Table 1.

Cohort studies exposed to different types of Adverse Childhood Experiences (ACEs) and their correlation with Cardiovascular Disease Risk.

Type of Adversity	Participants	Outcome	Reference
Childhood maltreatment (maternal rejection, physical abuse, harsh discipline, sexual abuse)	Members of the Dunedin Multidisciplinary Health and Development Study, age 32 (n=972)	Elevated levels of cardiovascular risk clusters: overweight, high blood pressure, high cholesterol, and low VO2 max, high hsCRP Higher smoking rates and sedentary lifestyle	(Danese et al., 2007)
Repeated sexual and/or physical abuse	Healthy women, age 18–45 with regular menses (n=49)	Increased pituitary-adrenal and autonomic responses Greater ACTH response to stress	(Heim et al., 2000)
Childhood Trauma Questionnaire including emotional, physical, and sexual abuse	-342 women from SWAN (Study of Women’s Health Across the Nation	Physical abuse but not sexual or emotional linked to development of metabolic syndrome including elevated blood pressure.	(Midei et al., 2013)
Physical abuse, sexual abuse, and childhood neglect	National Comorbidity Survey (n=5877)	3.7x likely to develop CVD childhood neglect associated with diabetes	(Goodwin and Stein, 2004)
Physical and sexual abuse; neglect, parental death; divorce, family violence, family economic adversity	WHO World Mental Health Surveys (n=18,630)	3 or more ACEs associated with hypertension in adulthood	(Stein et al., 2010)
ACE questionnaire: childhood abuse, neglect, and household dysfunction	ACE study, n=9367 women, 7970 men	Dose response relationship of ACEs to ischemic heart disease	(Dong et al., 2004)
Sexual abuse	Sexually abused females referred from CPS agencies in Washington, D.C. (n=84)	Significant increased risk for obesity by age 20–27 (43%)	(Noll et al., 2007)
7 Categories of ACE: psychological, physical, sexual, household dysfunction (substance abuse, mental illness, mother treated violently, criminal behavior)	13,494 adults completed questionnaire about ACE (the Adverse Childhood Experience Study)	Strong dose response relationship between severity of abuse/household dysfunction and risk factors for several chronic diseases including ischemic heart disease, cancer, chronic lung disease, and liver disease.	(Felitti et al., 1998)
Emotional neglect, physical neglect, household dysfunction, and abuse (similar to ACE Study)	1958 British Cohort (n=9310)	Certain severe ACEs linked with increased BMI and waist circumference Physical abuse had strongest link with obesity	(Thomas et al., 2008)
ACEs (with sexual and physical abuse omitted) including death of family member or pet, divorce, serious illness of family member, conflict between parents	1,234 middle school students from the Heart Behavioral and Environmental Assessment Team (HBEAT) Study	Those with >4 ACEs: Increased BMI, Increased resting heart rate Increased waist circumference	(Pretty et al., 2013)
Adapted questionnaire from ACE study (abuse, neglect, and household dysfunction)	The Georgia Stress and Heart Study (n=221)	Elevated levels of endothelin-1, higher total peripheral resistance index, diastolic blood pressure, and pulse wave velocity in healthy adolescents and young adults.	(Su et al., 2014)
Adapted questionnaire from ACE study (abuse, neglect, and household dysfunction)	The Georgia Stress and Heart Study (n=213 African Americans, n=181 European Americans)	Significant increase in BP levels in young adulthood due to multiple ACE exposure.	(Su et al., 2015)
Parental loss	N=88 adults with no current Axis I psychiatric disorder	Parental loss associated with increased cortisol responses.	(Tyrka et al., 2008)
Parental separation	1361 Finnish war evacuees	The separated subjects had significantly higher systolic blood pressure than non- separated controls.	(Alastalo et al., 2013)
Harsh family environments including low SES	Coronary Artery Risk Development in Young Adults N=2,738	Low SES and a harsh family environment predict increased blood pressure in adulthood.	(Lehman et al., 2009)
Parental divorce, death of a parent, parental incapacity through illness, serious debt, parental criminal behavior	Cohort members at the Royal Victoria Infirmary, Newcastle. N=412	3.2 % variation in carotid artery in men & 2.2% variation in females	(Lamont et al., 2000)
Holocaust exposure	70 European Jews born during 1940–1945	Prevalence of hypertension was elevated (62.9% vs 43%)	(Bercovich et al., 2014)