Intergenerational trauma, violence leads to cardiovascular disease in Native women

Intergenerational trauma and violence has led to increased cardiovascular disease in American/Alaskan Native (AI/AN) women in childbearing years, according to a scientific statement published by The American Heart Association (AHA) this week.

The scientific statement highlights pregnancy risk factors related to cardiovascular health for Native women, Circulation: Cardiovascular Quality and Outcomes, by a peer-reviewed AHA journal.

Per the statement, AI/AN women giving birth between the ages 35-40 are five times as likely to die than white women. As well, AI/AN women also experience significantly high rates of other pregnancy complications such as infection, postpartum hemorrhage or gestational diabetes — all complications that are associated with increased cardiovascular risk.

Garima Sharma, M.D., FAHA chair of the writing committee for the scientific statement, said common risk factors for cardiac disease are aggravated in AI/AN individuals by chronic stress, intergenerational trauma, violence, adverse childhood experiences, and food insecurity.

AI/AN women are more likely to have experienced a high number of adverse childhood experiences — such as neglect, abuse, or having a parent in prison — as well as racism and discrimination, which increases the likelihood of high-risk behaviors (cigarette smoking, substance use) and chronic disease in adulthood, including cardiac disease, according to the scientific statement.

“AI/AN women’s mental and behavioral health disparities reflect the toxic stress and trauma of violence,” Sharma said in a statement. “Maternal care for AI/AN women must address traditional as well as social and cultural determinants of health."

The scientific statement makes several recommendations to address the cardiovascular risks among AI/AN women, including:

Establishing a framework free of stigma and judgment to address AI/AN women’s mental health and substance use within the context of structural racism.

Developing an accessible workforce that provides culturally sensitive care.

Providing appropriate screening of higher-risk pregnancies.

Recognizing the personal stories of women living with heart disease as a resource for health care professionals and researchers to develop prevention and treatment programs.

“We need to understand the health status of AI/AN populations and work collaboratively to improve cultural competency among our clinicians and partner with policymakers, health care professionals, local communities, and tribal leadership to design better studies and include the voices of these patients in providing appropriate care,” Sharma said in a statement.