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Abuse as a Gendered Risk Factor for Cardiovascular Disease: A Conceptual Model

Scott-Storey, Kelly A. RN, MN, PhD(c)

The Journal of Cardiovascular Nursing: November/December 2013 - Volume 28 - Issue 6 - p E1–E8
doi: 10.1097/JCN.0b013e318279e372

Background: Cardiovascular disease (CVD) is one of the most serious health challenges facing women today. Investigations into CVD risk factors specific to women have focused primarily on sex-based differences, with little attention paid to gender-based influences. Abuse, such as child abuse, intimate partner violence, and sexual assault, is a serious gendered issue affecting one quarter to one-half of all women within their lifetime. Despite beginning evidence that abuse may increase CVD risk in women, the biological, behavioral, and psychological pathways linking abuse to CVD have received little attention from researchers and clinicians.

Purpose: The aim of this study was to propose a conceptual model that delineates the pathways by which abuse may increase CVD risk among women. Within the model, lifetime abuse is positioned as a chronic stressor affecting CVD risk through direct and indirect pathways. Directly, abuse experiences can cause long-term biophysical changes within the body, which increase the risk of CVD. Indirectly, smoking and overeating, known CVD risk behaviors, are common coping strategies in response to abuse. In addition, women with abuse histories frequently report depressive symptoms, which can persist for years after the abusive experience. Depressive symptoms are a known predictor of CVD and can potentiate CVD risk behaviors. Therefore, depressive symptoms are proposed as a mediator between lifetime abuse and CVD as well as between lifetime abuse and CVD risk behaviors.

Conclusions and Clinical Implications: To better promote cardiovascular health among women and direct appropriate interventions, nurses need to understand the complex web by which abuse may increase the risk for CVD. In addition, nurses need to not only pay attention to an abuse history and symptoms of depression for women presenting with CVD symptoms but also address CVD risk among women with abusive histories.

Kelly A. Scott-Storey, RN, MN, PhD(c) Lecturer, Faculty of Nursing, University of New Brunswick, Fredericton, Canada.

The author has received a Regional Partnership Program Doctoral Research Award (2009–2012) funded by the Canadian Institutes of Health Research, the New Brunswick Health Research Foundation, and the University of New Brunswick.

The author has no conflicts of interest to disclose.

Correspondence Kelly A. Scott-Storey, RN, MN, PhD(c), Faculty of Nursing, University of New Brunswick, PO Box 4400, Fredericton, NB, Canada E3B 5A3 (

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins