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Harmon ME, Fiamingo M, Toler S, Lee K, Kim Y, Martin B, Gilmour I, Farraj AK, Hazari MS. The effect of enriched versus depleted housing on eucalyptus smoke-induced cardiovascular dysfunction in mice. Inhal Toxicol 2024:1-12. [PMID: 38776456 DOI: 10.1080/08958378.2024.2352748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 04/30/2024] [Indexed: 05/25/2024]
Abstract
Objectives: Living conditions play a major role in health and well-being, particularly for the cardiovascular and pulmonary systems. Depleted housing contributes to impairment and development of disease, but how it impacts body resiliency during exposure to environmental stressors is unknown. This study examined the effect of depleted (DH) versus enriched housing (EH) on cardiopulmonary function and subsequent responses to wildfire smoke. Materials and Methods: Two cohorts of healthy female mice, one of them surgically implanted with radiotelemeters for the measurement of electrocardiogram, body temperature (Tco) and activity, were housed in either DH or EH for 7 weeks. Telemetered mice were exposed for 1 h to filtered air (FA) and then flaming eucalyptus wildfire smoke (WS) while untelemetered mice, which were used for ventilatory assessment and tissue collection, were exposed to either FA or WS. Animals were continuously monitored for 5-7 days after exposure. Results: EH prevented a decrease in Tco after radiotelemetry surgery. EH mice also had significantly higher activity levels and lower heart rate during and after FA and WS. Moreover, EH caused a decreased number of cardiac arrhythmias during WS. WS caused ventilatory depression in DH mice but not EH mice. Housing enrichment also upregulated the expression of cardioprotective genes in the heart. Conclusions: The results of this study indicate that housing conditions impact overall health and cardiopulmonary function. More importantly, depleted housing appears to worsen the response to air pollution. Thus, non-chemical factors should be considered when assessing the susceptibility of populations, especially when it comes to extreme environmental events.
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Affiliation(s)
- Molly E Harmon
- Curriculum in Toxicology and Environmental Medicine, University of NC - Chapel Hill, Chapel Hill, NC, USA
| | - Michelle Fiamingo
- Curriculum in Toxicology and Environmental Medicine, University of NC - Chapel Hill, Chapel Hill, NC, USA
| | - Sydnie Toler
- Gillings School of Global Public Health, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Kaleb Lee
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Yongho Kim
- Public Health Integrated Toxicology Division, Center for Public Health and Environmental Assessment, United States Environmental Protection Agency, NC, USA
| | - Brandi Martin
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Ian Gilmour
- Public Health Integrated Toxicology Division, Center for Public Health and Environmental Assessment, United States Environmental Protection Agency, NC, USA
| | - Aimen K Farraj
- Public Health Integrated Toxicology Division, Center for Public Health and Environmental Assessment, United States Environmental Protection Agency, NC, USA
| | - Mehdi S Hazari
- Public Health Integrated Toxicology Division, Center for Public Health and Environmental Assessment, United States Environmental Protection Agency, NC, USA
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Bhattarai S, Wagle D, Shrestha A, Åsvold BO, Skovlund E, Sen A. Role of Perceived Social Support in Adherence to Antihypertensives and Controlled Hypertension: Findings of a Community Survey from Urban Nepal. Patient Prefer Adherence 2024; 18:767-777. [PMID: 38558834 PMCID: PMC10981373 DOI: 10.2147/ppa.s455511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/13/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Social support is considered vital for effective management of chronic conditions, but its role in improving adherence to antihypertensive medication and control of hypertension in urban Nepal is unknown. We examined the role of social support in adherence to antihypertensives and controlled blood pressure to inform future interventions for hypertension management. Methods We analyzed cross-sectional data collected at baseline of a cluster randomized trial of hypertension patients (n=1252) in the community between May and November 2022. Multidimensional scale of perceived social support was used to measure social support, adherence to antihypertensives was measured using the Morisky medication adherence scale -8, and individuals with systolic- and diastolic- blood pressure less than 140 and 90 mmHg respectively were considered to have controlled hypertension. Modified Poisson regression models were used to estimate the prevalence ratios and corresponding 95% confidence intervals. Results We found that 914 (73%) individuals received moderate to high social support. Participants receiving high social support had a numerically lower proportion of controlled hypertension (51%) however not statistically significant. The proportion of good adherence to antihypertensives did not differ between the social support categories. There was no association in overall, family, friends, and significant other sub-scales of social support with controlled hypertension and adherence to antihypertensives. Discussion Further studies to understand the quality and mechanisms through which social support contributes to blood pressure control are needed for the health system to include social support in designing and implementing community-based interventions for hypertension management.
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Affiliation(s)
- Sanju Bhattarai
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Institute of Implementation Science and Health, Kathmandu, Nepal
| | - Dikshya Wagle
- Institute of Implementation Science and Health, Kathmandu, Nepal
| | - Archana Shrestha
- Institute of Implementation Science and Health, Kathmandu, Nepal
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
- Department of Chronic Disease Epidemiology, Center of Methods for Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, 06510, USA
| | - Bjørn Olav Åsvold
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Endocrinology, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Eva Skovlund
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Abhijit Sen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Center for Oral Health Services and Research (Tkmidt), Trondheim, Norway
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Morris MC, Moradi H, Aslani M, Sims M, Schlundt D, Kouros CD, Goodin B, Lim C, Kinney K. Predicting incident cardiovascular disease among African-American adults: A deep learning approach to evaluate social determinants of health in the Jackson heart study. PLoS One 2023; 18:e0294050. [PMID: 37948388 PMCID: PMC10637695 DOI: 10.1371/journal.pone.0294050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023] Open
Abstract
The present study sought to leverage machine learning approaches to determine whether social determinants of health improve prediction of incident cardiovascular disease (CVD). Participants in the Jackson Heart study with no history of CVD at baseline were followed over a 10-year period to determine first CVD events (i.e., coronary heart disease, stroke, heart failure). Three modeling algorithms (i.e., Deep Neural Network, Random Survival Forest, Penalized Cox Proportional Hazards) were used to evaluate three feature sets (i.e., demographics and standard/biobehavioral CVD risk factors [FS1], FS1 combined with psychosocial and socioeconomic CVD risk factors [FS2], and FS2 combined with environmental features [FS3]) as predictors of 10-year CVD risk. Contrary to hypothesis, overall predictive accuracy did not improve when adding social determinants of health. However, social determinants of health comprised eight of the top 15 predictors of first CVD events. The social determinates of health indicators included four socioeconomic factors (insurance status and types), one psychosocial factor (discrimination burden), and three environmental factors (density of outdoor physical activity resources, including instructional and water activities; modified retail food environment index excluding alcohol; and favorable food stores). Findings suggest that whereas understanding biological determinants may identify who is currently at risk for developing CVD and in need of secondary prevention, understanding upstream social determinants of CVD risk could guide primary prevention efforts by identifying where and how policy and community-level interventions could be targeted to facilitate changes in individual health behaviors.
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Affiliation(s)
- Matthew C. Morris
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Hamidreza Moradi
- Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
- Department of Computer Science, University of North Carolina Agricultural and Technical State University, Greensboro, North Carolina, United States of America
| | - Maryam Aslani
- Department of Data Analytics, University of North Texas, Denton, Texas, United States of America
| | - Mario Sims
- Department of Social Medicine, Population, and Public Health, University of California, Riverside, California, United States of America
| | - David Schlundt
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Chrystyna D. Kouros
- Department of Psychology, Southern Methodist University, Dallas, Texas, United States of America
| | - Burel Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, Texas, United States of America
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Crystal Lim
- Department of Health Psychology, University of Missouri, Columbia, Missouri, Texas, United States of America
| | - Kerry Kinney
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, United States of America
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Reges O, Krefman AE, Hardy ST, Yano Y, Muntner P, Pool LR, Gordon-Larsen P, Wang Y, Lloyd-Jones DM, Allen NB. Race- and Sex-Specific Factors Associated With Age-Related Slopes in Systolic Blood Pressure: Findings From the CARDIA Study. Hypertension 2023; 80:1890-1899. [PMID: 37470199 DOI: 10.1161/hypertensionaha.123.21217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/06/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Although blood pressure (BP) increases throughout young adulthood for most individuals, the age-related slope is not uniform. This study aimed to assess associations of demographic, clinical, behavioral, psychosocial, and neighborhood characteristics with age-related BP slope among 4 race-sex groups who participated in the Coronary Artery Risk Development in Young Adults study. METHODS Individuals (n=3554) aged 18 to 30 years were included in this analysis if they had normal BP at baseline and ≥2 BP measurements during the years 1985/1986 to 2015/2016. Associations of exposure variables with systolic BP slope were assessed using multivariate linear models. RESULTS Over a mean follow-up of ~30 years, greater decade increases in systolic BP were estimated among Black than White participants (mean difference between Black females and White females: 3.0 mm Hg/decade; between Black males and White males: 4.7 mm Hg/decade). The exposure risk factors associated with greater increases in systolic BP throughout adulthood varied by race and sex. None of these factors were associated with increases in systolic BP in all race-sex groups. Parent history of high BP was associated with a steeper positive slope among Black females (effect size per decade: 1.1 [95% CI, 0.6-1.6]; P<0.01), Black males (0.6 [95% CI, 0.02-1.2]; P<0.05), and White females (0.6 [95% CI, 0.2-1.0]; P<0.01). Other risk factors were associated with greater age-related yearly increases in systolic BP among 1 or 2 of the 4 race-sex groups or were not statistically significant. CONCLUSIONS Culturally tailored BP reduction approach should be considered in conjunction with primordial prevention, to moderate increases in BP throughout adulthood.
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Affiliation(s)
- Orna Reges
- Department of Health Systems Management, Ariel University, Israel (O.R.)
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL (O.R., A.E.K., L.R.P., Y.W., D.M.L.-J., N.B.A.)
| | - Amy E Krefman
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL (O.R., A.E.K., L.R.P., Y.W., D.M.L.-J., N.B.A.)
| | - Shakia T Hardy
- Department of Epidemiology, University of Alabama at Birmingham (S.T.H., P.M.)
| | - Yuichiro Yano
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (Y.Y.)
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham (S.T.H., P.M.)
| | - Lindsay R Pool
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL (O.R., A.E.K., L.R.P., Y.W., D.M.L.-J., N.B.A.)
| | - Penny Gordon-Larsen
- Department of Nutrition, University of North Carolina, Gillings School of Global Public Health, Chapel Hill, NC (P.G.-L.)
| | - Yaojie Wang
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL (O.R., A.E.K., L.R.P., Y.W., D.M.L.-J., N.B.A.)
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL (O.R., A.E.K., L.R.P., Y.W., D.M.L.-J., N.B.A.)
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL (O.R., A.E.K., L.R.P., Y.W., D.M.L.-J., N.B.A.)
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Magnani JW. Hypertension-A Social Disease in Need of Social Solutions. Hypertension 2023; 80:1414-1416. [PMID: 37315120 PMCID: PMC10424912 DOI: 10.1161/hypertensionaha.123.21296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Jared W. Magnani
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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Gavrilova L, Zawadzki MJ. Testing the Associations Between State and Trait Anxiety, Anger, Sadness, and Ambulatory Blood Pressure and Whether Race Impacts These Relationships. Ann Behav Med 2023; 57:38-49. [PMID: 34894226 DOI: 10.1093/abm/kaab098] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Anxiety, anger, and sadness are related to elevated ambulatory blood pressure (ABP), yet it is unclear whether each emotion exerts unique effects. Moreover, an understanding of who might be most susceptible to the negative effects of these emotions is limited, with the trait tendency to experience them or one's race as potential moderators. PURPOSE The study examined the potential for differential effects of momentary anxiety, anger, and sadness on ABP. The study assessed whether a trait tendency to experience these negative emotions and/or race (Black vs. non-Black) would moderate these relationships. METHODS Participants (n = 153) completed trait anxiety, anger, and depressive symptoms measures at baseline. ABP was collected over two 24-hour periods 3-4 months apart. Momentary measures of anxiety, anger, and sadness were assessed via ecological momentary assessment (EMA) after each ABP reading. RESULTS Momentary anxiety consistently predicted diastolic blood pressure but not systolic blood pressure. Momentary anger and sadness did not predict blood pressure (BP). Conditional effects were found with momentary anxiety and anger predicting elevated BP in those individuals with trait anxiety/anger at its mean. Trait anxiety and depression consistently predicted heightened BP in Black participants. Trait anger did not moderate the relationships between negative emotions and ABP. CONCLUSIONS Findings suggest that momentary anxiety and anger should be given attention as potential risk factors for hypertension and highlight the unique perspective of EMA methods. Black participants who were more anxious and depressed experienced heightened BP, with anxiety and depression providing possible intervention targets in improving racial disparities in cardiovascular health.
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Affiliation(s)
- Larisa Gavrilova
- Department of Psychological Sciences, University of California, Merced, Merced, CA, USA
| | - Matthew J Zawadzki
- Department of Psychological Sciences, University of California, Merced, Merced, CA, USA
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Yu SN, Lin IM, Wang SY, Hou YC, Yao SP, Lee CY, Chang CJ, Chu CS, Lin TH. Affective Computing Based on Morphological Features of Photoplethysmography for Patients with Hypertension. SENSORS (BASEL, SWITZERLAND) 2022; 22:8771. [PMID: 36433366 PMCID: PMC9698908 DOI: 10.3390/s22228771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/31/2022] [Accepted: 11/10/2022] [Indexed: 06/16/2023]
Abstract
Negative and positive emotions are the risk and protective factors for the cause and prognosis of hypertension. This study aimed to use five photoplethysmography (PPG) waveform indices and affective computing (AC) to discriminate the emotional states in patients with hypertension. Forty-three patients with essential hypertension were measured for blood pressure and PPG signals under baseline and four emotional conditions (neutral, anger, happiness, and sadness), and the PPG signals were transformed into the mean standard deviation of five PPG waveform indices. A support vector machine was used as a classifier. The performance of the classifier was verified by using resubstitution and six-fold cross-validation (CV) methods. Feature selectors, including full search and genetic algorithm (GA), were used to select effective feature combinations. Traditional statistical analyses only differentiated between the emotional states and baseline, whereas AC achieved 100% accuracy in distinguishing between the emotional states and baseline by using the resubstitution method. AC showed high accuracy rates when used with 10 waveform features in distinguishing the records into two, three, and four classes by applying a six-fold CV. The GA feature selector further boosted the accuracy to 78.97%, 74.22%, and 67.35% in two-, three-, and four-class differentiation, respectively. The proposed AC achieved high accuracy in categorizing PPG records into distinct emotional states with features extracted from only five waveform indices. The results demonstrated the effectiveness of the five indices and the proposed AC in patients with hypertension.
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Affiliation(s)
- Sung-Nien Yu
- Department of Electrical Engineering, National Chung Cheng University, Chiayi 621301, Taiwan
- Pervasive Artificial Intelligence Research (PAIR) Labs, Hsinchu 300093, Taiwan
| | - I-Mei Lin
- Pervasive Artificial Intelligence Research (PAIR) Labs, Hsinchu 300093, Taiwan
- Department of Psychology, College of Humanities and Social Sciences, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
| | - San-Yu Wang
- Department of Psychology, College of Humanities and Social Sciences, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Yi-Cheng Hou
- Department of Electrical Engineering, National Chung Cheng University, Chiayi 621301, Taiwan
| | - Sheng-Po Yao
- Department of Electrical Engineering, National Chung Cheng University, Chiayi 621301, Taiwan
| | - Chun-Ying Lee
- Division of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Departments of Family Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Chai-Jan Chang
- Division of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Departments of Family Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Chih-Sheng Chu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Department of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Department of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
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Depression and cardiovascular disease are not linked by high blood pressure: findings from the SAPALDIA cohort. Sci Rep 2022; 12:5516. [PMID: 35365701 PMCID: PMC8975826 DOI: 10.1038/s41598-022-09396-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/15/2022] [Indexed: 11/22/2022] Open
Abstract
Depression and cardiovascular disease (CVD) are main contributors to the global disease burden and are linked. Pathophysiological pathways through increased blood pressure (BP) are a common focus in studies aiming to explain the relationship. However, studies to date have not differentiated between the predictive effect of depression on the course of BP versus hypertension diagnosis. Hence, we aimed to elucidate this relationship by incorporating these novel aspects in the context of a cohort study. We included initially normotensive participants (n = 3214) from the second (2001–2003), third (2009–2011), and fourth (2016–2018) waves of the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA). We defined depression based on physician diagnosis, depression treatment and/or SF-36 Mental Health score < 50. The prospective association between depression and BP change was quantified using multivariable censored regression models, and logistic regression for the association between depression and incident hypertension diagnosis. All models used clustered robust standard errors to account for repeat measurements. The age-related increase in systolic BP was slightly lower among people with depression at baseline (β = − 2.08 mmHg/10 years, 95% CI − 4.09 to − 0.07) compared to non-depressed. A similar trend was observed with diastolic BP (β = − 0.88 mmHg/10 years, 95% CI − 2.15 to 0.39), albeit weaker and not statistically significant. Depression predicted the incidence of hypertension diagnosis (OR 1.86, 95% CI 1.33 to 2.60). Our findings do not support the hypothesis that depression leads to CVD by increasing BP. Future research on the role of depression in the pathway to hypertension and CVD is warranted in larger cohorts, taking into account healthcare utilization as well as medication for depression and hypertension.
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Harding BN, Hawley CN, Kalinowski J, Sims M, Muntner P, Young Mielcarek BA, Heckbert SR, Floyd JS. Relationship between social support and incident hypertension in the Jackson Heart Study: a cohort study. BMJ Open 2022; 12:e054812. [PMID: 35301208 PMCID: PMC8932258 DOI: 10.1136/bmjopen-2021-054812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 02/16/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Social support may be an important mitigating factor against adverse cardiovascular outcomes by facilitating health-promoting behaviours or by buffering against the negative effects of stress. This study examined the association of social support with incident hypertension. DESIGN Prospective cohort study. SETTING We evaluated the association of social support with incident hypertension among participants in the Jackson Heart Study, a community-based cohort of African Americans. PARTICIPANTS This study included African American adults, who were free of hypertension at baseline (2000-2004). Functional social support, structural social support and satisfaction with social support were assessed at baseline among 1516, 1240 and 1503 participants, respectively. OUTCOME MEASURES Incident hypertension was assessed at follow-up examinations in 2005-2008 and 2009-2013. Incident hypertension was defined by the first visit with systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg or self-reported antihypertensive medication use. Multivariable Poisson regression was used to estimate the association of baseline social support with incident hypertension, adjusting for relevant confounders. RESULTS At baseline, the mean age of participants was 50 years and 64% were men. During a median follow-up time of 6.9 years, 54% of participants developed hypertension. A high level of functional social support was associated with lower risk of incident hypertension (incident rate ratio 0.64, (95% CI 0.41 to 0.97)), compared with a low level of functional social support. Level of structural social support and satisfaction with social support were not associated with hypertension risk. CONCLUSIONS These results suggest that greater functional support may be associated with a lower risk of incident hypertension.
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Affiliation(s)
- Barbara N Harding
- Non-Communicable Diseases and Environment, Barcelona Institute for Global Health, Barcelona, Spain
| | - Caitlin N Hawley
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Jolaade Kalinowski
- Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Mario Sims
- Department of Internal Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Paul Muntner
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bessie A Young Mielcarek
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - James S Floyd
- Department of Medicine, University of Washington, Seattle, Washington, USA
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Banchani E, Tenkorang EY, Midodzi W. Examining the effects of individual and neighbourhood socioeconomic status/wealth on hypertension among women in the Greater Accra Region of Ghana. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:714-725. [PMID: 33016517 DOI: 10.1111/hsc.13185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 06/11/2023]
Abstract
Hypertension is one of the leading causes of morbidity and mortality among women in sub-Saharan Africa. Although research on the relationship between individual-level socioeconomic status (SES) and hypertension exists, to the best of our knowledge, limited empirical studies examined the effects of neighbourhood-level SES/wealth on the risks of living with hypertension in Ghana. Using data from the 2009 Women's Health Study of Accra (WHSA-II), and applying multilevel logistic regression, this study investigates the effects of both individual and neighbourhood wealth status on hypertension among women in the Greater Accra Region of Ghana. The results show that individual-level SES/wealth is a significant determinant of hypertension among Ghanaian women in Accra. Specifically, wealthy women are more likely to be hypertensive compared to poorer women. However, the effect of neighbourhood SES/wealth was attenuated after adjusting for individual-level SES/wealth. These findings suggest that it is important to develop health promotion programs targeted at a segment of SES group in the prevention, control and management of hypertension among women in the Greater Accra Region of Ghana.
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Affiliation(s)
| | - Eric Y Tenkorang
- Department of Sociology, Memorial University, St. John's, Canada
| | - William Midodzi
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, Canada
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11
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Nwanaji-Enwerem U, Onsomu EO, Roberts D, Singh A, Brummett BH, Williams RB, Dungan JR. Relationship Between Psychosocial Stress and Blood Pressure: The National Heart, Lung, and Blood Institute Family Heart Study. SAGE Open Nurs 2022; 8:23779608221107589. [PMID: 35769609 PMCID: PMC9234844 DOI: 10.1177/23779608221107589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/30/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Various domains of psychosocial stress have been significantly related to blood pressure. However, ambiguity is present in how these relationships are defined in the literature. Objective To add to the existing literature and examine the relationship between psychosocial stress (financial strain and job strain) and other cofactors on blood pressure. Methods This secondary analysis is designed to analyze the relationship between levels of job and financial stress and blood pressure outcomes among participants in the National Heart, Lung, and Blood Institute (NHLBI) Family Heart Study 2004-2008. The descriptive, cross-sectional design uses data from a subset of study participants, 350 White and 195 Black (n = 545), 338 female (62%), and all aged 18-56 years. Psychosocial stress was measured using the Singh Stress Scale. Resting systolic (SBP) and diastolic (DBP) blood pressure values obtained on a stress reactivity protocol day in the primary study, as well as calculated mean arterial pressure (MAP) were used for this analysis. Multivariate linear regression analyses were used to explore the relationship between psychosocial stress and blood pressure. Results In this young cohort, self-report of either financial strain or job strain was associated with lower blood pressure levels than those of participants who reported neither stressor. Differential sex and race effects appear to contribute to these results. Blood pressure levels were not significantly associated with self-report of both stressors. Conclusion Understanding the effects of various forms of stress on blood pressure may inform more precise HTN risk-factor screening and interventions to improve BP management.
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Affiliation(s)
- Uzoji Nwanaji-Enwerem
- Yale School of Nursing, Yale
University, West Haven, CT, USA
- Division of Nursing, Winston-Salem State
University, Winston-Salem, NC, USA
| | - Elijah O. Onsomu
- Division of Nursing, Winston-Salem State
University, Winston-Salem, NC, USA
| | - Dionne Roberts
- Division of Nursing, Winston-Salem State
University, Winston-Salem, NC, USA
| | - Abanish Singh
- Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
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Langford AT, Butler M, Booth JN, Jin P, Bress AP, Tanner RM, Kalinowski J, Blanc J, Seixas A, Shimbo D, Sims M, Ogedegbe G, Spruill TM. Stress and Depression Are Associated With Life's Simple 7 Among African Americans With Hypertension: Findings From the Jackson Heart Study. Am J Hypertens 2021; 34:1311-1321. [PMID: 34272853 PMCID: PMC8643585 DOI: 10.1093/ajh/hpab116] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/18/2021] [Accepted: 07/15/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The American Heart Association created the Life's Simple 7 (LS7) metrics to promote cardiovascular health (CVH) by achieving optimal levels of blood pressure, cholesterol, blood sugar, physical activity, diet, weight, and smoking status. The degree to which psychosocial factors such as stress and depression impact one's ability to achieve optimal CVH is unclear, particularly among hypertensive African Americans. METHODS Cross-sectional analyses included 1,819 African Americans with hypertension participating in the Jackson Heart Study (2000-2004). Outcomes were LS7 composite and individual component scores (defined as poor, intermediate, ideal). High perceived chronic stress was defined as the top quartile of Weekly Stress Inventory scores. High depressive symptoms were defined as Center for Epidemiologic Studies Depression scale scores of ≥16. We compared 4 groups: high stress alone; high depressive symptoms alone; high stress and high depressive symptoms; low stress and low depressive symptoms (reference) using linear regression for total LS7 scores and logistic regression for LS7 components. RESULTS Participants with both high stress and depressive symptoms had lower composite LS7 scores (B [95% confidence interval] = -0.34 [-0.65 to -0.02]) than those with low stress and depressive symptoms in unadjusted and age/sex-adjusted models. They also had poorer health status for smoking (odds ratio [95% confidence interval] = 0.52 [0.35-0.78]) and physical activity (odds ratio [95% confidence interval] = 0.71 [0.52-0.95]) after full covariate adjustment. CONCLUSIONS The combination of high stress and high depressive symptoms was associated with poorer LS7 metrics in hypertensive African Americans. Psychosocial interventions may increase the likelihood of engaging in behaviors that promote optimal CVH.
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Affiliation(s)
- Aisha T Langford
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Mark Butler
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - John N Booth
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Real-World Evidence and Late Phase, CTI Clinical Trials and Consulting Services, Inc., Covington, Kentucky, USA
| | - Peng Jin
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Adam P Bress
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Rikki M Tanner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jolaade Kalinowski
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Judite Blanc
- Department of Psychiatry & Behavioral Sciences, University of Miami, Miami, Florida, USA
| | - Azizi Seixas
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Daichi Shimbo
- Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Gbenga Ogedegbe
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
- Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, New York, USA
| | - Tanya M Spruill
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
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Bokhari S, Schneider RH, Salerno JW, Rainforth MV, Gaylord-King C, Nidich SI. Effects of cardiac rehabilitation with and without meditation on myocardial blood flow using quantitative positron emission tomography: A pilot study. J Nucl Cardiol 2021; 28:1596-1607. [PMID: 31529385 PMCID: PMC9178923 DOI: 10.1007/s12350-019-01884-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/21/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Psychosocial stress is recognized as a risk factor for coronary heart disease (CHD). High rates of CHD in African-Americans may be related to psychosocial stress. However, standard cardiac rehabilitation (CR) usually does not include a systematic stress-reduction technique. Previous studies suggest that the Transcendental Meditation (TM) technique may reduce CHD risk factors and clinical events. This pilot study explored the effects of standard CR with and without TM on a measure of CHD in African-American patients. METHODS Fifty-six CHD patients were assigned to CR, CR + TM, TM alone, or usual care. Testing was done at baseline and after 12 weeks. The primary outcome was myocardial flow reserve (MFR) assessed by 13N-ammonia positron emission tomography (PET). Secondary outcomes were CHD risk factors. Based on guidelines for analysis of small pilot studies, data were analyzed for effect size (ES). RESULTS For 37 patients who completed posttesting, there were MFR improvements in the CR + TM group (+20.7%; ES = 0.64) and the TM group alone (+12.8%; ES = 0.36). By comparison, the CR-alone and usual care groups showed modest changes (+ 5.8%; ES = 0.17 and - 10.3%; ES = - 0.31), respectively. For the combined TM group, MFR increased (+ 14%, ES = 0.56) compared to the combined non-TM group (- 2.0%, ES = - 0.08). CONCLUSIONS These pilot data suggest that adding the TM technique to standard cardiac rehabilitation or using TM alone may improve the myocardial flow reserve in African-American CHD patients. These results may be applied to the design of controlled clinical trials to definitively test these effects. TRIAL REGISTRATION ClinicalTrials.gov registration # NCT01810029.
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Affiliation(s)
- Sabahat Bokhari
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Robert H Schneider
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, 2100 Mansion Drive, Maharishi Vedic City, IA, 52556, USA.
| | - John W Salerno
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, 2100 Mansion Drive, Maharishi Vedic City, IA, 52556, USA
| | - Maxwell V Rainforth
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, 2100 Mansion Drive, Maharishi Vedic City, IA, 52556, USA
| | - Carolyn Gaylord-King
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, 2100 Mansion Drive, Maharishi Vedic City, IA, 52556, USA
| | - Sanford I Nidich
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, 2100 Mansion Drive, Maharishi Vedic City, IA, 52556, USA
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14
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Ko YA, Shen J, Kim JH, Topel M, Mujahid M, Taylor H, Quyyumi A, Sims M, Vaccarino V, Baltrus P, Lewis T. Identifying neighbourhood and individual resilience profiles for cardiovascular health: a cross-sectional study of blacks living in the Atlanta metropolitan area. BMJ Open 2021; 11:e041435. [PMID: 34330849 PMCID: PMC8327812 DOI: 10.1136/bmjopen-2020-041435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To simultaneously examine multiple individual-level neighbourhood perceptions and psychosocial characteristics and their relationships with cardiovascular health (CVH) among blacks. DESIGN Cross-sectional study. SETTING Subjects were recruited between 2016 and 2018 via convenience sampling. PARTICIPANTS 385 Black men and women, age 30-70 living in the Atlanta metropolitan area (Georgia, USA). PRIMARY OUTCOME MEASURE Individual's CVH was summarised as a composite score using American Heart Association's Life's Simple 7 (LS7) metrics. METHODS We implemented unsupervised learning (k-means) and supervised learning (Bayesian Dirichlet process clustering) to identify clusters based on 11 self-reported neighbourhood perception and psychosocial characteristics. We also performed principal component analysis to summarise neighbourhood perceptions and psychosocial variables and assess their associations with LS7 scores. RESULTS K-means and Bayesian clustering resulted in 4 and 5 clusters, respectively. Based on the posterior distributions, higher LS7 scores were associated with better neighbourhood perceptions and psychosocial characteristics, including neighbourhood safety, social cohesion, activities with neighbours, environmental mastery, purpose in life, resilient coping and no depression. Taken together, the first principal components of neighbourhood perceptions and psychosocial characteristics were associated with an increase of 0.07 (95% CI -0.17 to 0.31) and 0.31 (95% CI 0.06 to 0.55) in LS7 score, respectively, after accounting for age, sex, household income and education level. CONCLUSION Both neighbourhood perception and psychosocial domains were related to CVH, but individual psychosocial characteristics appeared to contribute to CVH most. Approaches that acknowledge the importance of factors in both domains may prove most beneficial for enhancing resilience and promoting CVH among black communities.
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Affiliation(s)
- Yi-An Ko
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Jenny Shen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeong Hwan Kim
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Matthew Topel
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mahasin Mujahid
- Division of Epidemiology, University of California Berkeley School of Public Health, Berkeley, California, USA
| | - Herman Taylor
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Arshed Quyyumi
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Viola Vaccarino
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Peter Baltrus
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Tene Lewis
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
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Chen Q, Li H, Liu Q, Wang W, Deng F, Sun Z, Guo X, Wu S. Does psychosocial stress modify the association of fine particulate matter and ozone with cardiovascular health indicators? ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 277:116726. [PMID: 33639598 DOI: 10.1016/j.envpol.2021.116726] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 01/12/2021] [Accepted: 02/08/2021] [Indexed: 06/12/2023]
Abstract
Fine particulate matter (PM2.5) and ozone (O3) air pollution can cause abnormal changes in blood pressure (BP), blood glucose and lipids, which are important indicators for cardiovascular health. Psychosocial stress could be a potential effect modifier for adverse health effects of air pollution, but research evidence is scarce. A cross-sectional study with 373 elderly subjects was conducted in Beijing during 2018-2019. We collected psychosocial stress information on anxiety, perceived stress and depression, obtained daily environmental data, measured resting BP, blood glucose and lipids in study participants, and analyzed the associations of PM2.5 or O3 with cardiovascular health indicators and the modification effect by psychosocial stress. Results showed that PM2.5 was significantly associated with increased systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP) ; and O3 was significantly associated with elevated DBP, glycated hemoglobin (HbA1c) and total triglyceride (TG). In addition, the associations of PM2.5 with TG, and O3 with SBP and TG were higher in participants with high psychosocial stress, whereas the associations of O3 with high-density lipoprotein cholesterol (HDL-C) were higher in participants with low psychosocial stress. For an interquartile range (IQR) (56.8 μg/m³) increase in PM2.5 at 4-d moving average, TG increased by 21.43% (95% CI: 2.90, 43.29) in high perceived-stress group, and decreased by 20.05% (95% CI: -30.31, -8.28) in low perceived-stress group (p for interaction = 0.04). For an IQR (63.0 μg/m³) increase in O3 at 2-d moving average, TG increased by 32.01% (95% CI: 7.65, 61.89) in high perceived-stress group, and increased by 7.95% (95% CI: -9.80, 29.20) only in low perceived-stress group (p for interaction = 0.04). For an IQR (64.0 μg/m³) increase in O3 at 3-d moving average, HDL-C decreased by 4.55% (95% CI: -12.15, 3.72) in high perceived-stress group, and increased by 0.57% (95% CI: -6.99, 8.75) in low perceived-stress group (p for interaction=0.002). In conclusion, our results indicated that short-term exposures to PM2.5 and O3 were associated with significant changes in BP, blood glucose and lipids, and psychosocial stress may increase the susceptibility of the participants to the adverse cardiovascular effects of PM2.5 and O3.
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Affiliation(s)
- Qiao Chen
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, 100191, China
| | - Hongyu Li
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, 100191, China
| | - Qisijing Liu
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, 100191, China
| | - Wanzhou Wang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, 100191, China
| | - Furong Deng
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, 100191, China
| | - Zhiwei Sun
- Department of Toxicology and Sanitary Chemistry, School of Public Health, Capital Medical University, Beijing, 100069, China; Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, 100069, China
| | - Xinbiao Guo
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, 100191, China
| | - Shaowei Wu
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, 100191, China.
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Hardy ST, Sakhuja S, Jaeger BC, Oparil S, Akinyelure OP, Spruill TM, Kalinowski J, Butler M, Anstey DE, Elfassy T, Tajeu GS, Allen NB, Reges O, Sims M, Shimbo D, Muntner P. Maintaining Normal Blood Pressure Across the Life Course: The JHS. Hypertension 2021; 77:1490-1499. [PMID: 33745299 PMCID: PMC8564773 DOI: 10.1161/hypertensionaha.120.16278] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/11/2021] [Indexed: 01/11/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Shakia T. Hardy
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Swati Sakhuja
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Byron C. Jaeger
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
| | - Suzanne Oparil
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL
| | | | - Tanya M. Spruill
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
| | - Jolaade Kalinowski
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT
| | - Mark Butler
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
| | - D. Edmund Anstey
- Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Tali Elfassy
- Department of Public Health Sciences, University of Miami, Miami, FL
| | - Gabriel S. Tajeu
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA
| | - Norrina B. Allen
- Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - Orna Reges
- Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Daichi Shimbo
- Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
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17
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Farrell MC, Giza RJ, Shibao CA. Race and sex differences in cardiovascular autonomic regulation. Clin Auton Res 2020; 30:371-379. [PMID: 32894376 DOI: 10.1007/s10286-020-00723-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/19/2020] [Indexed: 12/17/2022]
Abstract
Racial and ethnic differences in cardiovascular morbidity and mortality persist despite advances in risk factor identification and implementation of evidence-based treatment strategies. African American men and women are disproportionately affected by cardiovascular risk factors, particularly hypertension. In this context, previous studies have identified sex and racial differences in autonomic cardiovascular regulation which may contribute to the development of hypertension and its high morbidity burden among African Americans. In this review, we provide a comprehensive evaluation of the potential pathophysiological mechanisms of blood pressure control and their differences based on sex and race. These mechanisms include obesity-induced sympathetic activation, sympatho-vascular transduction, baroreflex sensitivity and adrenoreceptor vascular sensitivity, which have been the subjects of prior investigation in this field. Understanding the racial differences in the pathophysiology of hypertension and its co-morbid conditions would allow us to implement better treatment strategies tailored to African Americans, with the ultimate goal of reducing cardiovascular mortality in this population.
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Affiliation(s)
| | - Richard J Giza
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Cyndya A Shibao
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt Autonomic Dysfunction Center, Vanderbilt University Medical Center, 506 Robinson Research Building, Nashville, TN, 37232-6602, USA.
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Nam S, Dunton GF, Ordway MR, Ash GI, Jeon S, Vlahov D, Whittemore R, Nelson LE, Sinha R, Nunez-Smith M, Granger DA. Feasibility and acceptability of intensive, real-time biobehavioral data collection using ecological momentary assessment, salivary biomarkers, and accelerometers among middle-aged African Americans. Res Nurs Health 2020; 43:453-464. [PMID: 32856310 DOI: 10.1002/nur.22068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 08/15/2020] [Indexed: 01/21/2023]
Abstract
Perceived racial discrimination is linked to unhealthy behaviors and stress-related morbidities. A compelling body of research indicates that perceived racial discrimination may contribute to health disparities among African Americans (AAs). The purposes of this study were to describe the study protocol including data collection procedures and study measures and to evaluate the feasibility and acceptability of intensive biobehavioral data collection using ecological momentary assessment (EMA), salivary biomarkers, and accelerometers over 7 days among middle-aged AAs with a goal of understanding the relationships between perceived racial discrimination and biobehavioral responses to stress. Twelve AA men and women participated in the feasibility/acceptability study. They completed surveys, anthropometrics, and received in-person training in EMA and saliva sample collection at baseline. Participants were asked to respond to the random prompt text message-based EMA five times a day, wear an accelerometer daily for 7 days, and to self-collect saliva samples four times a day for 4 consecutive days. The EMA surveys included perceived racial discrimination, affective states, lifestyle behaviors, and social and physical contexts. The mean EMA response rate was 82.8%. All participants collected saliva samples four times a day for 4 consecutive days. About 83% of participants wore the accelerometer on the hip 6 out of 7 days. Despite the perception that the intensive nature of assessments would result in high participant burden, the acceptability of the study procedures was uniformly favorable.
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Affiliation(s)
- Soohyun Nam
- School of Nursing, Yale University, Orange, Connecticut
| | - Genevieve F Dunton
- Departments of Preventive Medicine and Psychology, University of Southern California, Los Angeles, California
| | | | - Garrett I Ash
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut.,Center for Medical Informatics, Yale University, New Haven, Connecticut
| | | | - David Vlahov
- School of Nursing, Yale University, Orange, Connecticut
| | | | | | - Rajita Sinha
- Yale Stress Center, Yale University, New Haven, Connecticut
| | | | - Douglas A Granger
- School of Social Ecology, Institute for Interdisciplinary Salivary Bioscience Research, University of California-Irvine, Irvine, California
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Sims M, Kershaw KN, Breathett K, Jackson EA, Lewis LM, Mujahid MS, Suglia SF. Importance of Housing and Cardiovascular Health and Well-Being: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes 2020; 13:e000089. [PMID: 32673512 DOI: 10.1161/hcq.0000000000000089] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cardiovascular disease disparities are shaped by differences in risk factors across racial and ethnic groups. Housing remains an important social determinant of health. The objective of this statement is to review and summarize research that has examined the associations of housing status with cardiovascular health and overall health. PubMed/Medline, Centers for Disease Control and Prevention data, US Census data, Cochrane Library reviews, and the annual Heart Disease and Stroke Statistics report from the American Heart Association were used to identify empirical research studies that examined associations of housing with cardiovascular health and overall well-being. Health is affected by 4 prominent dimensions of housing: stability, quality and safety, affordability and accessibility, and neighborhood environment. Vulnerable and underserved populations are adversely affected by housing insecurity and homelessness, are at risk for lower-quality and unsafe housing conditions, confront structural barriers that limit access to affordable housing, and are at risk for living in areas with substandard built environment features that are linked to cardiovascular disease. Research linking select pathways to cardiovascular health is relatively strong, but research gaps in other housing pathways and cardiovascular health remain. Efforts to eliminate cardiovascular disease disparities have recently emphasized the importance of social determinants of health. Housing is a prominent social determinant of cardiovascular health and well-being and should be considered in the evaluation of prevention efforts to reduce and eliminate racial/ethnic and socioeconomic disparities.
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20
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Glover LM, Cain‐Shields LR, Spruill TM, O'Brien EC, Barber S, Loehr L, Sims M. Goal-Striving Stress and Incident Cardiovascular Disease in Blacks: The Jackson Heart Study. J Am Heart Assoc 2020; 9:e015707. [PMID: 32342735 PMCID: PMC7428553 DOI: 10.1161/jaha.119.015707] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/04/2020] [Indexed: 12/12/2022]
Abstract
Background Goal-striving stress (GSS), the stress from striving for goals, is associated with poor health. Less is known about its association with cardiovascular disease (CVD). Methods and Results We used data from the JHS (Jackson Heart Study), a study of CVD among blacks (21-95 years old) from 2000 to 2015. Participants free of CVD at baseline (2000-2004) were included in this analysis (n=4648). GSS was examined in categories (low, moderate, high) and in SD units. Incident CVD was defined as fatal or nonfatal stroke, coronary heart disease (CHD), and/or heart failure. We used Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of incident CVD by levels of GSS, adjusting for demographics, socioeconomic status, health behaviors, risk factors, and perceived stress. The distribution of GSS categories was as follows: 40.77% low, 33.97% moderate, and 25.26% high. Over an average of 12 years, there were 140 incident stroke events, 164 CHD events, and 194 heart failure events. After full adjustment, high (versus low) GSS was associated with a lower risk of stroke (HR, 0.38; 95% CI, 0.17-0.83) and a higher risk of CHD (HR, 1.91; 95% CI, 1.10-3.33) among women. A 1-standard deviation unit increase in GSS was associated with a 31% increased risk of CHD (HR, 1.31; 95% CI, 1.10-1.56) among women. Conclusions Higher GSS may be a risk factor for developing CHD among women; however, it appears to be protective of stroke among women. These analyses should be replicated in other samples of black individuals.
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Affiliation(s)
| | | | - Tanya M. Spruill
- Department of Population HealthNYU Grossman School of MedicineNew YorkNY
| | | | - Sharrelle Barber
- Epidemiology and BiostatisticsDornsife School of Public HealthDrexel UniversityPhiladelphiaPA
| | - Laura Loehr
- Department of EpidemiologyUniversity of North Carolina at Chapel HillNC
| | - Mario Sims
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
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21
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Sims M, Glover LSM, Gebreab SY, Spruill TM. Cumulative psychosocial factors are associated with cardiovascular disease risk factors and management among African Americans in the Jackson Heart Study. BMC Public Health 2020; 20:566. [PMID: 32345300 PMCID: PMC7189712 DOI: 10.1186/s12889-020-08573-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 03/24/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Racial disparities in cardiovascular disease (CVD) have been attributed in part to negative psychosocial factors. Prior studies have demonstrated associations between individual psychosocial factors and CVD risk factors, but little is known about their cumulative effects. METHODS Using the Jackson Heart Study, we examined the cross-sectional associations of cumulative psychosocial factors with CVD risk factors among 5306 African Americans. We utilized multivariable Poisson regression to estimate sex-stratified prevalence ratios (PR 95% confidence interval-CI) of obesity, hypertension and diabetes prevalence and hypertension and diabetes control with negative affect (cynicism, anger-in, anger-out, depressive symptoms and cumulative negative affect) and stress (global stress, weekly stress, major life events-MLEs and cumulative stress), adjusting for demographics, socioeconomic status, and behaviors. RESULTS After full adjustment, high (vs. low) cumulative negative affect was associated with prevalent obesity among men (PR 1.36 95% CI 1.16-1.60), while high (vs. low) cumulative stress was similarly associated with obesity among men and women (PR 1.24 95% CI 1.01-1.52 and PR 1.13 95% CI 1.03-1.23, respectively). Psychosocial factors were more strongly associated with prevalent hypertension and diabetes among men than women. For example, men who reported high cynicism had a 12% increased prevalence of hypertension (PR 1.12, 95% CI 1.03-1.23). Psychosocial factors were more strongly associated with lower hypertension and diabetes control for women than men. Women who reported high (vs. low) cynicism had a 38% lower prevalence of hypertension control (PR 0.62, 95% CI 0.46-0.84). CONCLUSIONS Cumulative psychosocial factors were associated with CVD risk factors and disease management among African Americans. The joint accumulation of psychosocial factors was more associated with risk factors for men than women.
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Affiliation(s)
- Mario Sims
- Department of Medicine, University of Mississippi Medical Center, 350 W. Woodrow Wilson Avenue, Jackson, MS 39213, USA
| | - Lá Shauntá M. Glover
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | | | - Tanya M. Spruill
- Department of Population Health, NYU School of Medicine, New York, USA
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5219] [Impact Index Per Article: 1043.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Sims M, Glover LM, Norwood AF, Jordan C, Min YI, Brewer LC, Kubzansky LD. Optimism and cardiovascular health among African Americans in the Jackson Heart Study. Prev Med 2019; 129:105826. [PMID: 31473218 PMCID: PMC6985922 DOI: 10.1016/j.ypmed.2019.105826] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 08/20/2019] [Accepted: 08/28/2019] [Indexed: 01/05/2023]
Abstract
Little research has examined associations of positive psychosocial factors with the American Heart Association Life's Simple 7™ (LS7) among African Americans. This study examined the associations between positive optimistic orientation and LS7 among African Americans. Using exam 1 data (2000-2004) from the Jackson Heart Study, we examined cross-sectional associations of optimism (in tertiles) with LS7 components [smoking, physical activity, diet, body mass index, blood pressure, cholesterol, glucose] and a composite LS7 score (classified as poor, intermediate, ideal) among 4734 African Americans free of cardiovascular disease. Multivariable prevalence regression was used to estimate prevalence ratios (PR, 95% confidence interval-CI) of intermediate and ideal (vs. poor) individual LS7 components and composite LS7 score by optimism levels, adjusting for demographics, socioeconomic status, and depressive symptoms. For LS7 components with low prevalence, we estimated odds ratios. A greater percentage of participants with high vs. low optimism were younger, female, high SES, and not depressed. After full covariate adjustment, the prevalence ratio of ideal (vs. poor) composite LS7 score was 1.24 for participants who reported high (vs. low) optimism (95% CI 1.09-1.42) at exam 1. Higher levels of optimism were also associated with greater prevalence of ideal (vs. poor) physical activity and smoking. Promoting positive optimistic orientation may be an important step toward increasing the likelihood of achieving optimal cardiovascular health among African Americans.
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Affiliation(s)
- Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
| | - LáShauntá M Glover
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Arnita F Norwood
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Christina Jordan
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Yuan-I Min
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - LaPrincess C Brewer
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Laura D Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Spruill TM, Butler MJ, Thomas SJ, Tajeu GS, Kalinowski J, Castañeda SF, Langford AT, Abdalla M, Blackshear C, Allison M, Ogedegbe G, Sims M, Shimbo D. Association Between High Perceived Stress Over Time and Incident Hypertension in Black Adults: Findings From the Jackson Heart Study. J Am Heart Assoc 2019; 8:e012139. [PMID: 31615321 PMCID: PMC6898810 DOI: 10.1161/jaha.119.012139] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Chronic psychological stress has been associated with hypertension, but few studies have examined this relationship in blacks. We examined the association between perceived stress levels assessed annually for up to 13 years and incident hypertension in the Jackson Heart Study, a community‐based cohort of blacks. Methods and Results Analyses included 1829 participants without hypertension at baseline (Exam 1, 2000–2004). Incident hypertension was defined as blood pressure≥140/90 mm Hg or antihypertensive medication use at Exam 2 (2005–2008) or Exam 3 (2009–2012). Each follow‐up interval at risk of hypertension was categorized as low, moderate, or high perceived stress based on the number of annual assessments between exams in which participants reported “a lot” or “extreme” stress over the previous year (low, 0 high stress ratings; moderate, 1 high stress rating; high, ≥2 high stress ratings). During follow‐up (median, 7.0 years), hypertension incidence was 48.5%. Hypertension developed in 30.6% of intervals with low perceived stress, 34.6% of intervals with moderate perceived stress, and 38.2% of intervals with high perceived stress. Age‐, sex‐, and time‐adjusted risk ratios (95% CI) associated with moderate and high perceived stress versus low perceived stress were 1.19 (1.04–1.37) and 1.37 (1.20–1.57), respectively (P trend<0.001). The association was present after adjustment for demographic, clinical, and behavioral factors and baseline stress (P trend=0.001). Conclusions In a community‐based cohort of blacks, higher perceived stress over time was associated with an increased risk of developing hypertension. Evaluating stress levels over time and intervening when high perceived stress is persistent may reduce hypertension risk.
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Affiliation(s)
- Tanya M Spruill
- Department of Population Health New York University School of Medicine New York NY
| | - Mark J Butler
- Department of Population Health New York University School of Medicine New York NY
| | - S Justin Thomas
- Department of Psychiatry University of Alabama at Birmingham AL
| | - Gabriel S Tajeu
- Department of Health Services Administration and Policy Temple University Philadelphia PA
| | - Jolaade Kalinowski
- Department of Population Health New York University School of Medicine New York NY
| | - Sheila F Castañeda
- Graduate School of Public Health San Diego State University San Diego CA
| | - Aisha T Langford
- Department of Population Health New York University School of Medicine New York NY
| | - Marwah Abdalla
- Department of Medicine Columbia University Medical Center New York NY
| | - Chad Blackshear
- Department of Data Science University of Mississippi Medical Center Jackson MS
| | - Matthew Allison
- Department of Family Medicine and Public Health University of California at San Diego CA
| | - Gbenga Ogedegbe
- Department of Population Health New York University School of Medicine New York NY
| | - Mario Sims
- Department of Medicine University of Mississippi Medical Center Jackson MS
| | - Daichi Shimbo
- Department of Medicine Columbia University Medical Center New York NY
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Jordan CD, Glover LM, Gao Y, Musani SK, Mwasongwe S, Wilson JG, Reiner A, Diez-Roux A, Sims M. Association of psychosocial factors with leukocyte telomere length among African Americans in the Jackson Heart Study. Stress Health 2019; 35:138-145. [PMID: 30407711 DOI: 10.1002/smi.2848] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 09/12/2018] [Accepted: 10/28/2018] [Indexed: 01/30/2023]
Abstract
Leukocyte telomere length (LTL) is a biomarker of cellular aging. African Americans report more stress than other groups; however, the association of psychosocial stressors with biological aging among African Americans remains unclear. The current study evaluated the association of psychosocial factors (negative affect and stressors) with LTL in a large sample of African American men and women (n = 2,516) from the Jackson Heart Study. Using multivariable linear regression, we examined the sex-specific associations of psychosocial factors (cynical distrust, anger in and out, depressive symptoms, negative affect summary scores, global stress, weekly stress, major life events, and stress summary scores) with LTL. Model 1 adjusted for demographics and education. Model 2 adjusted for model 1, smoking, alcohol intake, physical activity, diabetes, hypertension, and high-sensitivity C-reactive protein. Among women, high (vs. low) cynical distrust was associated with shorter mean LTL in model 1 (b = -0.12; p = 0.039). Additionally, high (vs. low) anger out and expressed negative affect summary scores were associated with shorter LTL among women after full adjustment (b = -0.13; p = 0.011; b = -0.12, p = 0.031, respectively). High levels of cynical distrust, anger out, and negative affect summary scores may be risk factors for shorter LTL, particularly among African-American women.
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Affiliation(s)
- Christina D Jordan
- School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - LáShauntá M Glover
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Yan Gao
- School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Solomon K Musani
- School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Stanford Mwasongwe
- Jackson Heart Study, Jackson State University, Jackson, Mississippi, USA
| | - James G Wilson
- School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Alex Reiner
- School of Public Health, University of Washington, Seattle, Washington, USA
| | - Ana Diez-Roux
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Mario Sims
- School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Komnenov D, Levanovich PE, Rossi NF. Hypertension Associated with Fructose and High Salt: Renal and Sympathetic Mechanisms. Nutrients 2019; 11:nu11030569. [PMID: 30866441 PMCID: PMC6472002 DOI: 10.3390/nu11030569] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 02/26/2019] [Accepted: 03/04/2019] [Indexed: 02/06/2023] Open
Abstract
Hypertension is a leading cause of cardiovascular and chronic renal disease. Despite multiple important strides that have been made in our understanding of the etiology of hypertension, the mechanisms remain complex due to multiple factors, including the environment, heredity and diet. This review focuses on dietary contributions, providing evidence for the involvement of elevated fructose and salt consumption that parallels the increased incidence of hypertension worldwide. High fructose loads potentiate salt reabsorption by the kidney, leading to elevation in blood pressure. Several transporters, such as NHE3 and PAT1 are modulated in this milieu and play a crucial role in salt-sensitivity. High fructose ingestion also modulates the renin-angiotensin-aldosterone system. Recent attention has been shifted towards the contribution of the sympathetic nervous system, as clinical trials demonstrated significant reductions in blood pressure following renal sympathetic nerve ablation. New preclinical data demonstrates the activation of the renal sympathetic nerves in fructose-induced salt-sensitive hypertension, and reductions of blood pressure after renal nerve ablation. This review further demonstrates the interplay between sodium handling by the kidney, the renin-angiotensin-aldosterone system, and activation of the renal sympathetic nerves as important mechanisms in fructose and salt-induced hypertension.
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Affiliation(s)
- Dragana Komnenov
- Department of Physiology, Wayne State University, 4160 John R Street #908, Detroit, MI 48201, USA.
- Department of Internal Medicine, Wayne State University, 4160 John R Street #908, Detroit, MI 48201, USA.
| | - Peter E Levanovich
- Department of Physiology, Wayne State University, 4160 John R Street #908, Detroit, MI 48201, USA.
| | - Noreen F Rossi
- Department of Physiology, Wayne State University, 4160 John R Street #908, Detroit, MI 48201, USA.
- Department of Internal Medicine, Wayne State University, 4160 John R Street #908, Detroit, MI 48201, USA.
- John D. Dingell VA Medical Center, 4646 John R Street, Detroit, MI 48201, USA.
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Zilbermint M, Hannah-Shmouni F, Stratakis CA. Genetics of Hypertension in African Americans and Others of African Descent. Int J Mol Sci 2019; 20:ijms20051081. [PMID: 30832344 PMCID: PMC6429313 DOI: 10.3390/ijms20051081] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 02/07/2023] Open
Abstract
Hypertension is the leading cause of cardiovascular disease in the United States, affecting up to one-third of adults. When compared to other ethnic or racial groups in the United States, African Americans and other people of African descent show a higher incidence of hypertension and its related comorbidities; however, the genetics of hypertension in these populations has not been studied adequately. Several genes have been identified to play a role in the genetics of hypertension. They include genes regulating the renin-aldosterone-angiotensin system (RAAS), such as Sodium Channel Epithelial 1 Beta Subunit (SCNN1B), Armadillo Repeat Containing 5 (ARMC5), G Protein-Coupled Receptor Kinase 4 (GRK4), and Calcium Voltage-Gated Channel Subunit Alpha1 D (CACNA1D). In this review, we focus on recent genetic findings available in the public domain for potential differences between African Americans and other populations. We also cover some recent and relevant discoveries in the field of low-renin hypertension from our laboratory at the National Institutes of Health. Understanding the different genetics of hypertension among various groups is essential for effective precision-guided medical therapy of high blood pressure.
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Affiliation(s)
- Mihail Zilbermint
- Section on Endocrinology and Genetics, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, BG 31 RM 2A46, 31 Center Dr, Bethesda, MD 20892, USA.
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
- Johns Hopkins Community Physicians at Suburban Hospital, Bethesda, MD 20814, USA.
- Johns Hopkins University Carey Business School, Baltimore, MD 21202, USA.
| | - Fady Hannah-Shmouni
- Section on Endocrinology and Genetics, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, BG 31 RM 2A46, 31 Center Dr, Bethesda, MD 20892, USA.
| | - Constantine A Stratakis
- Section on Endocrinology and Genetics, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, BG 31 RM 2A46, 31 Center Dr, Bethesda, MD 20892, USA.
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McKenzie LM, Crooks J, Peel JL, Blair BD, Brindley S, Allshouse WB, Malin S, Adgate JL. Relationships between indicators of cardiovascular disease and intensity of oil and natural gas activity in Northeastern Colorado. ENVIRONMENTAL RESEARCH 2019; 170:56-64. [PMID: 30557692 PMCID: PMC6360130 DOI: 10.1016/j.envres.2018.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/30/2018] [Accepted: 12/04/2018] [Indexed: 05/23/2023]
Abstract
BACKGROUND Oil and natural gas (O&G) extraction emits pollutants that are associated with cardiovascular disease, the leading cause of mortality in the United States. OBJECTIVE We evaluated associations between intensity of O&G activity and cardiovascular disease indicators. METHODS Between October 2015 and May 2016, we conducted a cross-sectional study of 97 adults living in Northeastern Colorado. For each participant, we collected 1-3 measurements of augmentation index, systolic and diastolic blood pressure (SBP and DBP), and plasma concentrations of interleukin (IL)- 1β, IL-6, IL-8 and tumor necrosis factor alpha (TNF-α). We modelled the intensity of O&G activity by weighting O&G well counts within 16 km of a participant's home by intensity and distance. We used linear models accounting for repeated measures within person to evaluate associations. RESULTS Adjusted mean augmentation index differed by 6.0% (95% CI: 0.6, 11.4%) and 5.1% (95%CI: -0.1, 10.4%) between high and medium, respectively, and low exposure tertiles. The greatest mean IL-1β, and α-TNF plasma concentrations were observed for participants in the highest exposure tertile. IL-6 and IL-8 results were consistent with a null result. For participants not taking prescription medications, the adjusted mean SBP differed by 6 and 1 mm Hg (95% CIs: 0.1, 13 mm Hg and -6, 8 mm Hg) between the high and medium, respectively, and low exposure tertiles. DBP results were similar. For participants taking prescription medications, SBP and DBP results were consistent with a null result. CONCLUSIONS Despite limitations, our results support associations between O&G activity and augmentation index, SBP, DBP, IL-1β, and TNF-α. Our study was not able to elucidate possible mechanisms or environmental stressors, such as air pollution and noise.
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Affiliation(s)
- Lisa M McKenzie
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA.
| | - James Crooks
- Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, CO, USA; Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Jennifer L Peel
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA; Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA; Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Benjamin D Blair
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Stephen Brindley
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - William B Allshouse
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Stephanie Malin
- Department of Sociology & Colorado School of Public Health, Colorado State University, Fort Collins, CO, USA
| | - John L Adgate
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
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Mwasongwe S, Min YI, Booth JN, Katz R, Sims M, Correa A, Young B, Muntner P. Masked hypertension and kidney function decline: the Jackson Heart Study. J Hypertens 2018; 36:1524-1532. [PMID: 29601413 PMCID: PMC5990961 DOI: 10.1097/hjh.0000000000001727] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hypertension diagnosed by blood pressure (BP) measured in the clinic is associated with rapid kidney function decline (RKFD) and incident chronic kidney disease (CKD). The extent to which hypertension defined using out-of-clinic BP measurements is associated with these outcomes is unclear. METHODS We evaluated the association of any masked hypertension (daytime SBP/DBP ≥ 135/85 mmHg, night-time SBP/DBP ≥ 120/70 mmHg or 24-h SBP/DBP ≥ 130/80 mmHg) with RKFD and incident CKD among 676 African-Americans in the Jackson Heart Study with clinic-measured SBP/DBP less than 140/90 mmHg who completed ambulatory BP monitoring in 2000-2004. RKFD was defined as a decline in estimated glomerular filtration rate (eGFR) at least 30% and incident CKD was defined as development of eGFR less than 60 ml/min per 1.73 m with an at least 25% decline in eGFR between 2000-2004 and 2009-2013. RESULTS The mean age of participants was 57.6 years, 28.8% were men and 52.7% had any masked hypertension. After a median follow-up of 8 years, 13.8 and 8.6% of participants had RKFD and incident CKD, respectively. In unadjusted analyses, masked hypertension was associated with an increased odds for incident CKD [odds ratio (OR) 2.20, 95% confidence interval (CI) 1.22, 3.97]. This association remained statistically significant after adjustment for demographic characteristics, baseline eGFR and albumin-to-creatinine ratio (OR 1.95, 95% CI 1.04, 3.67) but was eliminated after propensity score adjustment (OR 1.62, 95% CI 0.87, 3.00). There was no association between masked hypertension and RKFD. CONCLUSION Masked hypertension may be associated with the development of CKD in African-Americans.
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Affiliation(s)
| | - Yuan-I Min
- University of Mississippi Medical Center, Jackson Heart Study, Jackson, Mississippi
| | - John N. Booth
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ronit Katz
- Division of Nephrology, Kidney Research Institute, University of Washington
| | - Mario Sims
- University of Mississippi Medical Center, Jackson Heart Study, Jackson, Mississippi
| | - Adolfo Correa
- University of Mississippi Medical Center, Jackson Heart Study, Jackson, Mississippi
| | - Bessie Young
- Division of Nephrology, Kidney Research Institute, University of Washington
- Veterans Affairs Puget Sound Healthcare System, Seattle, Washington, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
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Zaleski AL, Taylor BA, Pescatello LS, Dornelas EA, White CM, Thompson PD. Influence of Baseline Psychological Health on Muscle Pain During Atorvastatin Treatment. J Cardiovasc Nurs 2018; 32:544-550. [PMID: 27870723 PMCID: PMC6083859 DOI: 10.1097/jcn.0000000000000382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND 3-hydroxy-3-methylglutaryl coenzyme A reductase reductase inhibitors (statins) are generally well tolerated, with statin-associated muscle symptoms (SAMS) the most common side effect (~10%) seen in statin users. However, studies and clinical observations indicate that many of the self-reported SAMS appear to be nonspecific (ie, potentially not attributable to statins). OBJECTIVE Mental health and well-being influence self-perception of pain, so we sought to assess the effect of baseline well-being and depression on the development of muscle pain with 6 months of atorvastatin 80 mg/d (ATORVA) or placebo in healthy, statin-naive adults. METHODS The Psychological General Well-being Index (n = 83) and Beck Depression Inventory (n = 55) questionnaires were administered at baseline in participants (aged 59.5 ± 1.2 years) from the effect of Statins on Skeletal Muscle Function and Performance (STOMP) trial (NCT00609063). Muscle pain (Short-Form McGill Pain Questionnaire [SF-MPQ]), pain that interferes with daily life (Brief Pain Inventory [BPI]), and pain severity (BPI) were then measured before, throughout, and after treatment. RESULTS At baseline, there were no differences in well-being (Psychological General Well-being Index), depression (Beck Depression Inventory), or pain measures (SF-MPQ and BPI) (P values ≥ .05) between the placebo and ATORVA groups. Baseline well-being correlated negatively with baseline BPI pain severity (r = -0.290, P = .008). Baseline depression correlated with baseline pain (SF-MPQ; r = 0.314, P = .020). Baseline well-being and depression did not predict the change in pain severity or interference after 6 months among the total sample or between groups (P values ≥ .05). CONCLUSION Baseline well-being and depression were not significant predictors of pain after 6 months of ATORVA (P values ≥ .05). Thus, they do not appear to increase the risk of SAMS in otherwise healthy adults.
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Affiliation(s)
- Amanda L. Zaleski
- Henry Low Heart Center, Department of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA
- Department of Kinesiology, University of Connecticut, 2095 Hillside Rd, U-1110, Storrs, CT 06269, USA
| | - Beth A. Taylor
- Henry Low Heart Center, Department of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA
- School of Pharmacy, University of Connecticut, 69 North Eagleville Road, Unit 3092, Storrs, CT 06269, USA
| | - Linda S. Pescatello
- School of Pharmacy, University of Connecticut, 69 North Eagleville Road, Unit 3092, Storrs, CT 06269, USA
| | - Ellen A. Dornelas
- Henry Low Heart Center, Department of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA
| | - Charles Michael White
- Henry Low Heart Center, Department of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA
- School of Pharmacy, University of Connecticut, 69 North Eagleville Road, Unit 3092, Storrs, CT 06269, USA
| | - Paul D. Thompson
- Henry Low Heart Center, Department of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA
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Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137:e67-e492. [PMID: 29386200 DOI: 10.1161/cir.0000000000000558] [Citation(s) in RCA: 4454] [Impact Index Per Article: 742.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Gene-by-Psychosocial Factor Interactions Influence Diastolic Blood Pressure in European and African Ancestry Populations: Meta-Analysis of Four Cohort Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14121596. [PMID: 29258278 PMCID: PMC5751013 DOI: 10.3390/ijerph14121596] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/04/2017] [Accepted: 12/07/2017] [Indexed: 02/07/2023]
Abstract
Inter-individual variability in blood pressure (BP) is influenced by both genetic and non-genetic factors including socioeconomic and psychosocial stressors. A deeper understanding of the gene-by-socioeconomic/psychosocial factor interactions on BP may help to identify individuals that are genetically susceptible to high BP in specific social contexts. In this study, we used a genomic region-based method for longitudinal analysis, Longitudinal Gene-Environment-Wide Interaction Studies (LGEWIS), to evaluate the effects of interactions between known socioeconomic/psychosocial and genetic risk factors on systolic and diastolic BP in four large epidemiologic cohorts of European and/or African ancestry. After correction for multiple testing, two interactions were significantly associated with diastolic BP. In European ancestry participants, outward/trait anger score had a significant interaction with the C10orf107 genomic region (p = 0.0019). In African ancestry participants, depressive symptom score had a significant interaction with the HFE genomic region (p = 0.0048). This study provides a foundation for using genomic region-based longitudinal analysis to identify subgroups of the population that may be at greater risk of elevated BP due to the combined influence of genetic and socioeconomic/psychosocial risk factors.
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Psychosocial correlates of apparent treatment-resistant hypertension in the Jackson Heart Study. J Hum Hypertens 2017; 31:486. [PMID: 28588315 DOI: 10.1038/jhh.2017.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This corrects the article DOI: 10.1038/jhh.2016.100.
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Abstract
Black people have the highest prevalence of hypertension in the United States. Evidence suggests that psychosocial factors increase the risks for hypertension and help to account for racial differences in this condition. This article reviews research on psychosocial factors and hypertension, and contextualizes the findings within a health disparities framework. A wide range of psychosocial factors contribute to hypertension but understanding remains limited about how these factors relate to each other and accumulate to contribute to hypertension disparities. Future research on psychosocial factors and hypertension needs to enhance the effectiveness of interventions to reduce hypertension risk in ethnic minority communities.
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Affiliation(s)
- Adolfo G Cuevas
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Landmark Center, Room 428a, 401 Park Drive, Boston, MA 02215, USA
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, 6th Floor, Boston, MA 02115, USA; Department of African and African American Studies, Harvard University, 12 Quincy Street, Cambridge, MA 02138, USA.
| | - Michelle A Albert
- Division of Cardiology, Department of Medicine, Center for the Study of Adversity and Cardiovascular Disease [NURTURE Center], University of California, San Francisco, 505 Parnassus Avenue, M1177, San Francisco, CA 94143, USA
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Shallcross AJ, Butler M, Tanner RM, Bress AP, Muntner P, Shimbo D, Ogedegbe G, Sims M, Spruill TM. Psychosocial correlates of apparent treatment-resistant hypertension in the Jackson Heart Study. J Hum Hypertens 2017; 31:474-478. [PMID: 28124682 DOI: 10.1038/jhh.2016.100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/25/2016] [Accepted: 12/19/2016] [Indexed: 01/01/2023]
Abstract
Apparent treatment-resistant hypertension (aTRH) is associated with adverse cardiovascular outcomes. aTRH is common and disproportionately affects African Americans. The objective of this study is to explore psychosocial correlates of aTRH in a population-based cohort of African Americans with hypertension. The sample included 1392 participants in the Jackson Heart Study with treated hypertension who reported being adherent to their antihypertensive medications. aTRH was defined as uncontrolled clinic BP (⩾140/90 mm Hg) with ⩾3 classes of antihypertensive medication or treatment with ⩾4 classes of antihypertensive medication, including a diuretic. Self-reported medication adherence was defined as taking all prescribed antihypertensive medication in the 24 h before the study visit. The association of psychosocial factors (chronic stress, depressive symptoms, perceived social support and social network) with aTRH was evaluated using Poisson regression with progressive adjustment for demographic, clinical and behavioural factors. The prevalence of aTRH was 15.1% (n=210). Participants with aTRH had lower social network scores (that is, fewer sources of regular social contact) compared with participants without aTRH (P<0.01). No other psychosocial factors differed between groups. Social network was also the only psychosocial factor that was associated with aTRH prevalence in regression analyses. In age-, sex-adjusted and fully adjusted models, one additional unique source of social contact was associated with a 19% (PR=0.81; 95% confidence interval (CI): 0.68-0.94, P=0.001) and a 13% (PR=0.87; 95% CI 0.74-1.0, P=0.041) lower prevalence of aTRH, respectively. Social network was independently associated with aTRH and warrants further investigation as a potentially modifiable determinant of aTRH in African Americans.
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Affiliation(s)
- A J Shallcross
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - M Butler
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - R M Tanner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - A P Bress
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA
| | - P Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - D Shimbo
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - G Ogedegbe
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - M Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - T M Spruill
- Department of Population Health, New York University School of Medicine, New York, NY, USA
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Sims M, Lipford KJ, Patel N, Ford CD, Min YI, Wyatt SB. Psychosocial Factors and Behaviors in African Americans: The Jackson Heart Study. Am J Prev Med 2017; 52:S48-S55. [PMID: 27989292 DOI: 10.1016/j.amepre.2016.09.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/31/2016] [Accepted: 09/19/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION There are limited reports on the association of psychosocial factors with unhealthy behaviors, which are key mediators in the psychosocial-cardiovascular disease pathway. The Jackson Heart Study was used to examine the associations of multiple psychosocial factors with behaviors among African Americans. METHODS The Jackson Heart Study is a prospective, cohort study of cardiovascular disease among African Americans recruited from the Jackson, MS, metropolitan area between 2000 and 2004. Between 2015 and 2016, multivariable regression was used to analyze the cross-sectional associations of baseline negative affect (cynicism, anger-in, anger-out, and depressive symptoms) and stressors (global stress, Weekly Stress Inventory-event, Weekly Stress Inventory-impact, and major life events) with the odds of current smoking and mean differences in dietary fat intake, physical activity, and hours of sleep. RESULTS Men were more likely to smoke than women (p<0.001) and had higher physical activity scores (p<0.001). Women reported more hours of sleep (p=0.001). In fully adjusted models, each negative affect and stress measure was significantly associated with an increased odds of current smoking. For example, the odds of smoking increased by 14% for each 1-SD increase in cynical distrust score (OR=1.14, 95% CI=1.01, 1.27) in the fully adjusted model. Further, each negative affect and stress measure (except anger-out) was significantly associated with fewer hours of sleep in fully adjusted models. CONCLUSIONS Using a large sample of African Americans, this study found that multiple psychosocial risk factors were associated with unhealthy behaviors that are prevalent among this population.
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Affiliation(s)
- Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.
| | - Kristie J Lipford
- School of Social Work, Jackson State University, Jackson, Mississippi
| | - Nikhil Patel
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Cassandra D Ford
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, Alabama
| | - Yuan-I Min
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Sharon B Wyatt
- School of Nursing, University of Mississippi Medical Center, Jackson, Mississippi
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Gender differences in the relationships between psychosocial factors and hypertension. Maturitas 2016; 93:58-64. [PMID: 27338977 DOI: 10.1016/j.maturitas.2016.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 05/25/2016] [Accepted: 06/01/2016] [Indexed: 12/19/2022]
Abstract
Gender differences in the epidemiology, pathophysiology, clinical manifestations and outcomes of cardiovascular disease are well established but there is still a lack of awareness of this both in the general population and among healthcare providers. In addition to the traditionally recognized cardiovascular risk factors, more recently psychosocial risk factors such as stress, mood disorders, low socioeconomic status and sleep disorders have been linked to cardiovascular diseases and hypertension. Psychosocial factors may have different cardiovascular consequences in men and women; thus further efforts are required to explore pathophysiological mechanisms, to obtain gender-specific data from clinical trials and to translate this knowledge into everyday clinical practice.
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