Adverse childhood experiences, sexual orientation-related victimization, and cardiovascular disease risk among men with and without HIV

Objective: Adverse childhood experiences (ACEs) are traumatic events occurring before age 18 and can increase cardiovascular disease (CVD) risk. Many sexual minority men (SMM) and men with HIV (MWH) have trauma histories and elevated CVD risk. We investigated the association between ACEs and CVD risk among SMM with and without HIV (MWH and MWOH). Design and methods: Data were from the Multicenter AIDS Cohort Study (n=1245; n=650 MWOH, n=595 MWH). Participants self-reported 20 ACEs reflecting household dysfunction and victimization. CVD risk was measured with Framingham (FRS-H) and American College of Cardiology/American Heart Association-Pooled Cohort Equation (ACC/AHA-PCE) scores. Longitudinal generalized estimating equations (GEE) using 10years of repeated CVD measures were examined with each ACE type, total number of ACEs, and ACE latent classes. Results: The prevalence of each ACE was high, ranging from 50.3 to 83.8%. Childhood sexual orientation-related victimization was positively associated with CVD risk for MWOH (β FRS-H=2.95, SE=1.48, P=0.005; β ACC/AHA-PCE=3.31, SE=1.48, P=0.002) and MWH (β FRS-H=2.69, SE=1.58, P=0.03; β ACC/AHA-PCE=2.82, SE=1.62, P=0.03). Among MWH, ACE Class 2 (characterized by high sexual orientation-related victimization, moderate levels of parental abuse, and household dysfunction) was associated with higher CVD risk (β FRS-H=3.63, SE=1.78, P=0.03; β ACC/AHA-PCE=3.09, SE=1.78, P=0.05). Dose-response associations were observed for the full sample when considering the total number of ACEs, though attenuated in models stratified by HIV status. Conclusion: ACEs were associated with CVD risk among MWH and MWOH. Assessing ACE history in clinical encounters may yield important insights for the prevention and management of CVD. This study underscores the importance of trauma-informed care for this population.