Appendix Table 2.

Adult violence exposure and cardiovascular outcomes, by study design and sample size

Ref No.	First Author (Year)	Sample Size/ Gender/Age	Study Design/ Setting	Retrospective/ Prospective Exposure Assessment	Exposure Measurement	Self-report/ Measured Outcome Assessment	Outcome Measure	Results	Evidence Grade
Prospective Studies
33	Mason SM (2012)	51,434 F Mean age: 46	Prospective cohort of registered nurses in the US	Retrospective assessment of physical and sexual IPV and current assessment of emotional abuse	Any experience of physical or sexual IPV or emotional abuse in ongoing relationships (3 levels of severity)	Self-reported HTN	Physician-diagnosed HTN reported in 6 years of follow-up after exposure ascertainment	No significant association was noted between incident HTN and physical (AHR: 1.1, 95% CI: 1.0–1.1) or sexual IPV (AHR: 1.0, 95% CI: 0.9–1.1). Women with most severe emotional abuse had increased incidence of HTN (AHR: 1.2, 95% CI: 1.0–1.5) compared to women without emotional abuse.	++
34	Stene (2013)	5,593 F 31% 30 yo 45% 40,45 yo 24% 59,60 yo	Prospective population-based cohort of women aged 30–60 in Oslo, Norway	Retrospective assessment of IPV	Any experience of psychological IPV or physical and/or sexual IPV	CV drug use ascertained from national prescription database	Incident CV drug use ascertained from Norwegian Prescription Database including all CV drugs, anti-HTN drugs, and lipid-modifying drugs	Psychological IPV was not associated with any CV drug use. Physical/sexual IPV was associated with anti-HTN drug use (AIRR: 1.4, 95% CI: 1.1–1.7).	++
Cross-sectional Studies
35	Breiding MJ (2008)	70,156 M/F 61% F Age >18	Cross-sectional, representative survey of adults in 16 states in the US	Retrospective assessment of IPV	Any experience of threatened, attempted or completed physical or sexual violence by current or former intimate partner	Self-reported CV events or signs	History of physician-diagnosed high BP, high cholesterol, MI, stroke, CHD	Among women, IPV was associated with high cholesterol (AOR: 1.3, 95% CI: 1.1–1.4), stroke (AOR: 1.8, 95% CI: 1.4–2.2), high BP (AOR: 1.1, 95% CI: 1.0–1.2), MI (AOR: 1.4, 95% CI: 1.1–1.8) and CHD (AOR: 1.8, 95% CI: 1.5–2.1). Among men, IPV was associated with stroke (AOR: 1.4, 95% CI: 1.0–2.1).	+
44	Vives-Cases C (2011)	13,094 F 40% >50 yo	Cross-sectional nationally representative survey in Spain	Retrospective assessment of IPV and VAW	IPV defined as violence in the past 12 months where the perpetrator was the woman’s intimate partner; VAW defined as violence perpetrated by a unknown man or woman or known man who was not their partner	Self-reported HTN or CHD	Physician-diagnosed HTN or CHD	No association between HTN and IPV (AOR: 0.8, 95% CI: 0.5–1.5) or VAW (AOR: 1.0, 95% CI: 0.5–1.8) in past 12 months. Significant association noted between IPV and CHD (AOR 5.3 95% CI: 1.5, 19.3). Unable to estimate association between VAW and CHD due to small numbers.	+
38	Frayne SM (1999)	3,632 F Mean age: 47	Cross-sectional survey of women using VA health care	Retrospective assessment of sexual assault in the military	Any experience of sexual assault while in the military	Self-reported CVD events and symptoms	Reports of being bothered by angina or other heart problem; treatment for HTN, MI, TIA, or stroke in past 12 months	History of sexual assault in military was associated with angina (AOR: 1.6, 95% CI: 1.3–2.0), other heart problems (AOR: 1.6, 95% CI: 1.3–2.1), HTN (AOR: 1.3, 95% CI: 1.1–1.6), and MI (AOR: 2.3, 95% CI: 1.4–4.0) but not TIA (AOR: 1.2, 95% CI: 0.7–2.1) or stroke (AOR: 1.5, 95% CI: 0.8–2.9).	+
37	Frayne SM (2003)	3,632 F Mean age: 47	Cross-sectional survey of women using VA health care	Retrospective assessment of sexual assault in the military	Any experience of sexual assault while in the military	Self-reported HTN	Self-reported HTN	History of sexual assault in military was associated with HTN (AOR: 1.2, 95% CI: 1.0–1.5).	+
32	Bonomi AE (2009)	1,928 F 55% 45–64 yo	Cross-sectional study of healthcare plan members in Washington and Idaho, USA	Retrospective assessment of IPV	Any experience of physical, sexual or non-physical abuse by intimate partner in the past year compared with women with no history of IPV in adulthood	ICD-9 codes from health care visits	ICD-9 codes for CV signs and symptoms, disorders of lipid metabolism and HTN in the past year	No significant associations were noted between IPV in past year and CV s/s (AOR: 1.1, 95% CI: 0.7–1.7), disorders of lipid metabolism (AOR: 0.9, 95% CI: 0.5–1.6), or HTN (AOR: 1.3, 95% CI: 1.0–1.8).	++
41	Golding JM (1994)	1,610 F Mean age: 40	Cross-sectional representative survey of adults in Los Angeles, CA, US	Retrospective assessment of sexual assault	Lifetime experience of sexual assault including forced touching or intercourse	Self-reported heart disease or HTN	Lifetime history of heart disease and HTN	No significant associations between sexual assault and heart disease (AOR: 1.6, p–value=0.06) or HTN (AOR: 1.2, p–value=0.28).	+
39	Sparrenberger F (2008)	1,474 M/F 59% F Mean age: 49	Cross-sectional representative survey of adults in Porto Alegre, Brazil	Retrospective assessment of physical violence	Any type of physical violence experienced in the past year perpetrated by any person	Measured blood pressure	HTN was defined as blood pressure above 140/90 mmHg or use of blood pressure lowering medication	Adjusted analyses showed no significant associations between physical violence and HTN in either men (AOR: 0.3, 95% CI: 0.1–1.1) or women (AOR: 0.7, 95% CI: 0.2–3.0).	++
43	Ruiz-Perez, I (2007)	1,402 F Mean age: 39	Cross-sectional study of women attending family practices in Spain	Retrospective assessment of IPV	Current (past year) and past IPV (physical, psychological or sexual abuse by a partner) in 4 combinations of (psychological only, psychological and physical, psychological and sexual, all 3 types); duration of abuse recorded as no abuse, 1 month–1 year, >1 year	Self-reported HTN	Self-reported HTN	No association between any lifetime IPV and HTN (AOR: 1.0, 95% CI: 0.6–1.7) or between specific combinations of IPV and HTN.	+
40	Gass JD (2010)	1,229 F Age >18	Cross-sectional nationally-representative sample of adults in South Africa	Retrospective assessment of physical IPV	Physical IPV by current or most recent intimate partner	Self-reported stroke, MI, heart disease, and high BP	Stroke or MI in past 12 months; heart disease or high BP ever	IPV was not significantly associated with MI (AOR: 1.8, 95% CI: 1.0–3.3), stroke (AOR: 1.3, 95% CI: 0.6–2.8), high BP (AOR: 1.5, 95%CI: 1.0–2.2), or heart disease (AOR: 1.2, 95% CI: 0.7–2.2).	+
42	Lown EA (2001)	1,155 F Mean age: 32	Cross-sectional representative survey of Mexican Americans living in Fresno County, CA, USA	Retrospective assessment of IPV	Physical or sexual IPV by a current partner in past 12 months	Self-reported high BP, MI and other serious heart trouble	MI or serious heart trouble, or high BP in the past 12 months	Physical/sexual IPV was associated with MI (AOR: 17.0, 95% CI: 4.3–66.7) but not high BP (AOR: 0.9, 95% CI: 0.3–2.8).	+
30	Coker AL (2000)	1,152 F 44% 40 yo	Cross-sectional study of women attending family practice clinics in SC, USA	Retrospective assessment of IPV	Any experience of physical or sexual violence with or without psychological abuse by intimate partner; psychological abuse without any physical/sexual violence by intimate partner	Self-reported CV events or problems	Physician-diagnosed MI, stroke, HTN, angina, other heart or circulatory problems	Physical/sexual violence associated with angina (AOR: 2.0, 95% CI: 1.2–3.5) and other heart or circulatory problems (AOR: 1.5, 95% CI: 1.0–2.2) but not with HTN (AOR: 1.0, 95% CI: 0.8–1.3). Psychological abuse was not significantly associated with any CV outcome.	+
36	Keyes KM (2013)	1,054 M/F 53% F Mean age: 44	Population-based cohort of adults in Detroit, MI, USA	Retrospective assessment of assaultive violence	Assaultive violence included any experience of rape, other sexual assault, being shot, stabbed, held captive, tortured, kidnapped, mugged, held up, threatened with a weapon, or badly beaten up	Self-reported CVD	CVD included physician-diagnosed HTN, MI, stroke, chest pain, congestive heart failure	Assaultive violence was not associated with CVD (OR: 1.0, 95% CI: 0.7–1.3).	+
31	Newton TL (2005)	39 F Mean age: 51	Cross-sectional study	Retrospective assessment of lifetime victimization	Lifetime victimization severity score includes robbery, child physical abuse, stalking or threatening behavior, adult sexual or physical assault as well as other crime victimization	Measured BP and heart rate	Ambulatory BP and heart rate over an average 18 hours	Lifetime victimization severity was associated with heart rate variability.	+

Abbreviations: AIRR: Adjusted incident rate ratio, AHR: Adjusted hazard ratio, AOR: Adjusted odds ratio, BP: Blood pressure, CAD: Coronary artery disease, CHD: Coronary heart disease, CTS: Conflict Tactics Scales, CV: Cardiovascular, CVD: Cardiovascular disease, DBP: Diastolic blood pressure, HbA1C: Hemoglobin A1c, HDL: High density lipoprotein, HR: Hazard ratio, HRT: Heart rate, HRV: Heart rate variability, HTN: Hypertension, IHD: Ischemic heart disease, IPV: Intimate partner violence, MI: Myocardial infarction (heart attack), OR: Odds ratio, R-CTS: Revised Conflict Tactics Scale, SBP: Systolic blood pressure, TIA: Transient ischemic attack, VA: Veteran’s Administration, VAW: Violence against woman