Many things can cause heart disease, such as smoking, high blood pressure, diabetes and high amounts of fats and cholesterol in the blood.

However, biomedical factors are not the only aspects, as recent evidence in studies of women’s health shows.

“When we consider the determinants of women’s cardiovascular health, we need to think beyond biology alone,” said Rebecca Thurston, a professor of psychiatry at the University of Pittsburgh’s School of Medicine.

Thurston recently led a study that demonstrates how traumatic experiences in life are linked to later vascular health issues that place women at risk for heart disease.

The results showed that women reporting a higher number of traumatic experiences, three or more, had poorer endothelial function – that is, the function of the inner lining of the heart and blood vessels ­– which can make them more susceptible to a cardiovascular incident.

For the purposes of this study, traumatic experiences were defined as events such as sexual harassment, death of a child, being in a car accident, experiencing a natural disaster, or being beaten or mugged.

“These findings underscore the importance of psychosocial factors, such as trauma exposure, in the development of cardiovascular disease risk in midlife women,” said Thurston, who also serves as director of the Women's Biobehavioral Health Laboratory at Pitt.

To date, little research has been done to study the impact of traumatic experiences on vascular health as a precursor to heart disease, a leading cause of death in women, according to Thurston. Even less work has focused on this relationship during the menopause transition when the risk of heart disease is naturally increasing, along with deteriorating endothelial function.

“This issue is particularly germane given the many recent traumatic events, such as major weather disasters, mass shootings and sexual harassment and assault the population has been facing,” Thurston said.

According to the American Heart Association, cardiovascular diseases and stroke cause one in three women’s deaths each year, killing approximately one woman every 80 seconds.

In Thurston’s study of 272 peri- and postmenopausal nonsmoking women, researchers tested whether a greater number of lifetime traumatic experiences was related to poorer endothelial function, independent of demographic characteristics, other heart disease risk factors, estradiol and childhood abuse history.

“Experiencing these (traumatic) events, particularly multiple events throughout life, may play a role in women’s risk for later cardiovascular disease,” Thurston said.

Thurston presented her results during The North American Menopause Society’s annual meeting in Philadelphia in October. The study was published in the December 2017 issue of Menopause Journal.

“Given the large percentage of postmenopausal women affected by heart disease, this is an important study that should remind health care providers of the need to thoroughly discuss a woman’s history beyond simply asking about her physical health,” said JoAnn Pinkerton, the society’s executive director, in a news release.

Ultimately, Thurston hopes health care providers inquire about patients’ traumatic histories and understand that those women with a history of multiple traumatic exposures warrant specific attention when it comes to their cardiovascular health.

“Women who know that they have experienced multiple traumas should be attentive to engaging in positive health behaviors like a heart healthy diet, exercise and smoking cessation to maximize their cardiovascular health,” she said.

Thurston’s findings also showed that women who got enough sleep were buffered from the harmful vascular effect of trauma, with implications that maximizing sleep health may be particularly important to protecting women’s hearts and blood vessels.