Abstract
The aim of this systematic review and meta-analysis was to estimate the relationship between cumulative adverse childhood experiences (ACEs) and myocardial infarction (MI) in adulthood and to examine the role of potential confounding factors that may have contributed to the association. Studies examining the association of cumulative ACEs with MI among adults were identified by searching PubMed/MEDLINE, PsycINFO, ScienceDirect, and ProQuest Dissertations and Thesis. Individual estimates of odds ratios were pooled using random effects meta-analysis. Articles were pooled separately according to whether findings were adjusted for sociodemographic factors, cardiovascular disease (CVD) risk factors, and psychological factors. Several moderators were also examined: age, gender, race/ethnicity, type of MI assessment, type of cumulative ACEs assessment, and quality assessment of included studies. A total of 10 eligible studies met our inclusion criteria. The pooled ORs for the magnitude of the relationship between ACEs and MI were OR = 1.88; 95% CI, 1.40–2.53, before adjustment for CVD risk factors, and OR = 1.78; 95% CI, 1.24–2.57, after adjustment for CVD risk factors. The association between ACEs and MI was OR = 2.09; 95% CI, 1.43–3.06, after further adjustment for psychological factors. Effect sizes were larger when studies included participants predominantly over 55 years of age than younger participants. Cumulative ACEs is associated with an increased risk of MI in adulthood. However, further prospective studies are needed to better understand potential moderators that attenuate or amplify observed relations.