Appleton Allison A, Lee Serim, Kuniholm Mark H, Vásquez Elizabeth, Cohen Mardge H, Donohue Jessica, Floris-Moore Michelle, Friedman M Reuel, Gustafson Deborah, Hanna David B, Jones Deborah L, Mimiaga Matthew J, Moran Caitlin A, Plankey Michael W, Shitole Sanyog G, Teplin Linda A, Ware Deanna, Wise Jenni M
Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY.
Department of Social Welfare, Ewha Womans University, Seoul, South Korea.
AIDS. 2025 Sep 1;39(11):1621-1631. doi: 10.1097/QAD.0000000000004235. Epub 2025 May 14.
Adverse childhood experiences (ACEs) are traumatic events occurring before age 18 and can increase cardiovascular disease (CVD) risk. Many sexual minority men (SMM) and men with HIV (MWH) have trauma histories and elevated CVD risk. We investigated the association between ACEs and CVD risk among SMM with and without HIV (MWH and MWOH).
Data were from the Multicenter AIDS Cohort Study ( n = 1245; n = 650 MWOH, n = 595 MWH). Participants self-reported 20 ACEs reflecting household dysfunction and victimization. CVD risk was measured with Framingham (FRS-H) and American College of Cardiology/American Heart Association-Pooled Cohort Equation (ACC/AHA-PCE) scores. Longitudinal generalized estimating equations (GEE) using 10 years of repeated CVD measures were examined with each ACE type, total number of ACEs, and ACE latent classes.
The prevalence of each ACE was high, ranging from 50.3 to 83.8%. Childhood sexual orientation-related victimization was positively associated with CVD risk for MWOH ( βFRS-H = 2.95, SE = 1.48, P = 0.005; βACC/AHA-PCE = 3.31, SE = 1.48, P = 0.002) and MWH ( βFRS-H = 2.69, SE = 1.58, P = 0.03; βACC/AHA-PCE = 2.82, SE = 1.62, P = 0.03). Among MWH, ACE Class 2 (characterized by high sexual orientation-related victimization, moderate levels of parental abuse, and household dysfunction) was associated with higher CVD risk ( βFRS-H = 3.63, SE = 1.78, P = 0.03; βACC/AHA-PCE = 3.09, SE = 1.78, P = 0.05). Dose-response associations were observed for the full sample when considering the total number of ACEs, though attenuated in models stratified by HIV status.
ACEs were associated with CVD risk among MWH and MWOH. Assessing ACE history in clinical encounters may yield important insights for the prevention and management of CVD. This study underscores the importance of trauma-informed care for this population.
童年不良经历（ACEs）是指18岁之前发生的创伤性事件，会增加心血管疾病（CVD）风险。许多性少数男性（SMM）和感染艾滋病毒的男性（MWH）都有创伤史且心血管疾病风险升高。我们调查了感染艾滋病毒的SMM（MWH）和未感染艾滋病毒的SMM（MWOH）中ACEs与心血管疾病风险之间的关联。
数据来自多中心艾滋病队列研究（n = 1245；n = 650名MWOH，n = 595名MWH）。参与者自我报告了20种反映家庭功能障碍和受侵害情况的ACEs。使用弗雷明汉（FRS-H）和美国心脏病学会/美国心脏协会合并队列方程（ACC/AHA-PCE）评分来衡量心血管疾病风险。使用10年重复的心血管疾病测量数据，通过纵向广义估计方程（GEE）对每种ACE类型、ACEs总数和ACE潜在类别进行了研究。
每种ACE的患病率都很高，范围从50.3%到83.8%。童年与性取向相关的受侵害情况与MWOH（βFRS-H = 2.95，标准误 = 1.48，P = 0.005；βACC/AHA-PCE = 3.31，标准误 = 1.48，P = 0.002）和MWH（βFRS-H = 2.69，标准误 = 1.58，P = 0.03；βACC/AHA-PCE = 2.82，标准误 = 1.62，P = 0.03）的心血管疾病风险呈正相关。在MWH中，ACE类别2（其特征为与性取向相关的高受侵害情况、中度的父母虐待和家庭功能障碍）与较高的心血管疾病风险相关（βFRS-H = 3.63，标准误 = 1.78，P = 0.03；βACC/AHA-PCE = 3.09，标准误 = 1.78，P = 0.05）。在考虑ACEs总数时，全样本中观察到了剂量反应关联，不过在按艾滋病毒感染状况分层的模型中有所减弱。
ACEs与MWH和MWOH的心血管疾病风险相关。在临床诊疗中评估ACE病史可能会为心血管疾病的预防和管理提供重要见解。本研究强调了对该人群进行创伤知情护理的重要性。
