Child maltreatment and cardiovascular disease risk: examining psychosocial and immunological pathways in a prospective, longitudinal cohort

儿童虐待与心血管疾病风险：研究儿童的心理社会和免疫途径 一个具有前瞻性的纵向队列 派：汉娜·M·C·施赖尔 项目摘要/摘要 超过三分之一的美国年轻人在18岁之前因虐待儿童(CM)而接受调查。CM代表 对年轻人的心理和身体健康有深远影响的特别强大的早期生活压力源。 除其他因素外，CM增加了心血管疾病(CVD)的风险，这是32%的 所有发生在美国的死亡，其根源都可以在童年时期找到。因此，一个更好的 对CM与心血管疾病风险增加相关的生理机制的理解是 需要改善有心肌梗塞病史的年轻人的终身健康轨迹，这是一种尚未得到充分研究的高风险疾病 以及更好地了解早期生活逆境与晚年健康之间的生物学机制 更笼统地说。拟议的项目将建立在目前正在进行的儿童健康研究(CHS；HD089922， PI：Noll，Co-I：Schreier)，其中包括最近接受CM AS调查的675名8-13岁青年 此外，还招募了225名没有CM病史的对照青年，并对其进行了前瞻性跟踪。拿走 利用这一独特的和特别好的特征队列，我们将扩大生物心理社会 已经收集了数据来检查深入的免疫功能结果。为此，该项目将 评估体外微生物攻击后刺激的促炎和抗炎细胞因子的产生， 白细胞对糖皮质激素信号的敏感性，最后是潜在的病毒调节 多个时间点。这将使我们能够前瞻性和详细地调查 暴露于CM和免疫功能结果，这将是第一个在最近的样本中这样做的研究 虐待青年。此外，我们将能够将由此产生的免疫功能结果与早期 这些年轻人中心血管疾病风险的指标，既通过与现有的心脏代谢风险测量相联系，又通过与 并进一步链接到青年的行政记录，特别是医疗补助索赔数据。这将是 首次研究免疫功能结果与心血管疾病相关医疗保健使用之间的关系 在年轻人中间。最后，我们将调查包括青年在内的可塑性保护因素的程度 生活方式、家庭和同伴环境可能会保护年轻人免受CM对免疫系统改变的不利影响 功能结果和关键人口统计变量(年龄、青春期阶段、性别、 种族/民族、CM严重性)起了作用。跨学科研究团队包括 评估弱势青年的免疫功能结果和心血管疾病风险；招募和 保留未来的CM幸存者队列；以及使用行政记录回答问题 关于有CM病史的年轻人的幸福。由此产生的数据将对 CM和早期生活中的逆境文献。它还将向未来的预防和干预工作提供信息， 最终目标是减少不利的长期健康后果的风险，其中最 这将有助于减少人口中的弱势群体，并降低CM产生的医疗成本。

Child Maltreatment and Cardiovascular Disease Risk: Examining Psychosocial and Immunological Pathways in a Prospective, Longitudinal Cohort PI: Hannah M. C. Schreier PROJECT SUMMARY / ABSTRACT Over one third of U.S. youth are investigated for child maltreatment (CM) before the age of 18. CM represents an especially potent early life stressor with a profound impact on youth’s psychological and physical well-being. Among other things, CM increases the risk for cardiovascular disease (CVD), which is responsible for 32% of all deaths in the U.S. and the roots of which can already be found during childhood. Thus, a better understanding of the physiological mechanisms through which CM is associated with increased CVD risk is needed to improve the lifelong health trajectories of youth with a CM history, a high-risk yet understudied group, as well as to better understand biological mechanisms connecting early life adversity to later life health more generally. The proposed project will build on the currently ongoing Child Health Study (CHS; HD089922, PI: Noll, Co-I: Schreier), as part of which 675 youth aged 8-13 years who were recently investigated for CM as well as 225 comparison youth without a history of CM are being recruited and followed prospectively. Taking advantage of this unique and exceptionally well-characterized cohort, we will augment the biopsychosocial data already being collected to examine in-depth immune function outcomes. To this end, this project will assess stimulated pro- and anti-inflammatory cytokine production following in vitro microbial challenge, sensitivity to glucocorticoid signaling among white blood cells, and, finally, latent virus regulation, all across multiple timepoints. This will allow us to investigate prospectively and in detail the associations between exposure to CM and immune function outcomes and will be the first study to do so in a sample of recently maltreated youth. Additionally, we will be able to link the resulting immune function outcomes to early indicators of CVD risk among these youth, both by linking to existing measures of cardiometabolic risk in the cohort and further by linking to youth’s administrative records, specifically Medicaid claims data. This will be the first study to examine connections between immune function outcomes and CVD-relevant health care use among youth. Finally, we will be investigating the extent to which malleable protective factors, including youth lifestyle, family and peer environments, may protect youth from the adverse effects of CM on altered immune function outcomes and the extent to which key demographic moderators (age, pubertal stage, gender, race/ethnicity, CM severity) play a role. The interdisciplinary research team includes expertise in the assessment of immune function outcomes and CVD risk among vulnerable youth; the recruitment and retention of prospective cohorts of CM survivors; and the use of administrative records to answer questions pertaining to the well-being of youth with a history of CM. Resulting data will make important contributions to the CM and early life adversity literatures. It will also inform future prevention and intervention efforts with the ultimate goal of reducing the risk of adverse long-term health consequences among some of the most vulnerable individuals in the population as well as reducing the healthcare costs resulting from CM.