Insights into causal pathways for ischemic heart disease - Adverse childhood experiences study
Insights into causal pathways for ischemic heart disease - Adverse childhood experiences study
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DOI：
10.1161/01.cir.0000143074.54995.7f
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发表时间：
2004-09-28
期刊：
影响因子：
37.8
通讯作者：
Anda, RF
中科院分区：
文献类型：
--
作者：
Dong, MX;Giles, WH;Anda, RF
背景-本研究的目的是评估包括虐待、忽视和家庭功能障碍在内的不良童年经历(ACE)与缺血性心脏病(IHD)风险的关系，并考察传统的IHD危险因素和与AHD相关的心理因素对这种关系的中介影响。方法和结果：从1995年至1997年收集了17337名成人健康计划成员的回顾性队列调查数据。校正了年龄、性别、种族和教育的Logistic回归被用来估计ACE-IHD关系的强度以及IHD危险因素在这种关系中的中介影响。与没有ACEs的人相比，10种ACEs中的九种显著增加了IHD的风险1.3-1.7倍。调整后的优势比为3.6(95%可信区间，2.4至5.3)。与传统的IHD危险因素相比，ACE-IHD的关系更多地受到与ACE相关的个体心理危险因素的影响。我们观察到，报告的IHD(调整后的ORs)增加的可能性与抑郁情绪(2.1，1.9至2.4)和愤怒(2.5，2.1至3.0)以及传统危险因素(吸烟、缺乏运动、肥胖、糖尿病和高血压)之间存在显著关联，OR范围为1.2至2.7。结论-我们发现ACEs对IHD的剂量-反应关系，以及几乎所有个体ACEs与IHD的关系。在ACEs与IHD风险之间的关系中，心理因素似乎比传统的风险因素更重要。这些发现进一步揭示了童年的紧张经历可能会增加成年后患IHD的风险的潜在途径。
Background-The purpose of this study was to assess the relation of adverse childhood experiences (ACEs), including abuse, neglect, and household dysfunction, to the risk of ischemic heart disease (IHD) and to examine the mediating impact on this relation of both traditional IHD risk factors and psychological factors that are associated with ACEs.Methods and Results-Retrospective cohort survey data were collected from 17 337 adult health plan members from 1995 to 1997. Logistic regression adjusted for age, sex, race, and education was used to estimate the strength of the ACE-IHD relation and the mediating impact of IHD risk factors in this relation. Nine of 10 categories of ACEs significantly increased the risk of IHD by 1.3- to 1.7-fold versus persons with no ACEs. The adjusted odds ratios for IHD among persons with greater than or equal to7 ACEs was 3.6 (95% CI, 2.4 to 5.3). The ACE-IHD relation was mediated more strongly by individual psychological risk factors commonly associated with ACEs than by traditional IHD risk factors. We observed significant association between increased likelihood of reported IHD (adjusted ORs) and depressed affect (2.1, 1.9 to 2.4) and anger (2.5, 2.1 to 3.0) as well as traditional risk factors (smoking, physical inactivity, obesity, diabetes and hypertension), with ORs ranging from 1.2 to 2.7.Conclusions-We found a dose-response relation of ACEs to IHD and a relation between almost all individual ACEs and IHD. Psychological factors appear to be more important than traditional risk factors in mediating the relation of ACEs to the risk of IHD. These findings provide further insights into the potential pathways by which stressful childhood experiences may increase the risk of IHD in adulthood.