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Adverse childhood experiences (ACEs) and cardiovascular development from childhood to early adulthood: study protocol of the Niagara Longitudinal Heart Study
  1. Terrance J Wade1,2,3,
  2. Deborah D O’Leary1,2,
  3. Kylie S Dempster1,2,
  4. Adam J MacNeil1,
  5. Danielle S Molnar3,
  6. Jennifer McGrath4,
  7. John Cairney5
  1. 1Health Sciences, Brock University, St. Catharines, Ontario, Canada
  2. 2Brock-NIagara Centre for Health and Well-Being, Brock University, St. Catharines, Ontario, Canada
  3. 3Child and Youth Studies, Brock University, St. Catharines, Ontario, Canada
  4. 4Department of Psychology, Concordia University, Montreal, Quebec, Canada
  5. 5Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Terrance J Wade; twade{at}


Introduction Recent reviews have found substantial links between a toxic childhood environment including child abuse and severe household dysfunction and adult cardiovascular disease (CVD). Collectively referred to as adverse childhood experiences (ACEs), this toxic environment is prevalent among children, with recent Canadian estimates of child abuse at 27%–32%, and severe household dysfunction at 49%. Based on these prevalence rates, the potential effect of ACEs on CVD is more significant than previously thought. Yet, how ACEs amplify the risk for later CVD remains unclear. Lifestyle risk factors only partially account for this connection, instead directing attention to the interaction between psychosocial factors and physiological mechanisms such as inflammation. The Niagara Longitudinal Heart Study (NLHS) examines how ACEs influence cardiovascular health (CVH) from childhood to early adulthood. Integrating the stress process and biological embedding models, this study examines how psychosocial and physiological factors in addition to lifestyle factors explain the relationship between ACEs and CVH.

Methods This follow-up study combines three baseline studies from 2007 to 2012 that collected CVH measures including child blood pressure, heart rate, left ventricular structure and function, arterial stiffness indices and baroreflex sensitivity on 564 children. Baseline data also include anthropometric, biological, lifestyle, behavioural, and psychosocial measures that varied across primary studies. Now over 18 years of age, we will recruit and retest as many participants from the baseline studies as possible collecting data on ACEs, CVH, anthropometric, lifestyle and psychosocial measures as well as blood, saliva and hair for physiological biostress markers.

Ethics and dissemination Ethics approval has been received for the NLHS follow-up. Written consent to participate in the follow-up study is obtained from each participant. Results testing all proposed hypotheses will be submitted for publication in peer-reviewed journals.

  • echocardiography
  • immunology
  • cardiology
  • mental health
  • social medicine
  • community child health

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  • Contributors TJW, DDO and JC are the principal investigators for the funded project and were responsible for the baseline studies guiding this work, the conceptualisation and design of the work and the interpretation of the data. KSD was the project coordinator for the pilot study, is responsible for collecting all cardiovascular measures, their analysis and interpretation and has contributed to the conceptualisation and design of the orthostatic stress component of the study. AJM, DSM and JJM all made substantial contributions to the conceptual and design aspects of both the psychosocial and physiological components of the work and all will be involved in the analysis and interpretation of aspects pertinent to their expertise. All authors were involved in writing and editing the CIHR-funded NLHS research proposal. TJW took the lead in revising the grant proposal for publication. All authors contributed in editing and reviewing the manuscript, approved of the final submission and agreed to be personally accountable for their specific contributions.

  • Funding The NLHS is supported by the Canadian Institutes of Health Research (CIHR) (award #’s 363774, 399332). HBEAT was supported by the Ontario Heart and Stroke Foundation (HSFO award #SDA6237). PHAST was supported by CIHR (award #66959). BAM was supported by CIHR (award # 199944).

  • Competing interests None declared.

  • Ethics approval Ethics approval has been received from Brock University BREB (Biological Research Ethics Board), file numbers 16-078-WADE and 18-288- WADE. To improve our recruitment rate, we received ethics approval to employ a social media strategy adhering to specific parameters mandated by the University Research Ethics Board (REB) to respect data privacy and confidentiality.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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