Social Vulnerability, Sleep, and Early Hypertension Risk in Younger Adults

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PROJECT SUMMARY/ABSTRACT This K23 Career Development Award will support Dr. Allison Gaffey’s development into an independent patient-oriented investigator with a focus on women’s risk for hypertension (HTN) and cardiovascular disease (CVD), the contributions of social vulnerability (SV; e.g., stress from adverse childhood and adult exposures, and from social determinants of health) and insufficient sleep (e.g., short sleep duration) to this risk, and the identification of early opportunities to mitigate this risk. By age 35, women begin to show a steeper annual increase in blood pressure (BP) than men and over 1 in 3 premenopausal women exhibit an early stage HTN phenotype (i.e., elevated BP or Stage 1 HTN). SV and short sleep duration - each amenable to behavioral and public health interventions - are especially impactful for women, and may contribute to this observed, yet underappreciated BP increase prior to menopause. The K23 Award will ensure that Dr. Gaffey develops the knowledge and skills to investigate the social and behavioral determinants of early risk for HTN, to improve related behavioral CV prevention for women. In the resource rich environment of the Yale School of Medicine, Dr. Gaffey has assembled a multidisciplinary mentoring and advisory team to facilitate her transition to independence via training in: (1) the pathophysiology of BP, HTN, and CVD, including associations unique to women; (2) physiological and behavioral mechanisms of sleep, state-of-the-art sleep measurement, and sleep health disparities, including those specific to women; (3) social determinants of health in CV epidemiology, including associations unique to women; and (4) statistical modeling of longitudinal and repeated sampling data. Dr. Gaffey’s training will be complemented by a novel plan of research: (AIM 1) With longitudinal data from the Coronary Artery Risk Development in Young Adults Study (CARDIA), test associations of SV and self- reported sleep duration to: a) the onset of early stage HTN phenotypes, and b) the rate of BP change from early- to mid-adulthood. Analyses will be stratified by sex. (AIM 2) Limitations of CARDIA will be addressed by conducting a mixed methods, pilot study with a community sample of premenopausal women and same-aged men to, a) test short-term associations of home BP to SV-related stress exposures and ecologically, objectively assessed sleep duration; and b) qualitatively assess personal experiences of SV-related stress, barriers to sleep, and study feasibility/acceptability. Outcomes will include within-person variability in stress, sleep, and BP associations over time, contextual themes to inform future assessment of SV, stress, and sleep, and rates of recruitment, adherence, retention, and satisfaction. This K23 builds logically on Dr. Gaffey’s prior research and clinical background and provides her with the requisite expertise and evidence base to prepare a later R01 application to collect more comprehensive, objective, and ‘real-world’ assessments of SV, sleep, and BP. This knowledge will simultaneously address critical gaps concerning BP progression in younger adults and advance Dr. Gaffey’s planned career objective to identify earlier opportunities for HTN and CVD prevention in women.