Sexual assault and harassment linked to higher long-term heart attack risk in women
Cardiologist says the shortage of primary care providers in New Mexico isn’t helping either
Women who have experienced sexual assault and workplace sexual harassment are at higher long-term risk of developing high blood pressure and heart disease, a new study shows.
The study, published last month in the Journal of the American Heart Association, analyzed data from one of the largest investigations into risk factors for major chronic disease in women ever done by the National Institutes of Health.
Over 33,000 women with no history of hypertension were assessed in 2008 about their exposure to sexual violence and other trauma. The women, who were mostly white, middle-aged nurses, were contacted again over a seven-year followup period and asked about their blood pressure levels.
The medical records revealed about one in five of the women had developed high blood pressure, with the highest risk being for women who had experienced sexual trauma in their work and private lives.
The body’s reaction to trauma
Gail Starr, R.N. clinical coordinator at the Sexual Assault Nurse Examiner (SANE) program in Albuquerque, said these findings don’t surprise her. SANE provides support and treatment, including medical and forensic exams for sexual assault victims.
“Almost everyone coming in with domestic violence has anxiety, depression, and sometimes they’re on blood pressure medications,” Starr said.
Starr attributes the changes in blood pressure to the body’s reactions to stress over a long period of time.
“Cortisol —the hormone that is released in times of stress — is very powerful at getting us moving, getting us activated, getting us going, but long-term, cortisol just wreaks havoc on our system,” Starr said.
Cortisol is linked with long term autoimmune diseases and high levels of blood pressure.
These findings are consistent with other trauma studies that show that children who experience adverse childhood experiences are also at risk for increased rates of heart disease.
Sexual violence is a major public health problem in New Mexico with serious long-term physical and mental health consequences that disproportionately impact young people.
Nearly 40% (or an estimated 296,000) of women in New Mexico experience some form of sexual violence during their lifetime, according to NM’s Indicator Based Information System. This is nearly 10% higher than the national average, according to the Centers for Disease Control and Prevention.
The number of people who experience sexual assault is likely much higher than what is reported by the CDC, Starr said.
“We guesstimate around one out of five assaults that happen, actually come in and get help,” she said.
There are a number of factors that can discourage survivors from telling anyone, much less notifying the criminal legal system.
“The reputation of the police, the judiciary, and the way the news covers it may dissuade people from coming forward,” according to Starr.
The pandemic has exacerbated the problem, she added, with even fewer people reporting than they normally would.
Starr said the way our culture deals with sex is part of the reason the effects of these traumatic events are so profound and lifelong.
“What I see so often is that people are surrounded by people in their life who dismiss it, don’t believe them, and question if this was even really something that happened,” Starr said.
Starr said this societal diminishing of the problem also manifests in the survivors’ perceptions of what happened, which can lead to long-term stress and anguish.
“The victims themselves come forward and say ‘This happened to me, but was I raped enough to warrant this being called rape?’” Starr said.
This type of self-doubt and shame leads to years of stress, she added, but research has shown that in most cases the victims were actually incapable of responding in a more cognitive way while the assault was occurring.
Without effective treatment and therapy, Starr said, many people who have experienced sexual assault or sexual harassment feel shame about the way they handled the situation.
Shame can be a psychological way to regain a sense of control, she said, but that kind of thinking releases cortisol into the body, causing the cascading effects that lead to increased hypertension and ultimately cardiovascular disease.
Dr. Mark Bienviarz, an interventional cardiologist with New Mexico Heart Institute at Lovelace Medical Center, said this study illuminated how prevalent sexual assault is in our society and that it’s important for providers to be on the lookout for patients with histories of sexual violence.
“I think that should make us as physicians very sensitive to the fact that it’s an incredibly common problem,” he said.
Bienviarz also highlighted that the primary provider shortage and encouraged the state to continue to bolster mental health services, specifically post-sexual trauma counseling.
“Mental health care — that would improve the availability for counseling and also to point women who’ve been subjected to chronic trauma towards health care — is still a need of our state,” he said.
Gaps in care are hitting those who live in rural and poor areas the most, he added.
We know that this is a crisis, and women who've been subjected to sexual assault are kind of left isolated in a lot of places. – Dr. Mark Vienviarz, cardiologist
We know that this is a crisis, and women who've been subjected to sexual assault are kind of left isolated in a lot of places.
– Dr. Mark Vienviarz, cardiologist
“Improved services are really needed in some areas,” he said.
Rebecca Lawn, epidemiologist and lead researcher on the study, said that these findings confirm previous research and suggest that in addition to increased screening, even more resources must be put into sexual assault and harassment prevention.
“We must prevent sexual assault and workplace sexual harassment against women, and this is critical in its own right,” Lawn said. “In doing so, we may also benefit women’s cardiovascular health.”
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