The Role of Adverse Childhood Experiences in Cardiovascular Disease Risk: a Review with Emphasis on Plausible Mechanisms


Childhood adversity, characterized by abuse, neglect, and household dysfunction, is a problem that exerts a significant impact on individuals, families, and society. Growing evidence suggests that adverse childhood experiences (ACEs) are associated with health decline in adulthood, including cardiovascular disease (CVD). In the current review, we first provide an overview of the association between ACEs and CVD risk, with updates on the latest epidemiological evidence. Second, we briefly review plausible pathways by which ACEs could influence CVD risk, including traditional risk factors and novel mechanisms. Finally, we highlight the potential implications of ACEs in clinical and public health. Information gleaned from this review should help physicians and researchers in better understanding potential long-term consequences of ACEs and considering adapting current strategies in treatment or intervention for patients with ACEs.

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  1. 1.

    Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation. 2015;131(4):e29–322. doi:10.1161/CIR.0000000000000152.

    PubMed  Article  Google Scholar 

  2. 2.

    Berenson GS, Srinivasan SR, Bao W, Newman 3rd WP, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med. 1998;338(23):1650–6. doi:10.1056/NEJM199806043382302.

    CAS  PubMed  Article  Google Scholar 

  3. 3.

    Lynch J, Smith GD. A life course approach to chronic disease epidemiology. Annu Rev Public Health. 2005;26:1–35. doi:10.1146/annurev.publhealth.26.021304.144505.

    PubMed  Article  Google Scholar 

  4. 4.

    Kelishadi R, Poursafa P. A review on the genetic, environmental, and lifestyle aspects of the early-life origins of cardiovascular disease. Curr Probl Pediatr Adolesc Health Care. 2014;44(3):54–72. doi:10.1016/j.cppeds.2013.12.005.

    PubMed  Article  Google Scholar 

  5. 5.

    Miller GE, Chen E, Parker KJ. Psychological stress in childhood and susceptibility to the chronic diseases of aging: moving toward a model of behavioral and biological mechanisms. Psychol Bull. 2011;137(6):959–97. doi:10.1037/a0024768.

    PubMed Central  PubMed  Article  Google Scholar 

  6. 6.

    Danese A, Moffitt TE, Harrington H, et al. Adverse childhood experiences and adult risk factors for age-related disease: depression, inflammation, and clustering of metabolic risk markers. Arch Pediatr Adolesc Med. 2009;163(12):1135–43. doi:10.1001/archpediatrics.2009.214.

    PubMed Central  PubMed  Google Scholar 

  7. 7.

    Gilbert LK, Breiding MJ, Merrick MT, et al. Childhood adversity and adult chronic disease: an update from ten states and the District of Columbia, 2010. Am J Prev Med. 2015;48(3):345–9. doi:10.1016/j.amepre.2014.09.006.

    PubMed  Article  Google Scholar 

  8. 8.

    WHO. Adverse Childhood Experiences International Questionnaire (ACE-IQ). 2015. Accessed June 26 2015.

  9. 9.

    Bhan N, Glymour MM, Kawachi I, Subramanian SV. Childhood adversity and asthma prevalence: evidence from 10 US states (2009-2011). BMJ Open Respir Res. 2014;1(1):e000016. doi:10.1136/bmjresp-2013-000016.

    PubMed Central  PubMed  Article  Google Scholar 

  10. 10.

    Finkelhor D, Turner HA, Shattuck A, Hamby SL. Violence, crime, and abuse exposure in a national sample of children and youth: an update. JAMA Pediatr. 2013;167(7):614–21. doi:10.1001/jamapediatrics.2013.42.

    PubMed  Article  Google Scholar 

  11. 11.

    Dong M, Anda RF, Felitti VJ, et al. The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction. Child Abuse Negl. 2004;28(7):771–84. doi:10.1016/j.chiabu.2004.01.008.

    PubMed  Article  Google Scholar 

  12. 12.

    Dong M, Giles WH, Felitti VJ, et al. Insights into causal pathways for ischemic heart disease: adverse childhood experiences study. Circulation. 2004;110(13):1761–6. doi:10.1161/01.CIR.0000143074.54995.7F.

    PubMed  Article  Google Scholar 

  13. 13.

    Maniglio R. The role of child sexual abuse in the etiology of suicide and non-suicidal self-injury. Acta Psychiatr Scand. 2011;124(1):30–41. doi:10.1111/j.1600-0447.2010.01612.x.

    CAS  PubMed  Article  Google Scholar 

  14. 14.

    Naughton AM, Maguire SA, Mann MK, et al. Emotional, behavioral, and developmental features indicative of neglect or emotional abuse in preschool children: a systematic review. JAMA Pediatr. 2013;167(8):769–75. doi:10.1001/jamapediatrics.2013.192.

    PubMed  Article  Google Scholar 

  15. 15.

    Maguire SA, Williams B, Naughton AM, et al. A systematic review of the emotional, behavioural and cognitive features exhibited by school-aged children experiencing neglect or emotional abuse. Child Care Health Dev. 2015. doi:10.1111/cch.12227.

    PubMed  Google Scholar 

  16. 16.

    Fink DS, Galea S. Life course epidemiology of trauma and related psychopathology in civilian populations. Curr Psychiatr Rep. 2015;17(5):31. doi:10.1007/s11920-015-0566-0.

    Article  Google Scholar 

  17. 17.

    De Bellis MD, Zisk A. The biological effects of childhood trauma. Child Adolesc Psychiatr Clin N Am. 2014;23(2):185-222, vii. doi:10.1016/j.chc.2014.01.002.

  18. 18.

    Felitti V, Williams S. Long term follow-up and analysis of more than 100 patients who each lost more than 100 pounds. Perm J. 1998;2(3):17–21.

    Google Scholar 

  19. 19.

    Felitti VJ, Jakstis K, Pepper V, Ray A. Obesity: problem, solution, or both? Perm J. 2010;14(1):24–30.

    PubMed Central  PubMed  Article  Google Scholar 

  20. 20.

    Korhonen MJ, Halonen JI, Brookhart MA, et al. Childhood adversity as a predictor of non-adherence to statin therapy in adulthood. PLoS One. 2015;10(5):e0127638. doi:10.1371/journal.pone.0127638.

    PubMed Central  PubMed  Article  CAS  Google Scholar 

  21. 21.

    Steptoe A, Kivimäki M. Stress and cardiovascular disease. Nat Rev Cardiol. 2012;9(6):360–70.

    CAS  PubMed  Article  Google Scholar 

  22. 22.

    Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998;14(4):245–58.

    CAS  PubMed  Article  Google Scholar 

  23. 23.

    Korkeila J, Vahtera J, Korkeila K, et al. Childhood adversities as predictors of incident coronary heart disease and cerebrovascular disease. Heart. 2010;96(4):298–303. doi:10.1136/hrt.2009.188250.

    PubMed  Article  Google Scholar 

  24. 24.•

    Rich-Edwards JW, Mason S, Rexrode K, et al. Physical and sexual abuse in childhood as predictors of early-onset cardiovascular events in women. Circulation. 2012;126(8):920–7. doi:10.1161/CIRCULATIONAHA.111.076877. This is a large epidemiology study showing that severe child abuse is a prevalent risk for early adult CVD that is partially mediated by preventable risk factors.

    PubMed Central  PubMed  Article  Google Scholar 

  25. 25.

    Loucks EB, Almeida ND, Taylor SE, Matthews KA. Childhood family psychosocial environment and coronary heart disease risk. Psychosom Med. 2011;73(7):563–71. doi:10.1097/PSY.0b013e318228c820.

    PubMed  Article  Google Scholar 

  26. 26.

    Almeida ND, Loucks EB, Kubzansky L, et al. Quality of parental emotional care and calculated risk for coronary heart disease. Psychosom Med. 2010;72(2):148–55. doi:10.1097/PSY.0b013e3181c925cb.

    PubMed Central  PubMed  Article  Google Scholar 

  27. 27.

    Anda RF, Croft JB, Felitti VJ, et al. Adverse childhood experiences and smoking during adolescence and adulthood. JAMA. 1999;282(17):1652–8.

    CAS  PubMed  Article  Google Scholar 

  28. 28.••

    Bellis MA, Lowey H, Leckenby N, Hughes K, Harrison D. Adverse childhood experiences: retrospective study to determine their impact on adult health behaviours and health outcomes in a UK population. J Public Health (Oxf). 2013. doi:10.1093/pubmed/fdt038. This is the first ACE study in a relatively deprived and ethnically diverse UK population. Their findings that ACEs are linked to involvement in poor life-course health and social outcomes suggest a cyclic effect where those with higher ACE counts have higher risks of exposing their own children to ACEs.

    Google Scholar 

  29. 29.

    Dube SR, Felitti VJ, Dong M, Giles WH, Anda RF. The impact of adverse childhood experiences on health problems: evidence from four birth cohorts dating back to 1900. Prev Med. 2003;37(3):268–77.

    PubMed  Article  Google Scholar 

  30. 30.

    Ford ES, Anda RF, Edwards VJ, et al. Adverse childhood experiences and smoking status in five states. Prev Med. 2011;53(3):188–93. doi:10.1016/j.ypmed.2011.06.015.

    PubMed  Article  Google Scholar 

  31. 31.

    Chartier MJ, Walker JR, Naimark B. Health risk behaviors and mental health problems as mediators of the relationship between childhood abuse and adult health. Am J Public Health. 2009;99(5):847–54. doi:10.2105/AJPH.2007.122408.

    PubMed Central  PubMed  Article  Google Scholar 

  32. 32.

    Das-Munshi J, Leavey G, Stansfeld SA, Prince MJ. Does social disadvantage over the life-course account for alcohol and tobacco use in Irish people? Birth cohort study. Eur J Pub Health. 2014;24(4):594–9. doi:10.1093/eurpub/ckt122.

    Article  Google Scholar 

  33. 33.

    Dong M, Anda RF, Felitti VJ, et al. Childhood residential mobility and multiple health risks during adolescence and adulthood: the hidden role of adverse childhood experiences. Arch Pediatr Adolesc Med. 2005;159(12):1104–10. doi:10.1001/archpedi.159.12.1104.

    PubMed  Article  Google Scholar 

  34. 34.

    Dube SR, Cook ML, Edwards VJ. Health-related outcomes of adverse childhood experiences in Texas, 2002. Prev Chronic Dis. 2010;7(3):A52.

    PubMed Central  PubMed  Google Scholar 

  35. 35.

    Fuller-Thomson E, Filippelli J, Lue-Crisostomo CA. Gender-specific association between childhood adversities and smoking in adulthood: findings from a population-based study. Public Health. 2013;127(5):449–60. doi:10.1016/j.puhe.2013.01.006.

    CAS  PubMed  Article  Google Scholar 

  36. 36.

    Edwards VJ, Anda RF, Gu D, Dube SR, Felitti VJ. Adverse childhood experiences and smoking persistence in adults with smoking-related symptoms and illness. Perm J. 2007;11(2):5–13.

    PubMed Central  PubMed  Article  Google Scholar 

  37. 37.

    Smith PH, Saddleson ML, Homish GG, McKee SA, Kozlowski LT, Giovino GA. The relationship between childhood physical and emotional abuse and smoking cessation among U.S. women and men. Psychol Addict Behav: J Soc Psychol Addict Behav. 2015;29(2):338–46. doi:10.1037/adb0000033.

    Article  Google Scholar 

  38. 38.

    Strine TW, Edwards VJ, Dube SR, et al. The mediating sex-specific effect of psychological distress on the relationship between adverse childhood experiences and current smoking among adults. Subst Abuse Treat Prev Policy. 2012;7:30. doi:10.1186/1747-597X-7-30.

    PubMed Central  PubMed  Article  Google Scholar 

  39. 39.

    US Department of Health and Human Services. Preventing tobacco use among young people. A report of the Surgeon General. Atlanta, GA: Public Health Service, Centers for Disease Control and Prevention, Office on Smoking and Health; 1994.

  40. 40.

    Morton PM, Mustillo SA, Ferraro KF. Does childhood misfortune raise the risk of acute myocardial infarction in adulthood? Soc Sci Med. 2014;104:133–41. doi:10.1016/j.socscimed.2013.11.026.

    PubMed Central  PubMed  Article  Google Scholar 

  41. 41.

    Midei A, Matthews K. Interpersonal violence in childhood as a risk factor for obesity: a systematic review of the literature and proposed pathways. Obes Rev. 2011;12(5):e159–72.

    PubMed Central  CAS  PubMed  Article  Google Scholar 

  42. 42.

    Danese A, Tan M. Childhood maltreatment and obesity: systematic review and meta-analysis. Mol Psychiatry. 2014;19(5):544–54.

    CAS  PubMed  Article  Google Scholar 

  43. 43.

    Midei AJ, Matthews KA, Bromberger JT. Childhood abuse is associated with adiposity in mid-life women: possible pathways through trait anger and reproductive hormones. Psychosom Med. 2010;72(2):215.

    PubMed Central  PubMed  Article  Google Scholar 

  44. 44.

    Greenfield EA, Marks NF. Violence from parents in childhood and obesity in adulthood: using food in response to stress as a mediator of risk. Soc Sci Med. 2009;68(5):791–8.

    PubMed Central  PubMed  Article  Google Scholar 

  45. 45.

    Rohde P, Ichikawa L, Simon GE, et al. Associations of child sexual and physical abuse with obesity and depression in middle-aged women. Child Abuse Negl. 2008;32(9):878–87.

    PubMed Central  PubMed  Article  Google Scholar 

  46. 46.

    Alvarez J, Pavao J, Baumrind N, Kimerling R. The relationship between child abuse and adult obesity among California women. Am J Prev Med. 2007;33(1):28–33.

    PubMed  Article  Google Scholar 

  47. 47.

    Evenson KR, Scott MM, Cohen DA, Voorhees CC. Girls’ perception of neighborhood factors on physical activity, sedentary behavior, and BMI. Obesity. 2007;15(2):430–45.

    PubMed  Article  Google Scholar 

  48. 48.

    Thomas C, Hyppönen E, Power C. Obesity and type 2 diabetes risk in midadult life: the role of childhood adversity. Pediatrics. 2008;121(5):e1240–9.

    PubMed  Article  Google Scholar 

  49. 49.

    Duncan AE. Relationship between abuse and neglect in childhood and diabetes in adulthood: differential effects by sex, national longitudinal study of adolescent health. Prev Chron Dis. 2015;12.

  50. 50.

    Rich-Edwards JW, Spiegelman D, Lividoti Hibert EN, et al. Abuse in childhood and adolescence as a predictor of type 2 diabetes in adult women. Am J Prev Med. 2010;39(6):529–36. doi:10.1016/j.amepre.2010.09.007.

    PubMed Central  PubMed  Article  Google Scholar 

  51. 51.

    Al Odhayani A, Watson WJ, Watson L. Behavioural consequences of child abuse. Can Fam Physician Medecin Famille Can. 2013;59(8):831–6.

    Google Scholar 

  52. 52.

    Bellis MA, Hughes K, Leckenby N, et al. Adverse childhood experiences and associations with health-harming behaviours in young adults: surveys in eight eastern European countries. Bull World Health Organ. 2014;92(9):641–55. doi:10.2471/BLT.13.129247.

    PubMed Central  PubMed  Article  Google Scholar 

  53. 53.

    Church TS, Thomas DM, Tudor-Locke C, et al. Trends over 5 decades in U.S. occupation-related physical activity and their associations with obesity. PLoS One. 2011;6(5):e19657. doi:10.1371/journal.pone.0019657.

    PubMed Central  CAS  PubMed  Article  Google Scholar 

  54. 54.

    Biddle SJ, Asare M. Physical activity and mental health in children and adolescents: a review of reviews. Br J Sports Med. 2011;45(11):886–95. doi:10.1136/bjsports-2011-090185.

    PubMed  Article  Google Scholar 

  55. 55.

    Gangwisch JE. A review of evidence for the link between sleep duration and hypertension. Am J Hypertens. 2014;27(10):1235–42. doi:10.1093/ajh/hpu071.

    PubMed  PubMed Central  Article  Google Scholar 

  56. 56.

    Javaheri S, Storfer-Isser A, Rosen CL, Redline S. Sleep quality and elevated blood pressure in adolescents. Circulation. 2008;118(10):1034–40. doi:10.1161/CIRCULATIONAHA.108.766410.

    PubMed Central  PubMed  Article  Google Scholar 

  57. 57.

    Badran M, Yassin BA, Fox N, Laher I, Ayas N. Epidemiology of sleep disturbances and cardiovascular consequences. Can Cardiol. 2015;31(7):873–9. doi:10.1016/j.cjca.2015.03.011.

    Article  Google Scholar 

  58. 58.

    Chapman DP, Liu Y, Presley-Cantrell LR, et al. Adverse childhood experiences and frequent insufficient sleep in 5 U.S. States, 2009: a retrospective cohort study. BMC Public Health. 2013;13:3. doi:10.1186/1471-2458-13-3.

    PubMed Central  PubMed  Article  Google Scholar 

  59. 59.

    Baiden P, Fallon B, den Dunnen W, Boateng GO. The enduring effects of early-childhood adversities and troubled sleep among Canadian adults: a population-based study. Sleep Med. 2015;16(6):760–7. doi:10.1016/j.sleep.2015.02.527.

    PubMed  Article  Google Scholar 

  60. 60.

    Kajeepeta S, Gelaye B, Jackson CL, Williams MA. Adverse childhood experiences are associated with adult sleep disorders: a systematic review. Sleep Med. 2015;16(3):320–30. doi:10.1016/j.sleep.2014.12.013.

    PubMed  Article  Google Scholar 

  61. 61.

    Dvir Y, Ford JD, Hill M, Frazier JA. Childhood maltreatment, emotional dysregulation, and psychiatric comorbidities. Harvard Rev Psychiatr. 2014;22(3):149–61. doi:10.1097/HRP.0000000000000014.

    Article  Google Scholar 

  62. 62.

    Harkness KL, Bruce AE, Lumley MN. The role of childhood abuse and neglect in the sensitization to stressful life events in adolescent depression. J Abnorm Psychol. 2006;115(4):730–41. doi:10.1037/0021-843X.115.4.730.

    PubMed  Article  Google Scholar 

  63. 63.

    Silverman AB, Reinherz HZ, Giaconia RM. The long-term sequelae of child and adolescent abuse: a longitudinal community study. Child Abuse Negl. 1996;20(8):709–23.

    CAS  PubMed  Article  Google Scholar 

  64. 64.

    Chapman DP, Whitfield CL, Felitti VJ, Dube SR, Edwards VJ, Anda RF. Adverse childhood experiences and the risk of depressive disorders in adulthood. J Affect Disord. 2004;82(2):217–25. doi:10.1016/j.jad.2003.12.013.

    PubMed  Article  Google Scholar 

  65. 65.

    Patten SB, Wilkes TC, Williams JV, et al. Childhood adversity and subsequent mental health status in adulthood: screening for associations using two linked surveys. Epidemiology and psychiatric sciences. 2015:1-11. 10.1017/S2045796015000104

  66. 66.

    Coles J, Lee A, Taft A, Mazza D, Loxton D. Childhood sexual abuse and its association with adult physical and mental health: results from a national cohort of young Australian women. J Interpers Violence. 2015;30(11):1929–44. doi:10.1177/0886260514555270.

    PubMed  Article  Google Scholar 

  67. 67.

    Springer KW, Sheridan J, Kuo D, Carnes M. Long-term physical and mental health consequences of childhood physical abuse: results from a large population-based sample of men and women. Child Abuse Negl. 2007;31(5):517–30. doi:10.1016/j.chiabu.2007.01.003.

    PubMed Central  PubMed  Article  Google Scholar 

  68. 68.

    Patten SB, Wilkes TC, Williams JV, et al. Retrospective and prospectively assessed childhood adversity in association with major depression, alcohol consumption and painful conditions. Epidemiol Psychiatr Sci. 2015;24(2):158–65. doi:10.1017/S2045796014000018.

    CAS  PubMed  Article  Google Scholar 

  69. 69.

    Whalley B, Thompson DR, Taylor RS. Psychological interventions for coronary heart disease: cochrane systematic review and meta-analysis. Int J Behav Med. 2014;21(1):109–21. doi:10.1007/s12529-012-9282-x.

    PubMed  Article  Google Scholar 

  70. 70.

    Nemeroff CB, Goldschmidt-Clermont PJ. Heartache and heartbreak—the link between depression and cardiovascular disease. Nat Rev Cardiol. 2012;9(9):526–39. doi:10.1038/nrcardio.2012.91.

    CAS  PubMed  Article  Google Scholar 

  71. 71.

    Thombs BD, de Jonge P, Coyne JC, et al. Depression screening and patient outcomes in cardiovascular care: a systematic review. JAMA. 2008;300(18):2161–71. doi:10.1001/jama.2008.667.

    CAS  PubMed  Article  Google Scholar 

  72. 72.

    Lichtman JH, Bigger Jr JT, Blumenthal JA, et al. Depression and coronary heart disease: recommendations for screening, referral, and treatment: a science advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Psychiatric Association. Circulation. 2008;118(17):1768–75. doi:10.1161/CIRCULATIONAHA.108.190769.

    PubMed  Article  Google Scholar 

  73. 73.

    Stewart JC, Perkins AJ, Callahan CM. Effect of collaborative care for depression on risk of cardiovascular events: data from the IMPACT randomized controlled trial. Psychosom Med. 2014;76(1):29–37. doi:10.1097/PSY.0000000000000022.

    PubMed Central  PubMed  Article  Google Scholar 

  74. 74.

    Kearney CA, Wechsler A, Kaur H, Lemos-Miller A. Posttraumatic stress disorder in maltreated youth: a review of contemporary research and thought. Clin Child Fam Psychol Rev. 2010;13(1):46–76. doi:10.1007/s10567-009-0061-4.

    PubMed  Article  Google Scholar 

  75. 75.

    Copeland WE, Keeler G, Angold A, Costello EJ. Traumatic events and posttraumatic stress in childhood. Arch Gen Psychiatry. 2007;64(5):577–84. doi:10.1001/archpsyc.64.5.577.

    PubMed  Article  Google Scholar 

  76. 76.

    Scheeringa MS, Zeanah CH, Myers L, Putnam FW. Predictive validity in a prospective follow-up of PTSD in preschool children. J Am Acad Child Adolesc Psychiatry. 2005;44(9):899–906. doi:10.1097/01.chi.0000169013.81536.71.

    PubMed  Article  Google Scholar 

  77. 77.

    McCrory EJ, Viding E. The theory of latent vulnerability: reconceptualizing the link between childhood maltreatment and psychiatric disorder. Dev Psychopathol. 2015;27(02):493–505.

    PubMed  Article  Google Scholar 

  78. 78.

    Onose T, Nochioka K, Sakata Y, et al. Predictors and prognostic impact of post-traumatic stress disorder after the great East Japan earthquake in patients with cardiovascular disease. Circ J: Off J Jpn Circ Soc. 2015;79(3):664–7. doi:10.1253/circj.CJ-14-1403.

    Article  Google Scholar 

  79. 79.

    Wentworth BA, Stein MB, Redwine LS, et al. Post-traumatic stress disorder: a fast track to premature cardiovascular disease? Cardiol Rev. 2013;21(1):16–22. doi:10.1097/CRD.0b013e318265343b.

    PubMed  Article  Google Scholar 

  80. 80.

    Boscarino JA. PTSD is a risk factor for cardiovascular disease: time for increased screening and clinical intervention. Preventive medicine. 2012;54(5):363-4; author reply 5. doi:10.1016/j.ypmed.2012.01.001

  81. 81.

    Coughlin SS. Post-traumatic stress disorder and cardiovascular disease. Open Cardiovasc Med J. 2011;5:164–70. doi:10.2174/1874192401105010164.

    PubMed Central  PubMed  Article  Google Scholar 

  82. 82.

    Vaccarino V, Goldberg J, Rooks C, et al. Post-traumatic stress disorder and incidence of coronary heart disease: a twin study. J Am Coll Cardiol. 2013;62(11):970–8. doi:10.1016/j.jacc.2013.04.085.

    PubMed  Article  Google Scholar 

  83. 83.

    Edmondson D, Shaffer JA, Denton EG, Shimbo D, Clemow L. Posttraumatic stress and myocardial infarction risk perceptions in hospitalized acute coronary syndrome patients. Front Psychol. 2012;3:144. doi:10.3389/fpsyg.2012.00144.

    PubMed Central  PubMed  Article  Google Scholar 

  84. 84.

    Ahmadi N, Hajsadeghi F, Mirshkarlo HB, Budoff M, Yehuda R, Ebrahimi R. Post-traumatic stress disorder, coronary atherosclerosis, and mortality. Am J Cardiol. 2011;108(1):29–33. doi:10.1016/j.amjcard.2011.02.340.

    PubMed  Article  Google Scholar 

  85. 85.

    Thurston RC, Chang Y, Derby CA, et al. Abuse and subclinical cardiovascular disease among midlife women: the study of women’s health across the nation. Stroke; A J Cereb Circul. 2014;45(8):2246–51. doi:10.1161/STROKEAHA.114.005928.

    Article  Google Scholar 

  86. 86.

    Riley EH, Wright RJ, Jun HJ, Hibert EN, Rich-Edwards JW. Hypertension in adult survivors of child abuse: observations from the Nurses’ Health Study II. J Epidemiol Community Health. 2010;64(5):413–8. doi:10.1136/jech.2009.095109.

    PubMed Central  CAS  PubMed  Article  Google Scholar 

  87. 87.

    Stein DJ, Scott K, Haro Abad JM, et al. Early childhood adversity and later hypertension: data from the World Mental Health Survey. Ann Clin Psychiatr: Off J Am Acad Clin Psychiatr. 2010;22(1):19–28.

    Google Scholar 

  88. 88.

    Su S, Wang X, Pollock JS, et al. Adverse childhood experiences and blood pressure trajectories from childhood to young adulthood: the Georgia Stress and Heart Study. Circulation. 2015;131(19):1674–81. doi:10.1161/CIRCULATIONAHA.114.013104.

    PubMed  Article  Google Scholar 

  89. 89.

    Nusslock R, Miller GE. Early-life adversity and physical and emotional health across the lifespan: a neuro-immune network hypothesis. Biol Psychiatry. 2015. doi:10.1016/j.biopsych.2015.05.017.

  90. 90.

    Buss C, Entringer S, Wadhwa PD. Fetal programming of brain development: intrauterine stress and susceptibility to psychopathology. Sci Signal. 2012;5(245):t7. doi:10.1126/scisignal.2003406.

    Article  CAS  Google Scholar 

  91. 91.

    Wilson KR, Hansen DJ, Li M. The traumatic stress response in child maltreatment and resultant neuropsychological effects. Aggress Violent Behav. 2011;16(2):87–97.

    Article  Google Scholar 

  92. 92.

    Hart H, Rubia K. Neuroimaging of child abuse: a critical review. Front Hum Neurosci. 2012;6:52. doi:10.3389/fnhum.2012.00052.

    PubMed Central  PubMed  Article  Google Scholar 

  93. 93.

    Danese A, Caspi A, Williams B, et al. Biological embedding of stress through inflammation processes in childhood. Mol Psychiatry. 2011;16(3):244–6. doi:10.1038/mp.2010.5.

    PubMed Central  CAS  PubMed  Article  Google Scholar 

  94. 94.

    Danese A, McEwen BS. Adverse childhood experiences, allostasis, allostatic load, and age-related disease. Physiol Behav. 2012;106(1):29–39. doi:10.1016/j.physbeh.2011.08.019.

    CAS  PubMed  Article  Google Scholar 

  95. 95.

    Loria AS, D’Angelo G, Pollock DM, Pollock JS. Early life stress downregulates endothelin receptor expression and enhances acute stress-mediated blood pressure responses in adult rats. Am J Physiol Regul Integr Comp Physiol. 2010;299(1):R185–91. doi:10.1152/ajpregu.00333.2009.

    PubMed Central  CAS  PubMed  Article  Google Scholar 

  96. 96.

    Su S, Wang X, Kapuku GK, et al. Adverse childhood experiences are associated with detrimental hemodynamics and elevated circulating endothelin-1 in adolescents and young adults. Hypertension. 2014;64(1):201–7. doi:10.1161/HYPERTENSIONAHA.113.02755.

    PubMed Central  CAS  PubMed  Article  Google Scholar 

  97. 97.

    Browatzki M, Schmidt J, Kubler W, Kranzhofer R. Endothelin-1 induces interleukin-6 release via activation of the transcription factor NF-kappaB in human vascular smooth muscle cells. Basic Res Cardiol. 2000;95(2):98–105.

    CAS  PubMed  Article  Google Scholar 

  98. 98.

    MacCarthy PA, Grocott-Mason R, Prendergast BD, Shah AM. Contrasting inotropic effects of endogenous endothelin in the normal and failing human heart: studies with an intracoronary ET(A) receptor antagonist. Circulation. 2000;101(2):142–7.

    CAS  PubMed  Article  Google Scholar 

  99. 99.

    Rodriguez-Pascual F, Busnadiego O, Lagares D, Lamas S. Role of endothelin in the cardiovascular system. Pharmacol Res. 2011;63(6):463–72. doi:10.1016/j.phrs.2011.01.014.

    CAS  PubMed  Article  Google Scholar 

  100. 100.

    Khimji AK, Rockey DC. Endothelin—biology and disease. Cell Signal. 2010;22(11):1615–25. doi:10.1016/j.cellsig.2010.05.002.

    CAS  PubMed  Article  Google Scholar 

  101. 101.

    Campbell F, Conti G, Heckman JJ, et al. Early childhood investments substantially boost adult health. Science. 2014;343(6178):1478–85. doi:10.1126/science.1248429.

    PubMed Central  CAS  PubMed  Article  Google Scholar 

  102. 102.

    Garner AS, Shonkoff JP, Committee on Psychosocial Aspects of C, et al. Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health. Pediatrics. 2012;129(1):e224–31. doi:10.1542/peds.2011-2662.

    PubMed  Article  Google Scholar 

  103. 103.

    Mercy JA, Saul J. Creating a healthier future through early interventions for children. JAMA. 2009;301(21):2262–4. doi:10.1001/jama.2009.803.

    CAS  PubMed  Article  Google Scholar 

  104. 104.

    Repetti RL, Taylor SE, Seeman TE. Risky families: family social environments and the mental and physical health of offspring. Psychol Bull. 2002;128(2):330–66.

    PubMed  Article  Google Scholar 

  105. 105.

    Tasman AKJ, Lieberman JA, First MB, Maj M. Psychiatry. Hoboken: Wiley; 2008.

    Google Scholar 

  106. 106.

    Kuyken W, Hayes R, Barrett B, et al. Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial. Lancet. 2015;386(9988):63–73. doi:10.1016/S0140-6736(14)62222-4.

    PubMed  Article  Google Scholar 

  107. 107.

    Van Niel C, Pachter LM, Wade Jr R, Felitti VJ, Stein MT. Adverse events in children: predictors of adult physical and mental conditions. J Dev Behav Pediatr: JDBP. 2014;35(8):549–51. doi:10.1097/DBP.0000000000000102.

    PubMed  Article  Google Scholar 

  108. 108.

    Loucks EB, Taylor SE, Polak JF, Wilhelm A, Kalra P, Matthews KA. Childhood family psychosocial environment and carotid intima media thickness: the CARDIA study. Soc Sci Med. 2014;104:15–22. doi:10.1016/j.socscimed.2013.12.015.

    PubMed Central  PubMed  Article  Google Scholar 

  109. 109.••

    Raja S, Hasnain M, Hoersch M, Gove-Yin S, Rajagopalan C. Trauma informed care in medicine: current knowledge and future research directions. Fam Community Health. 2015;38(3):216–26. doi:10.1097/FCH.0000000000000071. This study discusses the implications of trauma-informed care (TIC) for clinical practice and future research.

    PubMed  Article  Google Scholar 

  110. 110.

    Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US). 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Available from:

  111. 111.

    Spring B, Ockene JK, Gidding SS, et al. Better population health through behavior change in adults: a call to action. Circulation. 2013;128(19):2169–76. doi:10.1161/01.cir.0000435173.25936.e1.

    PubMed Central  PubMed  Article  Google Scholar 

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Conflict of Interest

Shaoyong Su, Marcia P. Jimenez, Cole T.F. Roberts, and Eric B. Loucks declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Correspondence to Shaoyong Su.

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This article is part of the Topical Collection on Psychological Aspects of Cardiovascular Diseases

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Su, S., Jimenez, M.P., Roberts, C.T.F. et al. The Role of Adverse Childhood Experiences in Cardiovascular Disease Risk: a Review with Emphasis on Plausible Mechanisms. Curr Cardiol Rep 17, 88 (2015).

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  • Adverse childhood experiences
  • Childhood maltreatment
  • Cardiovascular disease
  • Risky behaviors
  • Depression
  • Intervention