Sexual Assault, Workplace Harassment Raises Hypertension Risk in Middle-aged Women

Women who reported ever experiencing sexual assault and workplace sexual harassment were at increased risk for developing hypertension (HTN) over a 7-year follow-up period, according to new research published in the Journal of the American Heart Association.

“We know that experiences of sexual violence in the form of sexual assault and workplace sexual harassment are common,” said lead author Rebecca B. Lawn, PhD, postdoctoral research fellow in epidemiology, Harvard T.H. Chan School of Public Health, Boston, in an American Heart Association statement. “However, exposure to sexual violence is not widely recognized as a contributor to women’s cardiovascular health. We felt it was important to investigate the relationship among common forms of sexual violence with the risk of developing hypertension. These links could help in the early identification of factors that influence women’s long-term cardiovascular health.”

Lawn and colleagues analyzed data from a substudy of the Nurses’ Health Study II and included 33 127 women who did not have HTN at the time they completed a sexual assault and workplace sexual harassment assessment (either physical or verbal) in 2008. The mean age at baseline was 53.1 years and 95% of participants were White.

For the purpose of the study, HTN was defined as self-reported doctor diagnosis or initiating antihypertensive medication use and was assessed biennially through 2015. Researchers assessed sexual violence exposure and developed models to estimate risk for developing HTN.

Investigators found that experiences of sexual assault and workplace sexual harassment were common, with lifetime prevalence of 23% and 12%, respectively; 6% of women experienced both. Approximately 21% of participants reported developing HTN over the follow-up period.

Compared with women with no exposure, women who experienced sexual assault and workplace sexual harassment had the highest risk of developing HTN (hazard ratio [HR], 1.21; 95% CI, 1.09–1.35), followed by those who experienced workplace sexual harassment (HR, 1.15; 95% CI, 1.05–1.25) and those who experienced sexual assault (HR, 1.11; 95% CI, 1.03–1.19). Results persisted after researchers adjusted for psychological distress and sociodemographic and family factors.

“Interestingly, we did not see associations between history of other traumas and risk of hypertension, suggesting that increased hypertension risk does not follow any trauma exposure and may be related to trauma type, frequency, and/or severity,” wrote Lawn and colleagues. “Our finding that experiencing both sexual assault and workplace sexual harassment showed the highest risk of hypertension underscores the potential compounding effects of multiple sexual violence exposures on health.”

The fact that researchers were able to examine multiple types of sexual violence and a range of other possible variables, including another type of trauma (eg, accident, disaster, or unexpected death of a loved one) was a strength of the study.

Limitations to the study included the fact that sexual violence was assessed retrospectively at 1 timepoint and could be subject to recall bias. Also, the timing and severity of sexual assault and workplace sexual harassment were not captured, which may make it difficult to “disentangle more specifically the relationships and pathways between these, other traumas, psychological distress and hypertension.

“The present study highlights the importance of investigating sexual violence, including in the workplace, in women’s health research. These results suggest that sexual assault and workplace sexual harassment are prospectively associated with greater risk of hypertension, which may place women at risk for future CVD,” concluded researchers. “Reducing such violence against women is important in its own right and may also provide an important strategy for improving women’s lifetime cardiovascular health.”

Reference: Lawn RB, Nishimi KM, Sumner JA, et al. Sexual violence and risk of hypertension in women in the Nurses' Health Study II: A 7-year prospective analysis. J Am Heart Assoc. Published online ahead of print February 22, 2022. doi: 10.1161/JAHA.121.023015.