Intimate Partner Violence and Subclinical Cardiovascular Disease in Midlife Women

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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.