Intimate Partner Violence and Subclinical Cardiovascular Disease in Midlife Women

项目摘要/摘要 卡伦·雅库博夫斯基博士是职业生涯早期的临床科学家，也是人际关系方面的新兴专家。 对女性心血管健康的创伤。NHLBI指导的以患者为中心的研究的目标 职业发展奖(K23)是研究亲密伴侣暴力(IPV)与亚临床的关系 中年女性的心血管疾病(CVD)，并测试睡眠不良作为联系IPV的机制的作用 和亚临床脑血管病。心血管疾病是女性死亡的主要原因。心理社会因素，如童年 成年期的虐待和慢性压力与心血管疾病的风险有关。然而，IPV，一种人际关系 超过35%的美国女性报告称，创伤与心血管疾病的关系知之甚少。中年是一个关键的时期 研究IPV与CVD的关系。中年是女性生理和心理社会转型的时期，通常 伴随着心血管疾病风险的累积。亚临床心血管疾病测量提供了心血管疾病风险的客观指标 中年女性，还没有被研究过与IPV的关系。睡眠不良等关键机制可能会将IPV联系起来 到亚临床脑血管病。了解IPV是否以及如何与心血管疾病风险相关，对于开发定制的 改善中年妇女心血管健康的干预措施。先前的研究受到依赖于 对心血管疾病和睡眠的回溯性自我报告测量，缺乏对引发和 在创伤暴露人群中保持睡眠不佳，并将重点放在年轻女性身上。拟议的培训计划 将涉及三个培训领域：(1)中年妇女的心血管健康和亚临床心血管疾病的测量， (2)IPV和对创伤暴露人群进行研究，以及(3)生态瞬时评估 (EMA)行为睡眠医学研究的方法和分析。这位候选人已经召集了一位 为实现这些培训目标而组建的跨学科导师团队。拟议的研究将调查两者之间的关系 有和没有IPV既往病史(N=100)的中年妇女样本中IPV与亚临床心血管疾病之间的关系 多维测量IPV(类型、慢性化)和亚临床CVD指数(颈动脉内膜中层厚度 和斑块)。女性将提供一周的EMA(睡眠质量、警觉性)和活动记录仪(睡眠连续性)， 它将提供睡眠的客观指数，并捕捉瞬间的社会、认知和行为因素 在创伤暴露的样本中开始并保持较差的睡眠。这项研究的目的是：(1)测试患有 有IPV病史的女性比没有这种病史的女性表现出更多的亚临床心血管疾病；(2)测试患有 有IPV病史的女性比无此病史的女性睡眠更差，警觉性更强；(3)测试睡眠是否较差 和警觉性与亚临床CVD相关，睡眠/警觉性在IPV与亚临床CVD的关系中的作用。 研究结果有可能阐明IPV在女性心血管健康中的作用，并为 降低中年女性心血管疾病风险的未来干预措施。拟议的研究和培训目标与 NHLBI努力确定女性心血管疾病的社会决定因素。研究和职业发展活动 将使候选人成为IPV和中年妇女心血管疾病方面的独立调查员和专家。

PROJECT SUMMARY/ABSTRACT Dr. Karen Jakubowski is an early career clinical scientist and emerging expert on the relationship of interpersonal trauma to women’s cardiovascular health. The objective of this NHLBI Mentored Patient-Oriented Research Career Development Award (K23) is to study the relation of intimate partner violence (IPV) to subclinical cardiovascular disease (CVD) in midlife women and to test the role of poor sleep as a mechanism linking IPV and subclinical CVD. CVD is the leading cause of death among women. Psychosocial factors, such as childhood abuse and chronic stress in adulthood, have been related to CVD risk. However, IPV, a type of interpersonal trauma reported by over 35% of U.S. women, is poorly understood in relation to CVD. Midlife is a critical time to study relations of IPV to CVD. Midlife is a period of biological and psychosocial transition for women that is often accompanied by accumulating CVD risk. Subclinical CVD measures provide objective indices of CVD risk among midlife women and have not been studied in relation to IPV. Key mechanisms, such as poor sleep, may link IPV to subclinical CVD. Understanding whether and how IPV is related to CVD risk is necessary to develop tailored interventions to improve midlife women’s cardiovascular health. Prior research is limited by a reliance on retrospective self-report measures of CVD and sleep, lack of consideration of contextual factors that initiate and maintain poor sleep in trauma-exposed populations, and a focus on younger women. The proposed training plan will address three training areas: (1) midlife women’s cardiovascular health and measurement of subclinical CVD, (2) IPV and conducting research with trauma-exposed populations, and (3) ecological momentary assessment (EMA) methods and analysis for behavioral sleep medicine research. The Candidate has assembled an interdisciplinary mentorship team to achieve these training aims. The proposed study will investigate the relation of IPV to subclinical CVD in a sample of midlife women with and without a past history of IPV (N=100), using a multidimensional measure of IPV (type, chronicity) and indices of subclinical CVD (carotid intima media thickness and plaque). Women will provide one week of EMA (sleep quality, vigilance) and actigraphy (sleep continuity), which will provide objective indices of sleep and capture momentary social, cognitive, and behavioral factors that initiate and maintain poor sleep in trauma-exposed samples. Study aims are to: (1) Test whether women with a history of IPV show greater subclinical CVD than women without this history; (2) Test whether women with a history of IPV show worse sleep and more vigilance than women without this history; (3) Test whether poor sleep and vigilance are related to subclinical CVD and the role of sleep/vigilance in relations of IPV to subclinical CVD. Results have the potential to elucidate the role of IPV in women’s cardiovascular health and suggest targets for future intervention to reduce CVD risk in midlife women. The proposed research and training aims align with NHLBI’s efforts to identify social determinants of CVD in women. Research and career development activities will prepare the candidate to be an independent investigator and expert in IPV and midlife women’s CVD.