Associations of adverse childhood experiences with midlife cardiovascular health in women.

Background: Cardiovascular health (CVH) may be influenced by early life factors, such as adverse childhood experiences (ACEs). Prior work suggests social stressors may particularly influence CVH trajectories across the lifecourse in women; however, this relationship remains poorly understood. We used data from a prospective longitudinal cohort study to evaluate associations of ACEs with CVH and its components among midlife women (mean 51.3y). Methods: We included 588 women from Project Viva who delivered a singleton livebirth between 1999 and 2003. The primary exposure was number of ACEs experienced (continuous and by domain) and the primary outcome was Life's Essential 8 (LE8) CVH score, an average of eight behavioral and biomedical factors (0-100 points, higher score = better CVH). Exclusion criteria included missing data for the primary exposure or all LE8 components. Results: At least one ACE was reported by 63 % of participants. Mean (SD) LE8 scores were 73.7 (13.9) overall, 73.4 (17.4) for the behavioral domain, and 71.6 (21.7) for the biomedical domain. A higher number of ACEs was associated with lower overall (β=-0.7, 95 %CI: -1.3, -0.1) and behavioral (β=-0.9 points, 95 %CI: -1.7, -0.2) LE8 scores. Higher continuous ACEs score was associated with lower LE8 scores for physical activity (β=-1.8 points, 95 %CI: -3.6, 0.0) and blood glucose (β=-1.5points, 95 %CI: -2.4, -0.5). Conclusions: Experiencing more ACEs was associated with lower overall and behavioral LE8 scores at midlife. These findings provide evidence for the long-term impact of ACEs on women's CVH and underscore the importance of trauma-informed care in cardiovascular disease prevention.