Abstract MP04: Association Between Early Trauma and Ideal Cardiovascular Health Among Black Americans: Results From the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity
Authors: Shabatun J Islam, Jeong Hwan Kim, Emma Joseph, Matthew L Topel, Peter Baltrus, Chang Liu, Yi-An Ko, Zakaria Almuwaqqat, Mahasin S Mujahid, Mario Sims, Mohamed Mubasher, Kiran Ejaz, Charles D Searles, Sandra B Dunbar, Priscilla E Pemu, Herman A Taylor, J Douglas Bremner, Viola Vaccarino, Arshed A QUYYUMI, Tene T Lewis
Journal: Circulation (2020)

Introduction: Early trauma (e.g. general, emotional, physical, and sexual abuse before age 18) has been associated with both cardiovascular disease (CVD) risk and lifestyle-related risk factors for CVD including smoking, obesity, and physical inactivity. However, previous studies have primarily focused on White participants, despite the fact that early trauma is more common in Blacks. In particular, the role played by low socioeconomic status (SES) in this population has been relatively understudied. Hypothesis: Black individuals reporting early trauma will have worse cardiovascular health (CVH) as measured by the American Heart Association’s Life’s Simple 7 (LS7) scores and these associations will vary by SES. Methods: We recruited 499 Black adults (age 53 ± 10, 38% male) without CVD from the Atlanta, GA metropolitan area. The Early Trauma Inventory (ETI) was administered to assess physical, sexual, emotional abuse and general trauma. CVH was determined by LS7 scores calculated from measured blood pressure, blood glucose, cholesterol, body mass index (BMI), and self-reported exercise, diet, and smoking and was categorized as poor (0-8), intermediate (9-10), and ideal (11-14). Multinomial logistic regression was used to examine the relationship between early trauma and the odds of intermediate (vs. poor) and ideal (vs. poor) CVH categories after adjusting for age, gender, household income, education, marital status, employment status, and depression. After testing for interaction between ETI and SES, stratified analysis was conducted separately on individuals with low and high SES (defined as household income less or greater than $50,000 per year, respectively). Results: A total of 55 (11%), 107 (21%), and 337 (67%) participants had ideal, intermediate, and poor LS7 scores, respectively. In the full cohort, higher levels of early trauma were associated with lower adjusted odds of ideal LS7 scores (OR 0.94, 95% CI [0.88 - 1.00] per 1 SD increase in the ETI score). In SES-stratified analyses, higher levels of early trauma (OR 0.91, 95% CI [0.84 - 0.98]), in particular emotional (OR 0.74, 95% CI [0.59 - 0.94]) and sexual abuse (OR 0.69, 95% CI [0.49 - 0.96]), were significantly associated with lower adjusted odds of ideal LS7 scores among lower, but not higher, SES Black participants (p value for interaction =0.03). Among the CVH components, emotional and sexual abuse were both associated with significantly lower adjusted odds of ideal BMI (OR 0.81, 95% CI [0.68-0.97] and OR 0.72, 95% CI [0.56-0.93], respectively) in low SES participants. Conclusion: Early trauma, particularly emotional and sexual abuse, was associated with worse CVH among Black individuals with lower SES. Further research is needed to investigate the mechanisms through which economic disadvantage potentiates the adverse influence of early trauma on CVH in Black individuals.