Research studies demonstrate that exposure to adverse childhood experiences (ACEs) lead to physical and mental health consequences in adulthood, including cardiovascular disease (Dong, Giles, Felitti et al, 2004; Felitti, Anda, Nordenberg, et al, 1998). One potential mechanism linking ACEs to cardiovascular disease is impaired social competence necessary for successful relationships and adequate social support. In the current study, the impact of ACEs on social support and subsequent incidence of acute coronary syndrome (ACS) was examined in a cohort of 6,596 older Seventh-day Adventists. After controlling for sociodemographic, lifestyle, and psychological factors, ACE exposure predicted increased risk of ACS by 31% for males only. Similarly, exposure to 3 or more ACEs resulted in a more than 3-fold increased risk of ACS for males compared to no ACEs. While ACE exposure had positive associations with negative social support and negative spouse/partner support, there were no associations with social integration. Social integration and support measures did not mediate the ACE-ACS relationship; even in supplementary analyses combining cardiac-related mortality and ACS. However, several gender and poverty moderation effects emerged. Church attendance decreased the risk of ACS in females in poverty, after controls and ACE exposure. Among females in poverty, negative social support and negative spouse support increased the risk of ACS incidence after controls and ACE exposure. Among males not in poverty, suppression effects were found, suggesting that having low negative support and negative spouse/partner support decreased the risk of ACS incidence as well as combined ACS and cardiac-mortality. Although non-significant, suppression patterns for poverty subgroups revealed that any increase in negative support or spouse/partner support, leads to increase in ACS incidence and combined ACS and cardiac mortality. Together, the findings highlight the long-term impact of ACEs on cardiac health, and the importance of considering non-traditional risk factors (such social support and church attendance), as critical pathways that can lead to cardiac health outcomes. Further examination of religiousness and emotion regulation pathways should follow to further elucidate on the mechanisms that underlie the ACE-ACS relationship.

LLU Discipline

Clinical Psychology




School of Behavioral Health

First Advisor

Morton, Lelly R.

Second Advisor

Lee, Jerry W.

Third Advisor

Vermeersch, David A.

Fourth Advisor

Boyd, Kendal C.

Degree Name

Doctor of Philosophy (PhD)

Degree Level


Year Degree Awarded

January 2013

Date (Title Page)




Library of Congress/MESH Subject Headings

Acute coronary syndrome;

Subject - Local

Acute coronary syndrome; Adverse Childhood Experiences



Page Count

78 p.

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses & Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives