Research Highlights:
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Experiencing a violent encounter, even once, with a partner or family member may increase a young adult’s risk of having a heart attack, stroke, or hospitalization for heart failure years later, according to preliminary research presented today. at the American Heart Association’s 2022 Scientific Sessions . The meeting, held virtually and in person in Chicago from November 5 to 7, 2022, is a global exchange of the latest scientific advances, research and updates to evidence-based clinical practice in cardiovascular science.
According to the Centers for Disease Control and Prevention (CDC), intimate partner violence is defined as physical, emotional, or mental abuse or aggression in a romantic relationship by a partner. a current or former spouse or partner. It includes physical violence, sexual violence, harassment and psychological aggression, which includes verbal or non-verbal communication with the intention of mentally or emotionally harming the partner or exerting control over them.
About one (1) in four (4) women and almost one (1) in ten (10) men indicated having suffered sexual violence, physical violence or harassment by their partner at some point in their lives, and stated some type of impact related to intimate partner violence. More than 43 million women and 38 million men in the United States have experienced psychological assault from an intimate partner during their lifetime, according to current CDC statistics.
Women between the ages of 18 and 34 tend to be victims of the highest rates of intimate partner violence, according to the National Domestic Violence Hotline.
“There is increasing evidence linking intimate partner violence, which is a significant mental and physical trauma, to adverse cardiovascular outcomes,” said the study’s lead author, Kathryn Recto, a candidate in the MD/MPH dual-degree program at the Northwestern University Feinberg School of Medicine in Chicago. “Most of the current evidence is limited to self-reported cardiovascular health and analyzes of a single time point, so it is very interesting that this study, which followed participants for almost 30 years, has been able to detect an association.”
Research staff collected information on hospitalizations and outpatient medical procedures during routine examinations and annual appointments. If there was any hospitalization or outpatient visit, physicians requested medical records and used them to review cardiovascular disease (CVD) clinical events. This study examined whether prior exposure to intimate partner violence might be related to future cardiovascular health and how these associations may manifest over a person’s lifetime.
Researchers evaluated data from the Coronary Artery Risk Development in Young Adults Study (CARDIA), a long-term study that began in 1985 with more than 5,000 black and white adults, ages 18 to 30 at the time. of enrollment, to examine factors that contribute to the development of cardiovascular disease. In CARDIA, participants were enrolled at four different centers in the following cities in the United States: Birmingham, Alabama, Chicago, Minneapolis, and Oakland, California. The study was designed to include a similar number of people at each center with similar baseline characteristics based on race, sex, and educational level. About half of the CARDIA study participants (51.5%) self-identified as black adults; 54.5% were women and 60% of the participants had completed post-secondary education.
Study participants were asked to participate in follow-up medical appointments every 2 to 5 years. Although the purpose of each visit varied, during the 28 years of follow-up, data was collected on different risk factors related to heart disease, such as blood pressure, glucose, cholesterol, dietary patterns, body composition, abuse substance abuse tests, magnetic resonance imaging (MRI) tests, psychological health and family history, as well as health conditions such as heart problems, type 2 diabetes and its complications, sleep apnea, adverse pregnancy outcomes, kidney problems, liver disease , cancer, respiratory diseases, depression and death.
For this analysis, researchers examined questionnaires completed between 1987 and 1988 by more than 4,300 people to assess exposure to domestic violence. The survey asked how often during the past year you had a violent argument with the following people: 1) with your spouse/partner (intimate partner); 2) with a family member other than the spouse/partner; 3) with another person they knew and 4) with someone they didn’t know. They were also asked if they had a gun at home for protection. The researchers then tabulated and reviewed the survey responses and analyzed statistical models to relate the responses to nonfatal heart attacks, nonfatal attacks or strokes, hospitalization for heart failure, and death related to other cardiovascular causes among the participants.
The analysis was adjusted for risk factors such as body mass index, smoking, nervous or mental disorders diagnosed by a doctor or nurse, diagnosis of type 2 diabetes, etc., to examine the relationship between exposure to intimate partner violence and the incidence of cardiovascular events or death.
Analysis of the data revealed the following information:
People who, at baseline, reported having been exposed to intimate partner violence in the past year also had higher alcohol consumption (16 millimeters/day or 0.5 ounces/day among those who reported having been exposed to intimate partner violence vs. 11 ml/day or 0.4 ounces/day) compared to those who were not exposed. Additionally, they smoked more (3.3 pack years for people who had experienced intimate partner violence vs. 2.4 pack years for those who were not exposed) and were more likely to report having depression (8.3% for exposed people vs. 6.0% in those who were not exposed) in the survey carried out at the beginning of the study.
62% of participants who reported experiencing intimate partner violence were black adults, and 38% were white adults.
When adjusted for age, sex, and race, exposure to intimate partner violence or family violence was associated with an increased risk of at least a 34% chance of cardiovascular events and an increased risk of at least a 34% chance of cardiovascular events. At least a 30% chance of dying from any cause.
Having had more than one episode of violence with an intimate partner in the last year also increased the risk of death from any cause by 34% of cases after additional adjustment for cardiovascular risk factors. The increased risk of death was 59% among people who reported that the violent episode involved a family member other than their spouse/partner; 34% if the episode involved another person they knew and 26% if it involved someone they did not know.
“The results indicate that intimate partner violence appears to be closely related to an increased risk of cardiovascular events or death.”
“It is essential that we better understand the association between these two public health problems in order to develop and implement better interventions. We hope that our study strengthens the need for clinicians to perform a routine preventive screening that screens for intimate partner violence, especially because people with a history of intimate partner violence may need increased monitoring if an increased risk of IPV is to be detected. cardiovascular events in the future.
Randi Foraker, Ph.D., MA, FAHA, vice chair of the American Heart Association’s Epidemiology & Cardiovascular Stroke Nursing Prevention Science Committee, said the summary uses the best available data on violence and modifiable cardiovascular risk factors among young adults to develop “our best estimate of cardiovascular risk attributable to violence.”
"The authors were careful to adjust for other modifiable cardiovascular disease risk factors, such as smoking, alcohol and depression, to reduce the impact of these risk factors in the analysis," said Foraker, professor of medicine and director from the Center for Population Health Informatics2 at Washington University School of Medicine in St. Louis. “In this work, we highlight the need to increase monitoring of individuals who experience incidents of violence to detect the risk of cardiovascular disease and control risk factors.”
The study authors also noted that future research should investigate biochemical pathways that might associate intimate partner violence with cardiovascular disease.
Limitations of the study include that participants were asked the number of episodes of intimate partner violence only at the beginning of the study but were not assessed at any other time. Additionally, the definition of what constitutes a “violent or potentially violent argument” was not clearly defined, so responses may be inaccurate or erroneous due to variations in individual perceptions of the event. Additionally, the CARDIA study only includes both white and black adults.
Co-authors are Donald M. Lloyd-Jones, MD, Sc.M., FAHA; Kiarri Kershaw, Ph.D., MPH and Laura Colangelo, MS Author disclosures are in the abstract.
This study was funded by the National Heart, Lung, and Blood Institute, a division of the National Institutes of Health.
