Life course history of physical and sexual abuse is associated with cardiovascular disease risk among women living with and without HIV

Abstract

Objective: Sexual and physical abuse predict cardiovascular disease (CVD) among women in the general population. Women living with HIV (WLWH) report more abuse and have higher CVD risk compared to other women, yet associations between abuse history and CVD have not been considered among WLWH. This study fills this gap, and describes possible pathways linking abuse to CVD risk among WLWH and women living without HIV (WLWOH). Methods: Using 25 years of data from the Women's Interagency HIV Study (n = 2734; WLWH n = 1963; WLWOH n = 771), we used longitudinal generalized estimating equations to test associations between sexual (SA) and physical abuse (PA) with CVD risk. Framingham (FRS-H) and the American College of Cardiology/American Heart Association-Pooled Cohort Equation (ACC/AHA-PCE) scores were examined. Analyses were stratified by HIV-serostatus. Results: Among WLWH, childhood SA was associated with higher CVD risk (βFRS-H = 1.25, SE = 1.08, p = 0.005; βACC/AHA-PCE = 1.14, SE = 1.07, p = 0.04) compared to no abuse. Adulthood SA was associated with higher CVD risk for WLWH (βFRS-H = 1.39, SE = 1.08, p < 0.0001) and WLWOH (βFRS-H = 1.58, SE = 1.14, p = 0.0006). Childhood PA was not associated with CVD risk for either group. Adulthood PA was associated with CVD risk for WLWH (βFRS-H = 1.44, SE = 1.07; p < 0.0001, βACC/AHA-PCE = 1.18, SE = 1.06, p = 0.002) and WLWOH (βFRS-H = 1.68, SE = 1.12, p < 0.0001; βACC/AHA-PCE = 1.24, SE = 1.11, p = 0.03). Several pathway factors were significant, including depression, smoking, and hepatitis-C infection. Conclusions: Life course abuse may increase CVD risk among WLWH and women at high risk of acquiring HIV. Some co-morbidities help explain the associations. Assessing abuse experiences in clinical encounters may help contextualize cardiovascular risk among this vulnerable population and inform intervention.