Sex-Specific Differences in the Association Between Childhood Adversity and Cardiovascular Disease in Adulthood: Evidence From a National Cohort Study
Sex-Specific Differences in the Association Between Childhood Adversity and Cardiovascular Disease in Adulthood: Evidence From a National Cohort Study
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DOI：
10.1016/j.cjca.2017.05.008
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发表时间：
2017-08-01
影响因子：
6.2
通讯作者：
Colman, Ian
中科院分区：
文献类型：
--
作者：
Garad, Yasmin;Maximova, Katerina;Colman, Ian
背景：童年期的逆境会增加成年期心血管疾病（CVD）的风险。以前提出的机制表明，该协会是介导的应激反应，已知是更高的妇女和加重成人的压力，但这尚未得到证实。因此，我们调查了性别差异，以更好地了解可能的途径，从童年逆境到CVD.Methods：全国人口健康调查，15年的队列研究，年龄在18-49岁的加拿大人在基线。Logistic回归与性别和应激性生活事件的交互作用被用来评估儿童期逆境后心血管疾病的风险。在二次分析中，我们使用系数乘积法评估了抑郁、吸烟、饮酒、运动和饮食的中介作用。结果：3+儿童期逆境与心血管疾病之间有很强的相关性（优势比[OR]，2.14，95%可信区间[CI]，1.562.94）。随着应激事件的增加，这种关联更强，并且具有3+应激事件的女性患者表现出CVD的最高风险（OR，4.40; 95%CI，1.98-9.75）。抑郁、吸烟和不良饮食部分介导了儿童期逆境与心血管疾病之间的关系（分别为14%、9%和9%），但这些行为的差异并不能完全解释中介调节分析中的性别特异性差异。儿童期不良事件对女性心血管疾病的影响更大，尤其是成年期压力大的女性，这种差异不是由抑郁、吸烟或不良饮食引起的。这些发现对于理解CVD风险的性别差异具有重要意义。
Background: Childhood adversity increases the risk for cardiovascular disease (CVD) in adulthood. Previously proposed mechanisms suggest that the association is mediated by stress reactivitydknown to be higher in womendand is aggravated by adult stress, but this has not yet been confirmed. Therefore, we investigated sex differences to better understand possible pathways from childhood adversity to CVD.Methods: The National Population Health Survey, a 15-year cohort study of Canadians aged 18-49 years at baseline was used. Logistic regression with interaction terms for sex and stressful life events was used to assess the risk of CVD after childhood adversity. In secondary analyses, we assessed mediation effects of depression, smoking, alcohol, exercise, and diet using the product of coefficient approach. Mediated moderation was subsequently used to explain sexmoderated effects.Results: There was a strong association between childhood adversity and CVD (odds ratio [OR], 2.14; 95% confidence interval [CI], 1.562.94) for 3+ childhood adversities. The association was stronger with increasing stressful events, and female patients with 3+ stressful events exhibited the highest risk of CVD (OR, 4.40; 95% CI, 1.98-9.75).association was found in men. Depression, smoking, and poor diet partially mediated the relationship between childhood adversity and CVD (14%, 9%, and 9%, respectively), but differences in these behaviours did not fully explain the sex-specific differences in the mediated moderation analysis.Conclusions: The effect of childhood adverse events on CVD is heightened among women, particularly women with stressful adulthoods, and this difference is not mediated by depression, smoking, or poor diet. These findings have important implications for understanding sex differences in CVD risk.