Adverse Childhood Experiences and the Risk of Coronary Heart Disease in Adulthood: Examining Potential Psychological, Biological, and Behavioral Mediators in the Whitehall II Cohort Study
Open accessAbstract
Background: This study investigated potential psycho‐bio‐behavioral mediators of the association between adverse childhood experiences (ACEs) and the risk of coronary heart disease (CHD) in adulthood. Methods and Results: Participants were 5610 British civil servants (mean age, 55.5; 28% women) from the Whitehall II cohort study without CHD at baseline in 1997 to 1999 (wave 5) when retrospective data on the number of ACEs were collected via questionnaire (range, 0–8). Potential mediators assessed at wave 5 included depression and anxiety symptoms, health behaviors (smoking, alcohol dependence, sleep, and physical activity), and cardiometabolic dysregulations. New diagnoses of CHD (myocardial infarction, definite angina, coronary artery bypass grafting, or percutaneous transluminal coronary angioplasty) were assessed from wave 6 (2001) to wave 11 (2012–2013). Logistic regressions examined associations between ACEs, potential mediators, and CHD during the follow‐up period. Natural indirect effects were examined using mediation analysis. A total of 566 (10.1%) participants developed CHD during the follow‐up period. ACEs were associated with an increased likelihood of CHD (odds ratio per ACE, 1.09; 95% CI, 1.00–1.19). Controlling for age and sex, mediation analyses revealed an indirect effect of depression symptoms (natural indirect effects, 1.05; 95% CI, 1.03–1.07), anxiety symptoms (natural indirect effects, 1.12; 95% CI, 1.10–1.15), and a greater number of cardiometabolic dysregulations (natural indirect effects, 1.02; 95% CI, 1.01–1.03) in the association between ACEs and incident CHD. Behavioral factors were not statistically significant mediators. Conclusions: Depression symptoms, anxiety symptoms, and cardiometabolic dysregulations partially mediated the association between ACEs and CHD. Regular screening and treatment of symptoms of psychological disorders and cardiometabolic dysregulations may help mitigate the long‐term health burden of ACEs.
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Chronic psychosocial stress exposure, including exposure to adverse childhood experiences or social or socioeconomic stress, promotes increased lifetime risk of cardiometabolic diseases such as type 2 diabetes, obesity, and cardiovascular disease.
“chronic psychosocial stress exposure, including exposure to adverse childhood experiences (ACEs) or social or socioeconomic stress, promotes increased lifetime risk of cardiometabolic diseases such as T2D, 131-133 obesity, 134,135 and cardiovascular disease.”
From The effects of sleep disruption on metabolism, hunger, and satiety, and the influence of psychosocial stress and exercise: A narrative review (2024) · cites this paper as [136]
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References 68 · Cited by 59
Research works printed but not linked: 3
- [41]World Health Organization. Global Recommendations on Physical Activity for Health. Geneva, Switzerland: World Health Organization; 2010. 26180873
- [52]Valeri L, VanderWeele TJ. Mediation analysis allowing for exposure–mediator interactions and causal interpretation: theoretical assumptions and implementation with SAS and SPSS macros. Psychol Methods. 2013; 18: 137. DOI: 10.1037/a0031034. 23379553 PMC3659198 · DOI · Paper page
- [55]Deschênes SS, Burns RJ, Schmitz N. Anxiety and depression symptom comorbidity and the risk of heart disease: a prospective community‐based cohort study. Psychosom Med. 2020; 82: 296– 304. DOI: 10.1097/PSY.0000000000000790. 32058463 · DOI
- Authors
- Deschênes, S. S., Kivimaki, M., & Schmitz, N.
- Affiliations
- University College Dublin (IE)
- Department of Epidemiology and Public Health University College London London United Kingdom
- Douglas Mental Health University Institute (CA)
- Corresponding author
- Deschênes, Sonya S.
- Venue
- Journal of the American Heart Association
- Published
- 2021-05-18
- Volume
- 10
- Issue
- 10
- Pages
- e019013-e019013
- ISSN
- 2047-9980 (ISSN-L)
- PMC
- PMC8200717
- OpenAlex
- W3158406334
- Cited by
- 59
- References
- 68
- Citations by year
- 2026: 10 · 2025: 11 · 2024: 15 · 2023: 11 · 2022: 9 · 2021: 3
- FWCI
- 6.48
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Journal of the American Heart Association (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- British Heart Foundation (RG/13/2/30098)
- NordForsk (R024227, 75021, K013351, 311492)
- National Institutes of Health
- Medical Research Council (MR/K013351/1, MR/R024227/1)
- National Institute on Aging (RF1AG062553, R01AG056477)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Social Sciences › Health › Health disparities and outcomes
- Keywords
- adverse childhood experiences, coronary artery disease, depressive symptoms, anxiety symptoms, mediation analysis, health behavior, myocardial infarction, public sector employees, psychological mediators, biological mediators
- MeSH terms
- Adverse Childhood Experiences, Adult, Anxiety, Behavior, Child, Coronary Disease, Depression, Female, Follow-Up Studies, United Kingdom, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, Stress, Psychological, Incidence
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