Investigation of Sex and Gender Differences in Cardiovascular Risk in Rural Communities

生活在美国农村的妇女经历了不成比例的早发冠心病增加， 2009年至2017年之间的冠心病死亡率与其他人口统计学群体相比， 冠心病事件减少。农村地区的心理健康状况日益恶化， 由于性别陈规定型观念的束缚，缺乏社会和经济能力， 资源有限，获得护理的机会有限。这些因素反过来可能会增加女性冠心病的风险， 自主神经、神经内分泌和炎症反应途径。我们预计，性别（社会） 结构）和性别（生物因素）及其相互作用都有牵连。我们的首要假设是 农村妇女遭受社会逆境和心理压力的风险极高，导致性- 特定的激素、炎症、自主神经和心血管后果共同增加CHD 风险我们还假设，这些影响更有可能发生在女性的生育年龄，部分原因是 通过改变生殖生理学和炎症。与正在进行的农村（风险 基础农村地区纵向）队列研究，我们将研究约3800个不同的样本 来自美国南部10个农村县的25-64岁的人接受详细的心血管检查， 表型和心理社会评估。我们将使用一个基于智能手机的新方法来研究日常压力。 工具并利用腕带可穿戴设备的数据来评估睡眠和昼夜节律模式， 与心理压力有关。我们还将检查心脏自主神经功能， 用一种新型的多模式动态心脏监测仪测量脑心对日常压力的反应性， 心电图（ECG）、脉搏波形、呼吸和运动。最后，我们将研究炎症 和生殖激素途径可能与压力和冠心病有关，以帮助了解 不成比例地加速年轻女性的CHD风险。在目标1中，我们考察了社会逆境中的差异 农村社区男女之间的心理健康因素，以及这些因素之间的关系 暴露与心脏代谢风险特征和亚临床CHD。在目标2中，我们将检查日常生活中的差异 压力和压力相关的心血管生理之间的妇女和男子进行了为期一周的 通过生理监测进行生态瞬时评估，以检查日常感知的情绪/压力， 压力性生活事件和相应的自主应激反应， 检查心脏和血管自主神经的影响。在目标3中，我们考察社会逆境、精神 健康因素和农村日常生活中的压力与免疫改变（白细胞介素-6）有关， 生殖老化（抗苗勒管激素）。这项研究将是第一个检查多因素 农村妇女冠心病令人不安的趋势背后的生物心理社会决定因素，并将加强我们的研究。 了解青年和中年人口中与性别有关的差异。

Women living in the rural United States experienced a disproportionate increase in premature coronary heart disease (CHD) mortality between 2009 and 2017 compared to other demographic groups, which otherwise enjoyed a reduction in CHD events. Worsening mental health is a growing concern in rural areas and may disproportionately affect rural women due to constraining gender stereotypes, lack of social and economic resources, and limited access to care. These factors in turn may increase CHD risk in women through autonomic, neuroendocrine, and inflammatory response pathways. We anticipate that both gender (social constructs) and sex (biological factors) and their interplay are implicated. Our overarching hypothesis is that rural women have disproportionally high exposure to social adversity and psychological stress, leading to sex- specific hormonal, inflammatory, autonomic, and cardiovascular consequences that collectively increase CHD risk. We also hypothesize that these effects are more likely to occur during women's reproductive years in part through alterations in reproductive physiology and inflammation. Partnering with the ongoing RURAL (Risk Underlying Rural Areas Longitudinal) cohort study, we will study a diverse sample of approximately 3,800 people of age 25-64 years from 10 rural counties in the Southern US undergoing detailed cardiovascular phenotyping and psychosocial evaluation. We will examine everyday stress using a novel smartphone-based tool and leverage data from wristband wearables to evaluate sleep and circadian patterns that in our studies were associated with psychological stress. We will also examine cardiac autonomic function to provide insight on brain-heart reactivity to daily stress with a novel multi-modal ambulatory heart monitor that measures electrocardiography (ECG), pulse waveform, respiration, and movement. Finally, we will examine inflammatory and reproductive hormonal pathways potentially related to both stress and CHD, to help understand the disproportionately accelerated CHD risk in young women. In aim 1, we examine differences in social adversity and mental health factors between women and men in rural communities, and in the relationship of these exposures with cardiometabolic risk profile and subclinical CHD. In aim 2, we will examine differences in daily stress and stress-related cardiovascular physiology between women and men by conducting a week-long ecological momentary assessment with physiological monitoring to examine daily perceived mood/stress, stressful life events, and corresponding autonomic stress responses with a multi-sensor chest patch that examines both cardiac and vascular autonomic effects. In aim 3, we examine whether social adversity, mental health factors, and stress in everyday rural life are related to immune alterations (interleukin-6) and reproductive aging (anti-Mullerian hormone). This study will be the first to examine multifactorial biopsychosocial determinants underlying disturbing trends in CHD among rural women and will sharpen our understanding of sex-related disparities in young and middle-aged populations.