Childhood trauma raises risk of adult CHD and depression.

VIENNA -- Childhood trauma was an independent predictor of coronary heart disease and major depression later in life in a study with 360 men.

"Childhood trauma can have important consequences, but it is a risk factor that physicians don't usually think about," Dr. Viola Vaccarino said while presenting a poster at the annual congress of the European Society of Cardiology.

"Once a person is identified with a history of childhood trauma, that person needs to be monitored very closely. Our data [suggest] that childhood trauma may be a key history to ask about," said Dr. Vaccarino, a professor of medicine and epidemiology at Emory University, Atlanta.

The study by Dr. Vaccarino and her associates used 360 male twins (180 pairs, either mono-or dizygotic) who were born in 1946-1956 and were enrolled in the Vietnam Era Twin Registry. The participants were all interviewed at Emory University. They were assessed using the Early Trauma Inventory (ETI), a measure of traumatic events occurring before age 18 years, and the Late Trauma Inventory (LTI), a measure of traumatic events that occur when a person is aged 18 years or older. Physical health was as- sessed by examination, and mental health was assessed with the Structured Clinical Interview for Psychiatric Disorders. In all, 33 participants were diagnosed with coronary heart disease (CHD), 82 were diagnosed with major depressive disorder, and 23 had posttraumatic stress disorder.

The participants were divided into quartiles based on their ETI scores.

The analysis showed that the men in the three lowest ETI quartiles had a 6% prevalence of CHD compared with an 18% rate in the quartile with the highest ETI score. When adjusted for age and smoking history, the men in the highest quartile for childhood trauma had about a twofold increased rate of CHD, compared with men with lower ETI scores, a statistically significant difference. (See box.)

A second analysis showed that men in the quartile with the greatest childhood trauma were also about twice as likely to have major depression, compared with men with lower ETI scores, also a significant difference, said Dr. Vaccrino, who is also director of EPICORE (Emory Program in Cardiovascular Outcomes Research and Epidemiology).

Initially, an excess of CHD and depression was also seen in men who had high scores on the LTI. But when the LTI analysis was adjusted for the prevalence of early trauma, the link between the LTI score and CHD and depression disappeared. In contrast, a strong link was also seen between high LTI scores and posttraumatic stress disorder, but this link was not affected by adjustment for ETI scores.

Childhood trauma can occur in the form of physical abuse, emotional abuse, sexual abuse, or general trauma, which is caused by events such as earthquakes and car accidents.

These findings suggest that primary care physicians should routinely ask patients about their trauma exposures as children. They may even want to administer the ETI, which has recently been streamlined to a single-page questionnaire, Dr. Vaccarino said in an interview.

Prevalence of Coronary Heart Disease And Depression in Later Life

                                       Coronary heart  Major depression
                                          disease
Lowest three quartiles for childhood         6%             18%
trauma scores

Higest quartile for childhood trauma         7%             36%
scores

Note: Based on a study of 180 pairs of male twins .

Source: Dr. Vaccarino

Note: Table made from bar graph.

BY MITCHEL L. ZOLER Philadelphia Bureau