Childhood sex abuse tied to heart risk

ORLANDO, Fla. — Women who report having had forced sex at a young age have an elevated risk of heart disease as adults. Some of the higher cardiac risk is traceable to behavioral and lifestyle factors, but much of it goes unexplained, researchers reported November 13 at a meeting of the American Heart Association.

“This tells us that the immediacy of the tragedy is being followed by risk that may have implications in later life,” says Clyde Yancy, a cardiologist at Northwestern University School of Medicine in Chicago who was not involved in the study. “That’s very disconcerting.”

The researchers analyzed data from more than 67,000 women who were age 25 to 42 when they volunteered to participate in a large healthcare study in 1989. Questionnaire responses revealed that 11 percent answered yes when asked whether they had had “forced sexual activity” during childhood or adolescence, the years through age 17.

After following the women in adulthood for 18 years and tabulating any heart problems they encountered in that time, the scientists were able to discern that women who had had at least one episode of forced sexual contact when young faced roughly a 56 percent greater risk in cardiovascular disease than did women with no history of childhood sex abuse.

“It’s clear that this association is strong,” said epidemiologist Donna Arnett of the University of Alabama at Birmingham, president-elect of the American Heart Association. “We need to do a better job screening and identifying child sexual abuse at an early age.”

The single biggest factor contributing to the heart disease risk was a tendency to become overweight, said study coauthor Janet Rich-Edwards, an epidemiologist at the Harvard School of Public Health and Brigham and Women’s Hospital in Boston. The abused women also had higher rates of smoking, drinking, high blood pressure and diabetes than women not abused in youth.

But taken together, these well-known risk factors for heart disease still accounted for less than half of the risk increase, Rich-Edwards said. “That’s a lot that’s left unexplained,” she said.

Some heart attacks have always been a mystery, with the patients showing no warning signs beforehand. Cardiologist Nieca Goldberg of New York University’s Langone Medical Center says that, in women, one source of that added risk might arise from the stresses of pregnancy, especially if a woman encounters high blood pressure, preeclampsia or gestational diabetes.

“In women, we need to look outside the traditional cardiovascular risk factors,” Goldberg said. Some biological changes occur in some women due to stress, such as chronically elevated levels of hormones such as cortisol, norepinephrine or epinephrine, she said. The new study suggests risk factors that “go beyond behavioral changes,” she says. “I think we need to look toward screening young women for cardiovascular risks.”