Cardiovascular disease risk higher in women who were abused as girls

Women who were severely sexually or physically abused in childhood have a higher risk of heart attacks, heart disease and strokes in adulthood, according to a study presented in November at the American Heart Assn.'s Scientific Session 2011.

Severe sexual abuse as a child or teenager -- for example, repeated episodes of forced sex without consent -- resulted in women being 62% more likely to develop cardiovascular disease compared with women who weren't molested or raped as young girls, the study showed.

Girls who encountered severe physical abuse in childhood or adolescence had a 45% increased risk of cardiovascular events. Study authors defined severe abuse to include such experiences as a parent or guardian hitting the girl with something that hurt her body on repeated occasions.

Data showed that mild to moderate physical or sexual abuse did not increase the risk of heart attacks, heart disease and stroke later in life.

The fact that abused girls tend to gain more weight during adolescence and into adulthood was the single biggest factor explaining the increased cardiovascular risk they face as women, said Janet Rich-Edwards, ScD, MPH, the study's lead author. She is an associate professor and director of developmental epidemiology at the Connors Center for Women's Health and Gender Biology at Brigham and Women's Hospital in Boston.

Traditional cardiovascular risk factors such as body mass index, smoking, alcohol use, hypertension and diabetes accounted for 41% of the association of severe physical abuse and cardiovascular events in the women. It accounted for 37% of the association in the cases where severe sexual abuse had occurred.

"That leaves more than half of the risk factors unexplained," Rich-Edwards said, adding that more studies are needed to explore those unknowns.

Discussing health effects with patients

Researchers looked at data collected from more than 67,000 women who participated in the Nurses' Health Study II, a questionnaire established for female registered nurses in 1976 and sent out biennially. They analyzed associations of child and adolescent abuse with confirmed heart attacks and strokes between 1989 and 2007.

Eleven percent of the women reported forced sexual activity when they were growing up, and 9% reported severe sexual abuse.

Earlier studies showed that physical and sexual abuse of girls leads to an increased risk of obesity, hypertension and diabetes. However, this is believed to be the first study to link abuse with higher risks of heart attacks and strokes.

Rich-Edwards said physicians should talk to women about abuse and inform them that studies have shown increased risk for diseases when abuse occurred at a young age.

"People are inclined to discount how prevalent abuse is," she said. "It does a disservice. You then don't get people the help they need."