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

生活在美国农村的女性经历了过早冠状动脉心脏病的不成比例的增加 2009至2017年间疾病(CHD)死亡率与其他人口群体的比较 享受CHD事件的减少。在农村地区，心理健康状况恶化是一个日益令人担忧的问题 由于限制性别陈规定型观念，缺乏社会和经济条件，对农村妇女的影响不成比例 资源有限，获得护理的机会有限。这些因素反过来可能通过以下途径增加女性患冠心病的风险 自主神经、神经内分泌和炎症反应途径。我们预计，性别(社交) 结构)和性别(生物因素)及其相互作用被牵连。我们最重要的假设是 农村妇女不成比例地暴露在社会逆境和心理压力下，导致性行为- 共同增加CHD的特定激素、炎症、自主神经和心血管后果 风险。我们还假设，这些影响更有可能发生在女性的生育期，部分原因是 通过生殖生理和炎症的改变。与持续的农村(风险)合作 基础农村地区纵向)队列研究，我们将研究大约3800个不同的样本 25岁人群-来自美国南部10个农村县，正在接受详细的心血管检查 表型和心理社会评价。我们将使用一种新型的基于智能手机的设备来研究日常压力 工具和利用腕带可穿戴设备的数据来评估我们研究中的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以提供洞察力 用一种新型多模式动态心脏监护仪研究脑心对日常应激的反应性 心电图、脉搏波形、呼吸和运动。最后，我们将检查炎症性 以及可能与应激和冠心病相关的生殖激素途径，以帮助理解 年轻女性的冠心病风险不成比例地增加。在目标1中，我们考察了社会逆境中的差异 和心理健康因素，以及在农村社区男女之间的关系 暴露于心脏代谢性风险档案和亚临床冠心病。在目标2中，我们将每天检查差异 通过对女性和男性进行为期一周的应激和应激相关心血管生理学研究 生态瞬时评估和生理监测，以检查日常感知的情绪/压力， 应激生活事件，以及相应的自主神经应激反应与多传感器胸部贴片， 检查心脏和血管自主神经的影响。在目标3中，我们考察了社会逆境、精神上的 健康因素和农村日常生活中的压力与免疫变化(白介素6)和 生殖衰老(抗苗勒氏激素)。这项研究将是第一次对多因素进行检验 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，并将使我们的 了解青年和中年人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.