Early Life Trauma Tied to Increased CVD Risk With MI History by Middle Age

By Lisa Rapaport

November 23, 2020

(Reuters Health) - Young and middle-age adults with a history of myocardial infarction may have a higher risk of adverse cardiovascular outcomes when they also have a history of early-life trauma, a new study suggests.

Researchers examined data on 300 patients aged 18 to 60 years (mean age 51) who had a history of myocardial infarction (MI) within the past 8 months. All participants completed the Early Trauma Inventory Self Report short form, scored from 0 (no trauma) to 27 (maximum trauma).

Overall, 154 people (51%) had a trauma score of 7 or higher, which researchers used as the cut point for separating those with little to no trauma from those with at least some exposure.

After three years of follow-up, there were a total of 59 adverse cardiovascular events including recurrent MI, stroke, heart failure hospitalization, and cardiovascular death. Participants with at least some early-life trauma exposure had a more than doubled risk of adverse cardiovascular events (hazard ratio 2.3) compared with those who had little or no early-life trauma exposure.

Each 4-point increase in early-life trauma scores was associated with a 30% higher risk of these cardiovascular events (HR 1.3).

While many previous studies have linked early life trauma to an increased risk of cardiovascular disease, it's been less clear from prior research if trauma exposure is a risk factor for adverse outcomes in people with coronary heart disease and patients who have a recent MI history, said senior author of the current study Dr. Viola Vaccarino of the Rollins School of Public Health at Emory University in Atlanta.

"We found that exposure to early life adversity is highly prevalent in the post-MI population, particularly in young and middle-aged patient groups with high representation of women and disadvantaged population," Dr. Vaccarino said by email. "Those who report these exposures are at substantially increased risk of recurrent cardiac events and mortality."

The results were published in JAMA Cardiology and presented at the annual meeting of the American Heart Association.

Many of the participants in the study were women (50%) and most were African-American (66%).

When the authors looked at markers of inflammation, they found that, compared to participants with MI and trauma score less than 7, those with a score of 7 or higher had higher levels of interleukin 6 and C-reactive protein at baseline.

One limitation of the study is its small size, the study team notes. Another limitation is the lack of data on patients with MI over 60 years old, limiting the generalizability of the results.

However, the current study showed that MI survivors with early life trauma may still have a higher risk for subsequent cardiovascular events after accounting for classical risk factors, mental health and systemic inflammation, said Frederick Ho, a researcher at the University of Glasgow who wasn't involved in the study.

"People who have a history of MI are often categorized as high risk of future cardiovascular events already," Ho said by email. "Apart from classical risk factors such as high cholesterol and smoking, clinicians may also need to beware of any signs of mental problems such as depression and chronic inflammation."

SOURCE: https://bit.ly/3kYfuCl JAMA Cardiology, online November 13, 2020.