Дискриминация и сексуальное насилие в подростковом возрасте повышают риск сердечной недостаточности у чернокожих женщин

Psychosocial stressors may play role in heart failure risk among Black women Key takeaways: - Discrimination and adolescent sexual abuse were linked to future heart failure risk among Black women. - Risk tied to these stressors was only partially mediated by BMI. Psychological stressors including perceived discrimination and adolescent sexual abuse were associated with future risk for heart failure among Black women, researchers reported. Although partially attenuated by BMI, discrimination in employment, housing or interactions with police as well as frequent sexual abuse in childhood was associated with significantly elevated risk for developing HF among Black women, according to data published in JAMA Network Open. “A prior finding that differences in heart failure risk among Black and white women appear to persist after accounting for the higher burden of traditional risk factors highlights an important gap in understanding and underscores the need to identify additional heart failure risk factors in Black women. Black women may be more likely to experience high levels of psychosocial stress in multiple domains, including early life, employment, finances, and relationships, as a result of both interpersonal and structural racism. Psychosocial stress is increasingly recognized as a critical contributor to CVD risk, especially in women,” Danielle N. Davis, MD, clinical instructor in general internal medicine at Boston Medical Center, and colleagues wrote. “The associations of specific domains of psychosocial stress with heart failure risk among Black women and how they relate to traditional heart failure risk factors remain incompletely understood.” The present analysis included data from 48,320 Black women who participated in the Black Women’s Health Study, a prospective cohort study for which researchers enrolled women aged 21 to 69 years in 1995 across 17 U.S. states (median age at baseline, 40 years; median baseline BMI, 27 kg/m2). Information on perceived interpersonal racism and childhood or adolescent abuse was ascertained via separate questionnaires. Participants were queried in 1997 and 2009 about their experiences with perceived interpersonal racism in everyday interactions and employment, housing and interactions with police, respectively. In 2005, participants were queried about their experiences with childhood and adolescence exposure to abuse, physical abuse only, exposure to genitals without sexual assault, and sexual assault, according to the study methods. Researchers evaluated the impact of these psychosocial stressors on future HF risk over a median follow-up of 24 years. After adjustment for demographic and clinical risk factors, researchers observed no significant association between HF risk and perceived interpersonal racism in everyday interactions, which was primarily attenuated by participants’ BMI. Risk for HF was higher among Black women who reported discrimination in more than one racism domain — employment, housing or interactions with police — compared with one domain (HR for two domains = 1.25; 95% CI, 1.08-1.45; HR for three domains = 1.27; 95% CI, 1.06-1.52), according to the study. The researchers reported that frequent adolescent sexual assault was associated with increased risk for HF, and was only partially attenuated after multivariable adjustment for age, BMI, education and more (HR = 1.44; 95% CI, 1.04-2). “The interrelatedness between obesity, heart failure risk, and psychosocial stress in the [Black Women’s Health Study] suggests that obesity may represent a key pathway through which stress contributes to heart failure risk, and this finding warrants further study,” the researchers wrote. “Taken together, our findings indicate that psychosocial stress exposures may be contributors to the disproportionate heart failure risk observed among U.S. Black women.”