Associations of threat- and deprivation-related adverse childhood experiences with risk of cardiovascular disease in later life

Exposure to adverse childhood experiences (ACEs) has consistent associations with increased long-term risk of cardiovascular disease (CVD). However, links of distinct ACE subtypes and particular ACEs with later-life CVD are insufficiently understood. This longitudinal cohort study initially recruited 20,452 participants from the China Health and Retirement Longitudinal Study and Life History Survey. Follow-up data were obtained from five waves conducted between 2011 and 2020. ACEs were measured with ten items adapted from the Life Stressor Checklist-Revised, a measure that includes five threat-related ACEs and five deprivation-related ACEs. The outcome measure was CVD (including heart disease and stroke) during the follow-up period. Multivariate Cox proportional hazards regression models assessed links of cumulative ACEs, ACE subtypes, and individual ACEs with CVD incidence. Of 13,920 included participants, 8434 (60.6 %) reported exposure to at least one ACE. During the study period of 9 years, 2689 participants (19.3 %) received a clinical diagnosis of CVD, including 2098 (15.1 %) with heart disease and 683 (4.9 %) with stroke. Both threat-related ACEs (hazard ratio [HR], 1.08; 95 % CI, 1.03-1.12) and deprivation-related ACEs (HR, 1.08; 95 % CI, 1.01-1.15) were independently associated with increased risk of CVD, with the strongest association observed for stroke. Findings underscore the importance of considering threat- and deprivation-related ACEs in assessments and targeted intervention studies as potential means of yielding long-term cardioprotective benefits.