How does childhood maltreatment influence cardiovascular disease? A sequential causal mediation analysis

Area of Science:

• Psychiatry and Psychology
• Public Health
• Cardiology

Background:

• Childhood maltreatment is a known risk factor for cardiovascular disease (CVD).
• The precise mechanisms linking childhood adversity to CVD remain unclear.
• Understanding these pathways is crucial for targeted interventions.

Purpose of the Study:

• To investigate the mediating roles of anxiety/depression, smoking, body mass index (BMI), and inflammation in the relationship between childhood maltreatment and CVD.
• To examine these associations in adult men and women aged 40-69 years in the UK.
• To determine the differential contributions of mediators based on maltreatment type and sex.

Main Methods:

• Utilized UK Biobank data from 40,596 men and 59,511 women.
• Employed a sequential mediation approach to estimate indirect effects of maltreatment on CVD via specified mediators.
• Assessed various forms of childhood maltreatment including physical, sexual, and emotional abuse, and neglect.

Main Results:

• All forms of childhood maltreatment were associated with increased CVD risk (HRs 1.09-1.27).
• Anxiety/depression, smoking, BMI, and inflammation collectively mediated 26-90% of the maltreatment-CVD association.
• Mediator contributions varied by maltreatment type and sex; anxiety/depression was key for emotional/sexual abuse, while BMI was significant for physical abuse in men.

Conclusions:

• Childhood maltreatment significantly elevates CVD risk through psychological, behavioral, and physiological pathways.
• Anxiety/depression, BMI, smoking, and inflammation are key modifiable mediators.
• Identifying these mediators offers opportunities to mitigate CVD burden in individuals with a history of childhood adversity.