risk.