{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T15:09:53Z","timestamp":1785510593410,"version":"3.56.0"},"reference-count":74,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,10,11]],"date-time":"2022-10-11T00:00:00Z","timestamp":1665446400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec><jats:title>Background and aim<\/jats:title><jats:p>Adverse childhood experiences (ACEs) are a major risk factor for unfavorable behavioral, mental and health outcomes later in life. However, the precise pathway<jats:italic>via<\/jats:italic>which ACEs convey these risks, in particular regarding health outcomes such as cardiovascular disease, remains unknown. Here, we combined psychiatric and cardiac methods to investigate the pathway<jats:italic>via<\/jats:italic>which childhood adversities may lead to adult adverse cardiovascular health, with a focus on epicardial adipose tissue (EAT) as a risk marker.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>210 adult congenital heart disease outpatients (mean age 35.5 y, 43% female) completed a thorough cardiac and psychiatric evaluation. Psychiatric measurements included an expert interview, the childhood trauma questionnaire (CTQ), Beck's depression inventory II (BDI-II), quality of life and the global scale of functioning, amongst others. All patients completed a full cardiac workup including EAT assessment using echocardiography. We then computed bootstrapping mediation models using ACEs as a predictor, depression and physical activity as mediators and EAT as dependent variable in PROCESS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>CTQ scores had a significant indirect effect on EAT<jats:italic>via<\/jats:italic>a serial mediation of BDI and physical activity [a<jats:sup>*<\/jats:sup>b2<jats:sup>*<\/jats:sup>d = 0.0260, 95% BCa CI [0.0047, 0.0619]].<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Using mediation analyses, we show that adverse childhood events are linked to increased depressive symptoms, which are linked to decreased physical activity, which in turn are linked to a higher amount of epicardial adipose tissue. While other pathways most certainly exist and replication is needed, this suggests a meaningful pathway<jats:italic>via<\/jats:italic>which ACEs lead to adverse cardiovascular health, with several potential targets for health interventions across time.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyt.2022.1002143","type":"journal-article","created":{"date-parts":[[2022,10,11]],"date-time":"2022-10-11T08:34:06Z","timestamp":1665477246000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":22,"title":["Behavioral pathway to a broken heart: The link between adverse childhood experiences, depression, physical exercise and cardiovascular 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