Shabatun J Islam1, Jeong Hwan Kim1, Emma Joseph1, Matthew Topel1, Peter Baltrus2,3, Chang Liu1,4, Yi-An Ko4, Zakaria Almuwaqqat1, Mahasin S Mujahid5, Mario Sims6, Mohamed Mubasher2, Kiran Ejaz1, Charles Searles1, Sandra B Dunbar7, Priscilla Pemu8, Herman Taylor8, J Douglas Bremner9,10, Viola Vaccarino1,11, Arshed A Quyyumi1, Tené T Lewis11. 1. Department of Medicine, Division of Cardiology (S.J.I., J.H.K., E.J., M.T., C.L., Z.A., K.E., C.S., V.V., A.A.Q.), Emory University School of Medicine, Atlanta, GA. 2. Department of Community Health and Preventive Medicine (P.B., M.M.), Morehouse School of Medicine, Atlanta, GA. 3. National Center for Primary Care (P.B.), Morehouse School of Medicine, Atlanta, GA. 4. Department of Biostatistics and Bioinformatics (C.L., Y.-A.K.), Emory University, Atlanta, GA. 5. Division of Epidemiology, School of Public Health, University of California, Berkeley (M.S.M.). 6. Department of Medicine, University of Mississippi Medical Center, Jackson (M.S.). 7. Rollins School of Public Health, and Nell Hodgson Woodruff School of Nursing (S.B.D.), Emory University, Atlanta, GA. 8. Department of Medicine (P.P., H.T.), Morehouse School of Medicine, Atlanta, GA. 9. Department of Psychiatry and Behavioral Sciences (J.D.B.), Emory University School of Medicine, Atlanta, GA. 10. Department of Radiology (J.D.B.), Emory University School of Medicine, Atlanta, GA. 11. Department of Epidemiology (V.V., T.T.L.), Emory University, Atlanta, GA.
Abstract
BACKGROUND: Early trauma (general, emotional, physical, and sexual abuse before age 18 years) has been associated with both cardiovascular disease risk and lifestyle-related risk factors for cardiovascular disease, including smoking, obesity, and physical inactivity. Despite higher prevalence, the association between early trauma and cardiovascular health (CVH) has been understudied in Black Americans, especially those from low-income backgrounds, who may be doubly vulnerable. Therefore, we investigated the association between early trauma and CVH, particularly among low-income Black Americans. METHODS: We recruited 457 Black adults (age 53±10, 38% male) without known cardiovascular disease from the Atlanta, GA, metropolitan area using personalized, community-based recruitment methods. The Early Trauma Inventory was administered to assess overall early traumatic life experiences which include physical, sexual, emotional abuse, and general trauma. Our primary outcome was the American Heart Association Life's Simple 7, which is a set of 7 CVH metrics, including 4 lifestyle-related factors (smoking, body mass index, physical activity, and diet) and three physiologically measured health factors (blood pressure, total blood cholesterol, and blood glucose). We used linear regression models adjusting for age, sex, socioeconomic status, and depression to test the association between early trauma and CVH and tested the early trauma by household income (<$50 000) interaction. RESULTS: Higher levels of early trauma were associated with lower Life's Simple 7 scores (β, -0.05 [95% CI, -0.09 to -0.01], P=0.02, per 1 unit increase in the Early Trauma Inventory score) among lower, but not higher, income Black participants (P value for interaction=0.04). Subtypes of early trauma linked to Life's Simple 7 were general trauma, emotional abuse, and sexual abuse. Exploratory analyses demonstrated that early trauma was only associated with the body mass index and smoking components of Life's Simple 7. CONCLUSIONS: Early trauma, including general trauma, emotional abuse, and sexual abuse, may be associated with worse CVH among low-, but not higher-income Black adults.
BACKGROUND: Early trauma (general, emotional, physical, and sexual abuse before age 18 years) has been associated with both cardiovascular disease risk and lifestyle-related risk factors for cardiovascular disease, including smoking, obesity, and physical inactivity. Despite higher prevalence, the association between early trauma and cardiovascular health (CVH) has been understudied in Black Americans, especially those from low-income backgrounds, who may be doubly vulnerable. Therefore, we investigated the association between early trauma and CVH, particularly among low-income Black Americans. METHODS: We recruited 457 Black adults (age 53±10, 38% male) without known cardiovascular disease from the Atlanta, GA, metropolitan area using personalized, community-based recruitment methods. The Early Trauma Inventory was administered to assess overall early traumatic life experiences which include physical, sexual, emotional abuse, and general trauma. Our primary outcome was the American Heart Association Life's Simple 7, which is a set of 7 CVH metrics, including 4 lifestyle-related factors (smoking, body mass index, physical activity, and diet) and three physiologically measured health factors (blood pressure, total blood cholesterol, and blood glucose). We used linear regression models adjusting for age, sex, socioeconomic status, and depression to test the association between early trauma and CVH and tested the early trauma by household income (<$50 000) interaction. RESULTS: Higher levels of early trauma were associated with lower Life's Simple 7 scores (β, -0.05 [95% CI, -0.09 to -0.01], P=0.02, per 1 unit increase in the Early Trauma Inventory score) among lower, but not higher, income Black participants (P value for interaction=0.04). Subtypes of early trauma linked to Life's Simple 7 were general trauma, emotional abuse, and sexual abuse. Exploratory analyses demonstrated that early trauma was only associated with the body mass index and smoking components of Life's Simple 7. CONCLUSIONS: Early trauma, including general trauma, emotional abuse, and sexual abuse, may be associated with worse CVH among low-, but not higher-income Black adults.
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