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?
- Dear Carolyn: “People can change for the better” (a follow-up to this blog post from a reader whose ACE score was 7)
- Resilience: it’s hard to feel like a victim when you’re laughing
- How our girlfriends can help us get through the toughest times
- Looking for meaning in a meaningless diagnosis
- When an illness narrative isn’t just about illness
- The bumpy road between diagnosis and getting better
- More about ACE from the ACES Too High website.
- Almost anything written by Dr. Jonathon Tomlinson, a GP in London who writes eloquently about ACE issues and social determinants of health in his highly recommended blog.