Psychosocial Factors, Chronic Stress and Progression of SCD in Women

Rush University Medical Center, Chicago IL

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Abstract

DESCRIPTION (provided by applicant): The proposed study will examine psychosocial risk factors in relation to 2-year progression of subclinical atherosclerosis in a sample of women undergoing menopause. Adverse changes in traditional cardiac risk factors that occur in women at midlife, whether due to aging or the changing hormonal milieu, cannot fully explain the increase in cardiovascular disease (CVD) risk that occurs in midlife. Psychosocial risk factors predict clinical coronary events, yet far less is known about their impact on progression of subclinical atherosclerosis, particularly when the psychosocial stressors are chronic or interactive. We will address these gaps in our knowledge in a highly effective manner by using existing data on 3 subclinical cardiovascular disease (SCD) measures (carotid IMT, coronary calcification, and endothelial function) assessed twice, 2 years apart, for the NHLBI-supported SWAN Heart Study, and pairing these data with psychosocial measures obtained annually for the NIA/NINR-supported SWAN study. Combining data from these studies enables us to test hypotheses regarding psychosocial risks and 2-year progression of SCD that, to our knowledge, cannot be addressed in any other epidemiological study of CVD risk in women. Aims are to: (1) determine whether established risk factors for CVD (depressive symptoms, major life events, lack of social support), assessed at one point in time, relate to increases in SCD;(2) determine whether the chronic experience of these risk factors over the past 5 years is related to 2- year increases in SCD, (3) determine whether an integrated psychosocial measure encompassing the three risk factors is related to SCD progression, (4) determine whether the chronic experience of the integrated risk score is related to SCD progression, and (5) to explore the impact of psychosocial risk on change in endothelial function. All aims will be evaluated with and without adjustment for age, menopausal status, statin use, and standard cardiovascular risk factors. PUBLIC HEALTH RELEVANCE: This study will allow us to understand how single stressors or their combination influence the beginnings of heart disease in women, and whether more enduring stress has a stronger and more consistent effect on this development.. Factors contributing to stress may come from the woman herself or from her social or environmental circumstances. Since most of these factors are modifiable, the results will inform interventions aimed at treating heart disease in women at an early stage before disease becomes clinically evident.