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

项目总结/摘要 这个K23职业发展奖将支持Allison Gaffey博士发展成为一名独立的 以患者为导向的研究者，重点关注女性高血压（HTN）和心血管疾病的风险 (CVD)社会脆弱性的贡献（SV;例如，童年和成年时受到不利影响所产生的压力， 以及健康的社会决定因素）和睡眠不足（例如，睡眠时间短）的风险， 及早发现机会，以减轻这一风险。到了35岁，女性开始表现出更陡峭的年增长率， 血压（BP）比男性升高，超过三分之一的绝经前女性表现出早期HTN 表型（即，血压升高或1期HTN）。SV和短睡眠时间-每一个都适合于行为和 公共卫生干预措施-对妇女特别有影响，可能有助于观察到这一点， 绝经前血压的升高被低估K23奖将确保Gaffey博士开发出 知识和技能，以调查HTN早期风险的社会和行为决定因素， 相关的行为CV预防女性。在耶鲁医学院资源丰富的环境中， 博士Gaffey已经组建了一个多学科的指导和咨询团队，以促进她的过渡， 通过培训的独立性：（1）BP，HTN和CVD的病理生理学，包括独特的协会， （2）睡眠的生理和行为机制，最先进的睡眠测量，以及睡眠 健康差异，包括女性特有的差异;（3）CV流行病学中健康的社会决定因素， 包括妇女特有的联系;（4）纵向和重复抽样的统计建模 数据Gaffey博士的培训将通过一项新的研究计划进行补充：（目的1）利用纵向数据 从年轻人冠状动脉风险发展研究（CARDIA）中，SV和自我的测试关联， 报告的睡眠持续时间：a）早期HTN表型的发作，和B）血压变化率， 成年早期到中期。分析将按性别分层。(AIM 2）将通过以下方式解决CARDIA的局限性： 对绝经前妇女和同龄妇女的社区样本进行混合方法的试点研究， 男性，a）测试家庭BP与SV相关压力暴露的短期关联， 评估睡眠持续时间;和B）定性评估SV相关压力的个人经历， 睡眠和研究可行性/可接受性。结果将包括压力、睡眠和 BP随时间变化的相关性，为SV、压力和睡眠的未来评估提供信息的背景主题，以及速率 招募、坚持、保留和满意度。这个K23逻辑上建立在Gaffey博士先前的研究基础上 和临床背景，并为她提供必要的专业知识和证据基础，以准备以后的R 01 应用程序，以收集更全面，客观和“真实世界”的SV，睡眠和BP评估。这 知识将同时解决有关年轻成人BP进展的关键差距， 博士Gaffey计划的职业目标是确定女性HTN和CVD预防的早期机会。

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.