Oh, great. Another cardiac risk factor to worry about…

by Carolyn Thomas    @HeartSisters    October 7, 2018

There are lots of cardiac risk factors that increase our chances of developing heart disease one day. Some are beyond our control (like having a family history) and many are not (like smoking or a sedentary lifestyle).

Some other risk factors are less familiar, so are often overlooked. Until two years after my heart attack, for example, I didn’t know that having pregnancy complications (like the preeclampsia I was diagnosed with while pregnant with my first baby) can mean women are 2-3 times more likely to be diagnosed with heart disease years later. But here’s a cardiac risk factor that was new to me until I learned about something called the ACE study. And this is a big one.

ACE stands for Adverse Childhood Experiences, essentially warning that the higher your ACE test score, the higher your risk for later health problems – ranging from headaches to cancer or heart disease.

Studies have identified what’s called the “long reach” of such adversity on health, observing that elevated ACE in early life often reflect stress exposure that’s “likely to be associated with incremental erosion of health.”(1)

I learned about ACE while reading Lisa Suennen’s Venture Valkyrie blog. Lisa’s a powerhouse venture capitalist and co-author with Dr. David Shaywitz of the 2013 book Tech Tonics: Can Passionate Entrepreneurs Heal Healthcare with Technology?

Lisa talks about pediatrician Dr. Nadine Burke Harris, who during her clinical work in a disadvantaged and under-served community in San Francisco realized how directly childhood trauma can lead to adult physical illness. (Her TED talk on the longterm health effects of childhood trauma has been seen over 4.4 million times so far). The ACE research made sense to her everyday doctoring experience:(2)

“This is highly specific, highly researched, and deeply disturbing data about how people who score high on the ACE test (‘a tally of different types of abuse, neglect, and other hallmarks of a rough childhood’) are far more likely to experience serious physical illnesses, like cardiovascular disease, later in life.

“And here’s what the work on the ACE test has found: if you have an ACE score of 4 or higher, you are 2-3 times more likely to have cardiovascular disease later in life than someone who scores under 4. If you score 7 on the ACE test, even if you are a person who does not drink, smoke, or overeat (in other words, who doesn’t have behaviors that contribute to heart disease), you have a predictive risk of ischemic heart disease that is 360% higher than those with an ACE score of 0.”

Lisa bluntly summed up these findings:

“Well, that sucks. What I came away with was this: holy shit, by the time we are adults, assuming we had a tough childhood, it may be too late – we have already made a mess.

“Broken hearts lead to, well, broken hearts, and the real treatment people need is psychiatric/psychological, not biological.

“For those who wonder about whether the social determinants of health matter, the research around ACE should give you clear evidence how important these things are.

“For those of you who spend all your time in the medical model, you may be missing something fundamental.”

The ACE test is a list of 10 questions that anyone can complete in less than three minutes; it asks you nothing about your medical history or your genetic makeup. Instead, it asks about your childhood home, whether anyone beat you, ridiculed you, drank to excess, was abusive to you or a parent, etc. You can take the ACE test HERE

When I took this test, my score was 4 after only the first five questions. I felt gobsmacked by my score. Not that the circumstances of my childhood were a surprise to me, of course, but my own childhood turned out to be a cardiac risk factor that I hadn’t even been aware of. I’d heard of ACE, but I think I was in denial. I’d pictured the children who suffered these adverse events as living marginalized lives in abject poverty, and that certainly didn’t define my childhood. But I didn’t want to explore this reality any more than I’d already done during years of helpful psychotherapy as a young adult.

What distressed Lisa (and me!) was that the focus of cardiology is rarely – if ever – on early childhood trauma and its lasting impact on our heart health.

Most of the more famous risk factors and conditions have scientific or tech solutions: we take drugs for blood pressure or cholesterol, our blocked coronary arteries get stented or bypassed, our wonky electrical circuits are zapped, we get long lists of evidence-based lifestyle changes we must make every day to help prevent a cardiac event. But as Lisa observed:

“If you come to the game with a loaded psychological deck, you have a much higher burden to overcome, and that is likely to suppress the value of the traditional treatments. Science is essential, but so is social science and psychology.

“Can medical treatment even work if psychological treatment isn’t attended to?”

And here’s something that made me feel better. As Harvard pediatrician Dr. Jack Shonkoff, director of the Center on the Developing Child at Harvard, told NPR:

“There are people with high ACE scores who do remarkably well. ACE scores don’t tally the positive experiences in early life that can help build resilience and protect a child from the effects of trauma. Having a grandparent who loves you, a teacher who understands and believes in you, or a trusted friend you can confide in may mitigate the longterm effects of early trauma.”

Reading those lines reminded me of the positive experiences and remarkable role models, teachers, professional therapists and friends who truly made a difference in my life. As Dr. Burke Harris says in her TED talk, this is a condition that’s treatable, and beatable.

Resilience, Dr. Shonkoff adds, can build throughout life, and close relationships are key.(3)

1. Nurius, P. S. et al.  “Stress pathways to health inequalities: Embedding ACEs within social and behavioral contexts. International Public Health Journal, 8(2), 2016. 241–256.
2. Felitti VJ, Anda RF. “Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study.” Am J Prev Med. 1998 May;14(4):245-58.
3. Whitaker R. “Adverse childhood experiences, dispositional mindfulness, and adult health.” Prev Med; 2014 Jul 3067:147-53.
Image: Robert Wood Johnson Foundation

Q: What’s your take on the ACE test?

See also:

19 thoughts on “Oh, great. Another cardiac risk factor to worry about…

  1. Hi, i found this article of yours today while googling “high ACEs score atrial fibrillation” as my sister is in the ER this a.m. for the 3rd time this week, newly diagnosed with heart issues and having several recent related events…

    i know we have a super high ACEs score…where can i find resources to help understand the gravity of this intersection of issues for her? and how does one approach this with a doctor, bring in the research? Thanks for any help-

    Liked by 1 person

    1. Hello Debra – I hope your sister will be feeling better soon. You might want to refer her to Dr. John Mandrola’s website. He’s a cardiologist who treats atrial fibrillation, but has also been diagnosed with AFib himself (my favourite kind of doctor!)

      For ACEs resources, I’d recommend you check out the ACEs Too High website. Lots of info here on trauma-informed care, the Center for Disease Control ACEs study, and much more (including a “Support” section that’s useful for adults with high ACEs scores).

      When approaching a physician about this, best to bring up the most research-based info you can find, especially if the doctor’s not familiar with this risk factor’s link to cardiovascular disease. Don’t bring in a big stack of photocopied journal articles, but just one or two that seem most relevant. Best of luck to you and your sister…


  2. NOTE FROM CAROLYN: This comment has been removed because it was attempting to advertise a product/service to my readers. For more info on how to get your commercial comment removed, please read my fascinating Disclaimer Page.


  3. Incredible article.

    “Remember this, too: ACE scores don’t tally the positive experiences in early life that can help build resilience and protect a child from the effects of trauma. Having a grandparent who loves you, a teacher who understands and believes in you, or a trusted friend you can confide in may mitigate the long-term effects of early trauma, psychologists say.”

    Liked by 1 person

    1. Meshack, the story of Rosetta – the Italian village which transplanted itself from Italy to Pennsylvania is living evolving proof of a supportive society transcending harsh working environments, living in a foreign land and even, eventually, the haute cuisine of the times ! 😉

      But it was a dilution of that original population’s cohesiveness that took their ‘then-ZERO’ heart disease – slowly but inexorably to the national average.
      Diet only played a minor role.

      And these people agree that ‘Living’ is just as important…


  4. Makes total sense to me – the “stress response” and its impact on brain/body development etc doesn’t discriminate between bombs being dropped on countries and “bombs” being dropped in our personal lives.

    Liked by 1 person

    1. Hi Judy-Judith – Bombs being dropped is such a good analogy. I picture the personal ones as small bombs, not big enough to blow up your house or kill you, but little relentless bombs, and you never know when they will come…

      Liked by 1 person

    2. Going back, say, the last 70 years (for easier access) look at every population that has been carpet-bombed with social disruption and dis-order… compare their heart – health with stable, grounded and happily peaceful social groups & nations. ie, Swiss with the Australian Aborigne, French with the Scots. Amish with the Lithuanians, Mediterraneans with Ukraine…

      Not every “bad” diet gives bad outcomes, and an “approved” dietary intake cannot be relied upon!


  5. “Oh, great!” is right. Apparently I was doomed from the start. My ACE score was 6, having grown up with neglect and then my parents’ divorce. (Surprisingly, my husband’s was only 2 despite the fact that he grew up with an angry abuse victim mom — she was abused in childhood, not in marriage — who to this day is extremely reactive and difficult to cope with — I think the wording of the test questions may have affected the way he answered because I thought he would have had a much higher score.) It could be that the personality type of the child has a lot to do with it. My husband is easygoing and not generally ruffled by things, and I am highly sensitive.

    This post is very helpful because I’ve been interested in exploring the heart to heart connections between the physical and emotional heart and how they affect each other. Clearly there is a strong link even from earliest childhood — now we have more evidence of that.

    The other day I ordered a book about this connection on interlibrary loan which I’m waiting to receive — “Heartbreak and Heart Disease” by cardiologist Dr. Stephen Sinatra. Have you ever heard of this book or doctor?

    Thanks Carolyn!

    Liked by 1 person

    1. Hello Meghan – yes, it’s no surprise that there are both physical and emotional aspects to heart disease. I wonder if a child’s personality affects the ACE test scores, or does a history of ACE affect the personality? Chicken or egg? It’s like photos of babies in Eastern European orphanages who don’t cry anymore. Do they stop crying because they’re no longer unhappy, or do they stop crying because they now know that expecting anybody to pick them up is futile?

      Re Dr. Sinatra: I normally don’t mention books here that I would NOT recommend, but since you asked my opinion…
      I have not read this book (although I’m guessing he covers the ACE topic since that research was published in ’98 and his book came out the following year) – nor would I recommend anything he writes.

      He is a proponent of what I consider “junk science” (e.g groundology, earthing, claiming for example that shoes cause autoimmune diseases and are “the most destructive invention in human history”, which is simply a ridiculous thing to say). Scientists whom I admire (e.g. Dr. Harriet Hall) have written lots about pseudoscience and quackery, and he’s right up there high on her list (along with Dr. Oz, another person who was at one time a respected cardiologist, too). But even if I knew nothing of Dr. Sinatra’s reputation, the fact that he’s selling his own massive line of retail supplements is unethical for any physician, in my opinion.


      1. I agree. I love Dr. Hall. I read Skeptic and Skeptic Inquirer mags regularly. VooDoo science and all health care that is not evidence medicine, like homeopathy, makes me cringe.

        Love James Randi who has dis-proved the worth of these so called therapies and concoctions.

        Liked by 1 person

      2. Thank you Carolyn and Dr. Keddy for your perspective here. I appreciate what you said. I did wonder about those other books and his products — I too distrust a doctor who sells his own line of products. But the topic of this particular book sounded good. Glad I ordered it through the library rather than buying it! I’ll still read it and let you know if it’s any good at all.

        I also am not a fan of Dr. Oz from what little I’ve read of his stuff. Once a doctor becomes a “celebrity,” I tend to distrust them.

        Carolyn, maybe you should talk more about the books and advice you wouldn’t recommend and address the topic of quackery if you’ve never done so. I’m sure many people fall for the false advice that’s out there. I once attended a talk given by a woman who claimed she was a “wellness expert” and supposedly received her Ph.D. in 18 months because she was some kind of genius about health issues. Turns out she was just selling her line of products and making all kinds of miraculous claims for their health benefits. She was there with two of her “disciples” who seemed devoted to this woman. At the time my husband had just been diagnosed with high blood pressure, so I asked her about that. She actually said to me that his problem was that he had “dirty blood!” She lost me right there — it was clear that she didn’t know what she was talking about!

        Liked by 1 person

        1. Hi again Meghan – A few years ago I received a threatening letter from the Boston-based law firm Skadden, Arps, Slate, Meagher & Flom (which I thought at the time sounds like it’s from a Saturday Night Live skit). I had written about their client, a celebrity doctor, and his very large online retail supplement sales, which – as I said – I consider to be unethical.

          So that threat of legal action cured me from writing negative “reviews”. I’d much rather write about books I really like, those that I’d recommend to my readers!

          “Dirty blood” – that’s a good one!


          1. I completely understand and don’t blame you for your reluctance!

            Speaking of which, I’m going to be speaking briefly at our annual Cardiac Rehab Reunion event this week about finding emotional support and about the support group I lead, and I plan to bring your book with me and mention how much your book and blog have helped me. 8^)

            Liked by 1 person

      3. Carolyn, you don’t need to go as far as ‘grounding’ to find evidence of science ‘unburdened with facts’. Past Editors of the NEJM and Lancet have both come to the reluctant conclusion that around HALF of the Results / Research papers published are…False. Doubly so if we’re talking about ‘Drug Trials’ funded and run by the company making & profiting from those fantastic outcomes.

        At least a doctor selling a line of Snake Oil alongside his advice is in no position to change medical or social guidelines or make a $quillion dollar$, – not in the same way as a Big Pharma or Big Food does with consummate ease.
        I can expose or fight the little guy and maybe embarrass him into behaving himself, but that doesn’t work on BIG Sugar or Soda or Factory Foods.


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