Bakema Maryse J, van Zuiden Mirjam, Collard Didier, Zantvoord Jasper B, de Rooij Susanne R, Elsenburg Leonie K, Snijder Marieke B, Stronks Karien, van den Born Bert-Jan H, Lok Anja
Department of Psychiatry, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, Netherlands.
Department of Internal and Vascular Medicine, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, Netherlands.
Front Psychiatry. 2020 Mar 17;11:69. doi: 10.3389/fpsyt.2020.00069. eCollection 2020.
A mounting body of literature emphasizes the potential negative effects of adverse childhood experiences (ACEs) on both mental and physical health throughout life, including an increased risk for developing cardiovascular disease (CVD). Since CVD is one of the leading causes of mortality and morbidity worldwide, it is of great importance to advance our understanding of the effects of on CVD. This holds both for the actual incidence and for intermediate biological pathways that may convey CVD risk, such as imbalance in autonomic nervous system regulation, resulting in a chronically heightened sympathetic activity and lowered reactivity. In a large urban, multi-ethnic population-based cohort study we investigated whether there is an association between child maltreatment, CVD incidence and autonomic regulation.
Within the Health in an Urban Setting (HELIUS) study, a large, multi-ethnic population cohort study including n = 22,165 Amsterdam residents, we used logistic regression analyses to investigate the association between the number of self-reported types of child maltreatment (range 0-4), and self-reported adverse cardiovascular outcome (aCVO). Self-reported child maltreatment included emotional neglect, emotional abuse, physical abuse, and sexual abuse. Furthermore, in a subsample (n = 10,260), mean age 44.3, we investigated associations between child maltreatment, autonomic regulation, and aCVO using linear regression analyses. Both baroreflex sensitivity (BRS) and heart rate variability (HRV) were assessed as non-invasive indices of autonomic regulation.
The number of endorsed child maltreatment types was significantly associated with a higher aCVO risk. The association remained significant after adjustment for demographic, socioeconomic, health-behavioral, and psychological covariates (p = 0.011, odds ratio: 1.078, confidence interval: 1.018-1.142). The cumulative exposure to child maltreatment was negatively associated with BRS and HRV, but the association was no longer significant after correction for socioeconomic and demographic covariates.
In a large, multi-ethnic urban-population cohort study we observed a positive association between number of endorsed child maltreatment types and self-reported aCVO but not autonomic regulation, over and above the effect of relevant demographic, health, and psychological factors. Future studies should examine the potential role of the dynamics of autonomic dysregulation as potential underlying biological pathways in the association between ACEs and CVD, as this could eventually facilitate the development of preventive and therapeutic strategies for CVD.
越来越多的文献强调童年不良经历（ACEs）对一生中心理和身体健康的潜在负面影响，包括患心血管疾病（CVD）风险增加。由于CVD是全球死亡和发病的主要原因之一，加深我们对其影响的理解非常重要。这对于实际发病率以及可能传递CVD风险的中间生物学途径都适用，比如自主神经系统调节失衡，导致交感神经活动长期增强和反应性降低。在一项基于城市多民族人群的大型队列研究中，我们调查了儿童虐待、CVD发病率与自主调节之间是否存在关联。
在“城市健康”（HELIUS）研究中，这是一项包含n = 22,165名阿姆斯特丹居民的大型多民族人群队列研究，我们使用逻辑回归分析来研究自我报告的儿童虐待类型数量（范围为0 - 4）与自我报告的不良心血管结局（aCVO）之间的关联。自我报告的儿童虐待包括情感忽视、情感虐待、身体虐待和性虐待。此外，在一个平均年龄为44.3岁的子样本（n = 10,260）中，我们使用线性回归分析研究儿童虐待、自主调节与aCVO之间的关联。压力反射敏感性（BRS）和心率变异性（HRV）均作为自主调节的非侵入性指标进行评估。
认可的儿童虐待类型数量与较高的aCVO风险显著相关。在对人口统计学、社会经济、健康行为和心理协变量进行调整后，该关联仍然显著（p = 0.011，优势比：1.078，置信区间：1.018 - 1.142）。儿童虐待的累积暴露与BRS和HRV呈负相关，但在对社会经济和人口统计学协变量进行校正后，该关联不再显著。
在一项大型多民族城市人群队列研究中，我们观察到认可的儿童虐待类型数量与自我报告的aCVO之间存在正相关，但与自主调节无关，这超出了相关人口统计学、健康和心理因素的影响。未来的研究应检查自主神经调节异常动态变化作为ACEs与CVD之间关联潜在基础生物学途径的潜在作用，因为这最终可能有助于开发CVD的预防和治疗策略。
