[Traumatic childhood experiences and cardiovascular health using the example of adults with congenital heart disease].

Background: Adverse childhood experiences (ACE) are a risk factor for an unfavorable lifestyle, mental disorders and cardiometabolic diseases. However, the mechanisms through which these risks are mediated have not been conclusively investigated.

Research question: Is there a connection between ACE and cardiovascular health in adults with congenital heart disease (ACHD)?

Methods: A total of 609 ACHD were included. Sociodemographic parameters, ACE (Childhood Trauma Questionnaire, CTQ), depressive symptoms (Hospital Anxiety and Depression Scale, HADS) and physical activity were assessed. Patients underwent a full cardiological examination including the measurement of epicardial adipose tissue (EAT) using echocardiography. Bootstrapped mediation analyses were performed with ACE as the predictor, depressive symptoms and physical activity as mediators and EAT as the dependent variable.

Results: The CTQ sum score showed a significant indirect effect on EAT, which was serially mediated by depressive symptoms and physical activity (CTQ → HADS-D → Exercise → EAT; a*d*b2 = 0.0171, 95% confidence interval, CI 0.0080, 0.0285). Comparable significant effects were found for the individual CTQ domains (emotional/physical neglect, emotional/physical abuse, sexual trauma).

Discussion: We show that ACE are associated with increased depressive symptoms, which in turn lead to reduced physical activity and increased EAT, a risk marker for cardiac events. Our findings point to a key mechanism through which ACE impair cardiovascular health and highlight several targets for primary and secondary preventive interventions within a multimodal treatment approach for ACHD.