The impact of adverse childhood experiences on cardiovascular disease risk in middle-aged and older adults

OBJECTIVE: This study examines the association between Adverse Childhood Experiences (ACEs) and cardiovascular disease (CVD) risk among middle-aged and older adults in China, investigating the roles of socially patterned factors (age, gender, marital status, education, urban/rural residence) and health behaviors/conditions (smoking, drinking, hypertension, diabetes) in this association. METHODS: Using prospective data from 16,521 participants aged ≥45 years in the China Health and Retirement Longitudinal Study (CHARLS), we assessed 20 ACE indicators. Participants were categorized by ACE burden (0, 1-3, ≥4). Cox proportional hazards models estimated the ACE-CVD association, adjusting for demographic, socioeconomic, behavioral, and clinical covariates. Subgroup analyses tested effect modification by key characteristics. RESULTS: There was a statistically significant dose dependency between ACEs and subsequent risk of CVD. This association remained significant after full adjustment for important confounders (HR per ACE = 1.08, 95 %CI: 1.06-1.10). People with four or more ACEs had 59 % greater risk than those without. The research found that the associations were similar across the subgroups, albeit the risks were stronger among the married, rural, and educated. An interaction of gender was not significant; men had slightly higher hazard ratios. The relationship between ACEs and CVD was observed even in non-hypertensive participants, while functional limitations weakened this association. CONCLUSIONS: ACE exposure is strongly associated with elevated CVD risk in later life among Chinese adults, independent of adult socioeconomic position, behaviors, and health conditions. Findings highlight the critical need for trauma-informed public health strategies addressing childhood adversity as a social determinant of health. Early-life interventions and policies mitigating ACEs are essential to reduce long-term cardiovascular disparities.