By Laurie Saurborn, APRN-CNP, PMHNP-BC
In celebration of Valentine’s Day, take a moment to pause, maybe placing a hand over your heart and sit, if only for a moment, with the amazing organ so central to sustaining your body, mind and being. Right along with you, it has lived through so much. And if you are a survivor of adverse childhood experiences (ACEs), or work with clients who have experienced ACEs, it is important to be aware that what happens in childhood can affect the health of our hearts throughout adulthood.
On average, people who report three or more ACEs are at much greater risk for developing cardiovascular diseases (CVDs) in adulthood. As the research reminds us, ACEs are “unmodifiable” – that is, they cannot be undone. Plus, experiencing depression and anxiety can go hand-in-hand with cardiac complications (aka, “cardiometabolic dysregulations”), and influence our choices around smoking, alcohol, diet and exercise.
The Whitehall II Cohort Study underscored the intertwined relationship between ACEs, adult mental health, and cardiac health outcomes, highlighting the importance of trauma informed intervention measures at all ages. Healthcare providers must recognize the necessity of screening patients for past and present trauma. As the Whitehall study demonstrates, a patient who smokes, over-utilizes alcohol, and is diagnosed with CVD is more likely to have experienced ACEs in childhood and to be experiencing anxiety or depression, or both. Although more long-term studies are needed to further explore the myriad connections between ACEs and adult mental and physical health, researchers suggest the allostatic load, or the combined physiological, biological and psychological stresses carried by the body, may veer into “allostatic overload” and cause important body systems—such as the immune and the endocrine systems— to become dysregulated and ultimately more susceptible to injury and chronic disease.
Given these studies, what can we do as survivors and providers to decrease the effects of negative events in childhood on adult heart health? Knowledge is power, as is commonly said. Screening patients in healthcare settings that may not immediately bring TIC and mental health to mind, such as cardiac care, is an opportunity for providers to comprehensively treat their patients and for their patients to gain a greater understanding of how childhood trauma may have played a role in developing current cardiac health conditions, including coronary heart disease (CHD), stroke, and atrial fibrillation (AF). The risks of developing CVDs in adulthood after experiencing ACEs decreases when people embrace, or adopt, heart-healthy behaviors such as daily physical activity, stopping smoking, and limiting alcohol intake.
Easier said than done! As we all know, change can be an uphill battle. Often, we are only prompted towards new behaviors when the challenge of staying the same becomes less than the challenge of making a change. One “change formula” writes it out like this: D x V x F > R. In translation: Resistance (R) is overcome when dissatisfaction (D) with one’s current situation is combined with a future-oriented vision (V) and taking those important (yet oh-so-difficult) “first steps” (F) towards that vision.
No matter the messages received in childhood, modeling positive change in adulthood can be one of the most impactful ways we have to demonstrate to ourselves, our families, and our clients and colleagues the power inherent in choosing differently. Small steps are all part of a longer journey, and while no heart beats forever, there are ways to help our hearts beat more fully, and more powerfully, every day.
