Bertele Sebastian, Heitland Ivo, Fraccarollo Daniela, Stapel Britta, Bauersachs Johann, Westhoff-Bleck Mechthild, Kahl Kai G
Department of Psychiatry, Social Psychiatry and Psychotherapy, Hanover Medical School, Hanover, Germany.
Department of Cardiology and Angiology, Hanover Medical School, Hanover, Germany.
Front Psychiatry. 2022 Oct 11;13:1002143. doi: 10.3389/fpsyt.2022.1002143. eCollection 2022.
Adverse childhood experiences (ACEs) are a major risk factor for unfavorable behavioral, mental and health outcomes later in life. However, the precise pathway which ACEs convey these risks, in particular regarding health outcomes such as cardiovascular disease, remains unknown. Here, we combined psychiatric and cardiac methods to investigate the pathway which childhood adversities may lead to adult adverse cardiovascular health, with a focus on epicardial adipose tissue (EAT) as a risk marker.
210 adult congenital heart disease outpatients (mean age 35.5 y, 43% female) completed a thorough cardiac and psychiatric evaluation. Psychiatric measurements included an expert interview, the childhood trauma questionnaire (CTQ), Beck's depression inventory II (BDI-II), quality of life and the global scale of functioning, amongst others. All patients completed a full cardiac workup including EAT assessment using echocardiography. We then computed bootstrapping mediation models using ACEs as a predictor, depression and physical activity as mediators and EAT as dependent variable in PROCESS.
CTQ scores had a significant indirect effect on EAT a serial mediation of BDI and physical activity [ab2d = 0.0260, 95% BCa CI [0.0047, 0.0619]].
Using mediation analyses, we show that adverse childhood events are linked to increased depressive symptoms, which are linked to decreased physical activity, which in turn are linked to a higher amount of epicardial adipose tissue. While other pathways most certainly exist and replication is needed, this suggests a meaningful pathway which ACEs lead to adverse cardiovascular health, with several potential targets for health interventions across time.
童年不良经历（ACEs）是日后出现不良行为、心理和健康后果的主要风险因素。然而，ACEs传递这些风险的确切途径，尤其是与心血管疾病等健康后果相关的途径，仍然未知。在此，我们结合精神病学和心脏学方法，研究童年逆境可能导致成人不良心血管健康的途径，重点关注心外膜脂肪组织（EAT）作为一种风险标志物。
210名成年先天性心脏病门诊患者（平均年龄35.5岁，43%为女性）完成了全面的心脏和精神病学评估。精神病学测量包括专家访谈、童年创伤问卷（CTQ）、贝克抑郁量表第二版（BDI-II）、生活质量和整体功能量表等。所有患者均完成了全面的心脏检查，包括使用超声心动图评估EAT。然后，我们在PROCESS中使用ACEs作为预测因子、抑郁和身体活动作为中介变量、EAT作为因变量，计算了自抽样中介模型。
CTQ评分对EAT有显著的间接影响——BDI和身体活动的系列中介作用[ab2d = 0.0260，95% BCa CI [0.0047，0.0619]]。
通过中介分析，我们表明童年不良事件与抑郁症状增加有关，抑郁症状增加与身体活动减少有关，而身体活动减少又与心外膜脂肪组织量增加有关。虽然肯定存在其他途径且需要重复验证，但这表明了一条ACEs导致不良心血管健康的有意义途径，且在不同阶段有几个潜在的健康干预靶点。
