Sexual violence tends to be under-appreciated in general, but it is especially overlooked as a cardiovascular risk factor for women, as a Harvard University study shows.

The team looked at the association between sexual assault and workplace sexual harassment and hypertension in more than 33,000 women with no history of hypertension enrolled in NHANES, the Nurses Health Study II. Women who experienced both sexual assault and sexual harassment had the highest risk of developing hypertension during the seven-year study period.

“This finding underscores the potential compounding effects of multiple sexual violence exposures on women’s long-term cardiovascular health,” Rebecca Lawn, the study’s lead author, told TheDoctor.

More than 20 percent of women in the study had experienced sexual assault; 12 percent had experienced workplace sexual harassment; and six percent reported experiencing both assault and harassment.

Although primary care physicians have begun screening their female patients more often for intimate partner violence, many women experience workplace sexual harassment or sexual assault by someone other than their partner. Screening for different types of sexual violence and addressing its potential effect on cardiovascular health may be an important consideration going forward, according to Lawn.

“Healthcare professionals should think beyond what we consider typical cardiovascular risk factors and consider the implications of experiences such as sexual violence and harassment on women,” explained Lawn, a postdoctoral research fellow at the Harvard T.H. Chan School of Public Health.

More than 20 percent of women in the study had experienced sexual assault, 12 percent had experienced workplace sexual harassment, and six percent reported experiencing both assault and harassment. At the end of the follow-up period in 2015, more than 7, 000 of these women reported they had developed hypertension. Their diagnoses were validated using medical records.

Those who reported experiencing both sexual assault and workplace sexual harassment had a 21 percent increased risk of hypertension compared to those who experienced neither assault nor workplace harassment. Those who reported workplace harassment had a 15 percent increased risk of hypertension and those who experienced assault had an 11 percent increase in hypertension risk.

Recently, the team has been using data that include more detailed information on the timing and severity of sexual violence and the onset of psychological distress, including post-traumatic stress disorder and depression. Lawn and her colleagues hope that this data may help them better understand more clearly how sexual violence and the psychological distress it causes can lead to the development of cardiovascular disease.

Future work will also include data from a more diverse population in terms of gender, ethnicity and professional background than that of the current study.

The study is published in the Journal of the American Heart Association.