School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
Center for Research on Population Health, National Institute of Public Health, Mexico City, Mexico.
J Am Heart Assoc. 2017 Aug 17;6(8):e006249. doi: 10.1161/JAHA.117.006249.
Violence against women has become a global public health threat. Data on the potential impact of exposure to violence on cardiovascular disease are scarce.
We evaluated the association between exposure to violence and subclinical cardiovascular disease in 634 disease-free women from the Mexican Teachers' Cohort who responded to violence-related items from the Life Stressor Checklist and underwent measures of carotid artery intima-media thickness in 2012 and 2013. We defined exposure to violence as having ever been exposed to physical and/or sexual violence. Intima-media thickness was log-transformed, and subclinical carotid atherosclerosis was defined as intima-media thickness ≥0.8 mm or plaque. We used multivariable linear and logistic regression models adjusted for several potential confounders. Mean age was 48.9±4.3 years. Close to 40% of women reported past exposure to violence. The lifetime prevalence of sexual violence was 7.1%, and prevalence of physical violence was 23.5% (7.7% reported both sexual and physical violence). Relative to women with no history of violence, exposure to violence was associated with higher intima-media thickness (adjusted mean percentage difference=2.4%; 95% confidence interval 0.5, 4.3) and subclinical atherosclerosis (adjusted odds ratio=1.60; 95% confidence interval 1.10, 2.32). The association was stronger for exposure to physical violence, especially by mugging or physical assault by a stranger (adjusted mean % difference=4.6%; 95% confidence interval 1.8, 7.5, and odds ratio of subclinical carotid atherosclerosis=2.06; 95% confidence interval 1.22, 3.49).
Exposure to violence, and in particular assault by a stranger, was strongly associated with subclinical cardiovascular disease in Mexican middle-aged women.
针对女性的暴力行为已成为全球公共健康的一大威胁。目前有关接触暴力行为对心血管疾病潜在影响的数据较为匮乏。
我们评估了 634 名无疾病的墨西哥教师队列女性中，接触暴力与亚临床心血管疾病之间的关联，这些女性对生活应激清单中的与暴力相关项目做出了回应，并在 2012 年至 2013 年期间接受了颈动脉内膜中层厚度的检测。我们将接触暴力定义为曾经历过身体暴力和/或性暴力。将内膜中层厚度取自然对数，亚临床颈动脉粥样硬化定义为内膜中层厚度≥0.8mm 或斑块。我们使用了经过多种潜在混杂因素调整的多变量线性和逻辑回归模型。平均年龄为 48.9±4.3 岁。近 40%的女性报告曾有过接触暴力的经历。终生性暴力的发生率为 7.1%，身体暴力的发生率为 23.5%（7.7%的人报告同时经历过性暴力和身体暴力）。与没有暴力史的女性相比，接触暴力与更高的内膜中层厚度（调整后的平均百分比差异=2.4%；95%置信区间 0.5, 4.3）和亚临床动脉粥样硬化（调整后的比值比=1.60；95%置信区间 1.10, 2.32）相关。接触身体暴力的关联更强，尤其是被抢劫者或陌生人殴打（调整后的平均差异百分比=4.6%；95%置信区间 1.8, 7.5，亚临床颈动脉粥样硬化的比值比=2.06；95%置信区间 1.22, 3.49）。
接触暴力，尤其是被陌生人袭击，与墨西哥中年女性的亚临床心血管疾病密切相关。
