Girls who experience severe sexual and physical abuse may have a higher risk of heart attack, heart disease and stroke, according to a recent study that researchers say is among the first to examine the correlation.
The research, presented Sunday at the American Heart Association's 2011 scientific sessions, found that women who reported repeated episodes of forced sex in childhood or adolescence had a 62 percent higher risk of cardiovascular disease.
Severe physical abuse in childhood or adolescence was linked to a 45 percent higher risk of cardiovascular events.
"It's almost hard to imagine stressors much greater than physical and sexual abuse," Janet Rich-Edwards, lead author of the study and associate professor in the Department of Medicine at Brigham and Women's Hospital told HuffPost. "When we think about stress and health, abuse is the elephant in the room."
According to the Centers for Disease Control, Child Protective Services found that in 2008, 772,000 children were victims of maltreatment -- including neglect and physical, sexual and emotional abuse -- but many more cases go unreported.
Researchers used information from the Nurse's Health Study -- one of the longest running investigations into women's health in the U.S. They studied data collected between 1989 and 2007 from more than 67,000 respondents (most of whom were white). Some 9 percent of the women reported severe physical abuse during childhood and 11 percent reported forced sex. (Mild physical and sexual abuse were not associated with increased risk.)
In a statement, Rich-Edwards said the biggest factor behind the apparent connection between abuse and cardiovascular events was the tendency of girls who were abused to have gained weight throughout adolescence and into adulthood.
"Often, other cardiac risk factors come hand-in-hand with obesity -- diabetes, pre-diabetes, hypertension, abnormal cholesterol levels -- so it's not entirely surprising," said Dr. Helene Glassberg, an assistant professor in preventive cardiology at the University of Pennsylvania, who was not associated with the study.
Other risk factors for cardiovascular events, including smoking and alcohol use, also played a role. Together with weight and weight-related medical risks, these factors accounted for more than 40 percent of the increased risk for cardiovascular events among women who had been abused, suggesting that much of the risk could be prevented with what experts already know about cutting cardiovascular risk through screening, prevention and treatment efforts.
But many of the factors that underlie the association are not yet understood.
"Some of the best clues come from literature on post-traumatic stress disorder, which is common among women with a history of abuse," Rich-Edwards said.
She explained that some animal and human research has suggested early-life abuse might leave a lasting imprint on individuals' stress reactivity. Women who have been subject to severe abuse may have pronounced responses to stressors unrelated to their original trauma.
Glassberg added that psychological stressors may have direct hormonal impacts, while stress-related disorders have been linked with higher resting heart rates and blood pressure.
As efforts continue to understand these factors better, researchers hope their findings can help to increase awareness, particularly among pediatricians, of the diverse, lasting health impacts of abuse.
"The first thing is to bring child abuse out of the shadows," Rich-Edwards said. "Abuse is far more common than most people realize, including most physicians. Increasing the awareness of the medical profession and the public about the prevalence of abuse would help reduce the shame that enshrouds it and encourage frank discussions about the long-term health implications of abuse."