Sexual violence linked with CVD risk

Women who are exposed to sexual violence, particularly in childhood, may be more prone to poorer cardiovascular health later in their lives.

Women who are exposed to sexual violence, particularly in childhood, are more prone to poorer cardiovascular health in midlife, according to a systematic review and meta-analysis presented at the annual meeting of the North American Menopause Society (NAMS), being held Sept. 22-25 in Washington, D.C.

“Psychosocial experiences, including childhood abuse and trauma, are increasingly recognized as being related to risk for cardiovascular disease (CVD),” said principal investigator Karen Jakubowski, PhD, an assistant professor of psychiatry at the University of Pittsburgh in Pennsylvania. “However, less is known about the relationship between sexual violence and CVD risk, despite the prevalence of sexual violence; for example, over one-third of women in the United States report a history of sexual violence.”

The authors searched the databases PubMed and PsycINFO through March 1, 2021, for studies in persons aged 18 or older who had a measure of sexual violence, such as sexual abuse/assault, military sexual trauma, sexual harassment, and sexual intimate partner violence.

Persons also needed to have at least 1 cardiovascular outcome like clinical CVD, subclinical CVD (including measures of carotid plaque and atherosclerosis), and select CVD risk factors like blood pressure, diabetes and high cholesterol.

A total of 45 studies, comprising 830,579 adults, of whom 77.1% were women, were included in the meta-analysis.

Effects were largely drawn from midlife samples, with 113 effects expressed as odds ratios (OR) and 9 effects expressed as hazard ratios (HR), which are 2 different ways of statistically expressing the relationship between sexual violence and CVD risk.

®adjustments for sociodemographics, psychological factors and/or other cardiovascular risk factors, such as obesity or smoking.

Results indicated that sexual violence was linked to adult CVD risk: OR (95% confidence interval [CI]) = 1.25 (1.11 to 1.40) and HR (95% CI) = 1.17 (1.05 to 1.31).

Results varied by cardiovascular outcome type, measurement method and timing of violence, with larger effects for associations of sexual violence to cardiovascular health in 3 observed conditions: clinical CVD outcomes rather than subclinical CVD or CVD risk factors; self-reported health outcomes as opposed to direct measurement/medical record; and sexual violence occurring in childhood or over the lifecourse rather than in adulthood only.

“The studies that met inclusion criteria for our meta-analysis reflected a diverse group of samples, types of sexual violence measures and cardiovascular outcomes,” Jakubowski told Contemporary OB/GYN®. “Despite this variability across studies, the take-home message is clear: a history of sexual violence is related to increased CVD risk.”

Further, effects were drawn from models adjusted for important demographic and health-related covariates, which suggests that the overall OR and HR effects of sexual violence on CVD risk may actually be conservative, according to Jakubowski.

The analysis also indicates an urgent need for interventions to improve the health of women exposed to sexual violence, “which may help reduce CVD risk in midlife and aging adults,” Jakubowski said. “Overall, considering sexual violence history may help inform broader efforts in the prevention of CVD.”

Jakubowski noted there is a need for clinicians to better understand the sexual violence histories of their patients. “Clinicians are in a position to support survivors and connect them to services that can help improve their cardiovascular health and overall well-being,” she said.

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Disclosure

Jakubowski reports no relevant financial disclosures.

Reference

Jakubowski, K. Sexual Violence and Cardiovascular Disease Risk: Systematic Review/Meta Analysis. The North American Menopause Society Annual Meeting. September 24, 2021. Washington, D.C.