Associations between adverse childhood experiences and vascular indicators of atherosclerosis measured in childhood and early to mid-adulthood: A systematic review

OBJECTIVES: Adverse childhood experiences are associated with impaired vascular function and cardiovascular disease incidence and mortality, but mechanisms remain unclear. This systematic review assessed associations between adverse childhood experiences and vascular indicators of subclinical atherosclerosis, including the effects of mediating or moderating variables. METHODS: Searches were conducted through May 2024. Cross-sectional and longitudinal studies from childhood through adulthood, reporting cumulative measurement of ≥5 adverse childhood experiences exposures, and outcomes including ≥1 vascular indicators of subclinical atherosclerosis were included. The review was reported using Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. RESULTS: 3338 articles were identified, with 10 meeting the inclusion criteria (total participants = 4784). Five studies were longitudinal, four were cross-sectional, and one used pilot intervention baseline data. All 10 studies used retrospective adverse childhood experiences measurement. The strongest evidence was between adverse childhood experiences and arterial stiffness, with 5/8 studies showing positive associations. Positive associations between adverse childhood experiences and atherosclerotic progression (2/3 studies), and negative associations with endothelial function (2/2 studies) were identified, although quantity of evidence was small. Mediating and moderating variables were heterogeneous among studies, with only 5 measuring the effects of variables in isolation and limiting our ability to make inferences about their effects. CONCLUSIONS: Findings support associations between adverse childhood experiences and subclinical atherosclerotic progression, but evidence lacks quantity and quality. Prospective evidence identifying vascular changes associated with adverse childhood experiences, including analysis of mediating and moderating variables, is required to better understand the mechanisms underpinning associated risk of cardiovascular disease.