Individual Psychosocial Resilience, Neighborhood Context, and Cardiovascular Health in Black Adults: A Multilevel Investigation From the Morehouse-Emory Cardiovascular Center for Health Equity Study

The Modifying Role of Resilience on Allostatic Load and Cardiovascular Disease Risk in the Jackson Heart Study

We examined whether resilience modified associations between allostatic load (AL), a physiological indicator of coping with repeated stressors, and cardiovascular disease (CVD) among 2758 African Americans in the Jackson Heart Study. Baseline AL was quantified using biological measures of metabolic, cardiovascular, and immune markers. We constructed a multidimensional resilience measure using validated questionnaires for social support, social networks, religious experiences, and optimism. Participants were followed until 2016 for stroke, coronary heart disease (CHD), and heart failure (HF). We used multivariable-adjusted, sex-stratified Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between dichotomous AL and CVD. High AL was associated with CHD among women (HR = 1.73, 95% CI = 1.00, 2.99) and HF among women (HR = 1.52, 95% CI = 0.98, 2.37) and men (HR = 2.17, 95% CI = 1.28, 3.68). Among women, resilience did not modify the AL-CVD relationship. Among men, we observed higher stroke risk among men with low resilience (HR = 2.21, 95% CI = 0.94, 5.22) and no association among those with high resilience. Counterintuitively, high AL was associated with greater HF (HR = 5.80, 95% CI = 2.32, 14.47) in the subgroup of men with high resilience. Future studies addressing different facets of resilience are needed to elucidate underlying mechanisms for CVD prevention among African Americans.

Maternal Psychosocial Stress Is Associated with Reduced Diversity in the Early Infant Gut Microbiome

The developing infant gut microbiome is highly sensitive to environmental exposures, enabling its evolution into an organ that supports the immune system, confers protection from infection, and facilitates optimal gut and central nervous system function. In this study, we focus on the impact of maternal psychosocial stress on the infant gut microbiome. Forty-seven mother-infant dyads were recruited at the HEAL Africa Hospital in Goma, Democratic Republic of Congo. Extensive medical, demographic, and psychosocial stress data were collected at birth, and infant stool samples were collected at six weeks, three months, and six months. A composite maternal psychosocial stress score was created, based on eight questionnaires to capture a diverse range of stress exposures. Full-length 16S rRNA gene sequences were generated. Infants of mothers with high composite stress scores showed lower levels of gut microbiome beta diversity at six weeks and three months, as well as higher levels of alpha diversity at six months compared to infants of low stress mothers. Longitudinal analyses showed that infants of high stress mothers had lower levels of health-promoting Lactobacillus gasseri and Bifidobacterium pseudocatenulatum at six weeks compared to infants of low stress mothers, but the differences largely disappeared by three to six months. Previous research has shown that L. gasseri can be used as a probiotic to reduce inflammation, stress, and fatigue, as well as to improve mental state, while B. pseudocatenulatum is important in modulating the gut-brain axis in early development and in preventing mood disorders. Our finding of reduced levels of these health-promoting bacteria in infants of high stress mothers suggests that the infant gut microbiome may help mediate the effect of maternal stress on infant health and development.

Depressed mood and environmental mastery as potential pathways linking family relationship quality and disease self-management for African Americans with hypertension

African Americans are at significantly greater risk of hypertension and worse cardiovascular outcomes than other racialized groups, yet hypertension intervention effects remain limited. Thus, it is necessary to understand the potential mechanisms whereby interventions may be more effectively targeted to improve health. Supported by prior research evidence and guided by the Biobehavioral Family Model, this study examined associations between family relationship quality, psychological wellbeing, and self-management behaviors for African Americans with hypertension. Data were pooled from three Midlife Development in the U.S. projects, resulting in a sample of 317 African Americans (63.4% female, M_age  = 53.32) with self-reported high blood pressure in the past 12 months. We tested four cross-sectional multiple mediator models, with depressed mood and environmental mastery mediating associations between family strain and exercise, smoking, problematic alcohol use, and stress-eating. Environmental mastery mediated the association between greater family strain and decreased odds of achieving recommended exercise levels; greater odds of reporting problematic alcohol use; and greater stress-eating. Though family strain was associated with depressed mood in each model, this variable did not serve as an indirect pathway to self-management behaviors. Family strain, and the potential pathway identified via environmental mastery, may be a meaningful predictor of disease self-management for African Americans with hypertension. Longitudinal studies are needed to examine directionality and to support intervention trials for improving self-management and hypertension outcomes.

Social Determinants of Cardiovascular Health in US Adolescents: National Health and Nutrition Examination Surveys 1999 to 2014

Background Cardiovascular health (CVH) is suboptimal in US adolescents. Social determinants of health (SDOH) may affect CVH. We examined SDOH by race and ethnicity and assessed for associations between SDOH and CVH among US adolescents. Methods and Results We analyzed data from the National Health and Nutrition Examination Survey for 3590 participants aged 12 to 19 years from 1999 to 2014. SDOH variables were chosen and an SDOH score assigned (range, 0-7 points; higher=more favorable). CVH was classified according to American Heart Association criteria. We estimated population prevalence and used multivariable linear and polytomous logistic regression for associations between SDOH and CVH. SDOH varied by group, with the non-Hispanic White group (n=1155) having a higher/better mean SDOH score compared with non-Hispanic Black (n=1223) and Mexican American groups (n=1212). Associations between SDOH and CVH differed between racial and ethnic groups (interaction P<0.0001). For the non-Hispanic White group, each additional favorable SDOH variable was associated with a CVH score higher/better by 0.3 points (β, 0.3, P<0.0001), 20% higher odds for moderate (versus low) CVH (odds ratio [OR], 1.2 [95% CI, 1.1-1.4]), and 80% higher odds for high/favorable (versus low) CVH (1.8 [1.5-2.1]). Associations between SDOH and CVH were more modest among the Mexican American group (β, 0.12, P=0.001; OR 1.1 [1.0-1.2] for moderate CVH; OR, 1.3 [1.1-1.6] for high CVH) and were not significant among the non-Hispanic Black group (β, 0.07; P=0.464). Conclusions SDOH and CVH were more favorable for non-Hispanic White adolescents compared with non-Hispanic Black and Mexican American adolescents. SDOH were strongly associated with CVH among the non-Hispanic White group. Racially and culturally sensitive public policy approaches may improve CVH in US adolescents.

The role of behavioral science in addressing cardiovascular health disparities: A narrative review of efforts, challenges, and future directions

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in the United States. Despite improvements in the prevention and treatment of CVD over the past 20 years, racial/ethnic minority groups including non-Hispanic Blacks, Hispanic/Latinos, and some Asian subgroups (e.g., Asian Indians, Filipinos) experience higher rates of CVD risk factors and morbidity and mortality from CVD than non-Hispanic Whites. Therefore, addressing cardiovascular health disparities is an immediate priority. Behavioral science can play an important role in reducing disparities by capitalizing on expertise in human behavior change, social determinants of health, and implementation science. In this narrative review, we describe the efforts made within behavioral science to address CVD health disparities. We review current interventions to reduce CVD health disparities and provide practical recommendations that can be used as the field moves forward. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Life's Essential 8: Updating and Enhancing the American Heart Association's Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association

In 2010, the American Heart Association defined a novel construct of cardiovascular health to promote a paradigm shift from a focus solely on disease treatment to one inclusive of positive health promotion and preservation across the life course in populations and individuals. Extensive subsequent evidence has provided insights into strengths and limitations of the original approach to defining and quantifying cardiovascular health. In response, the American Heart Association convened a writing group to recommend enhancements and updates. The definition and quantification of each of the original metrics (Life's Simple 7) were evaluated for responsiveness to interindividual variation and intraindividual change. New metrics were considered, and the age spectrum was expanded to include the entire life course. The foundational contexts of social determinants of health and psychological health were addressed as crucial factors in optimizing and preserving cardiovascular health. This presidential advisory introduces an enhanced approach to assessing cardiovascular health: Life's Essential 8. The components of Life's Essential 8 include diet (updated), physical activity, nicotine exposure (updated), sleep health (new), body mass index, blood lipids (updated), blood glucose (updated), and blood pressure. Each metric has a new scoring algorithm ranging from 0 to 100 points, allowing generation of a new composite cardiovascular health score (the unweighted average of all components) that also varies from 0 to 100 points. Methods for implementing cardiovascular health assessment and longitudinal monitoring are discussed, as are potential data sources and tools to promote widespread adoption in policy, public health, clinical, institutional, and community settings.

Psychological and social support associations with mortality and cardiovascular disease in middle-aged American Indians: the Strong Heart Study

PURPOSE

Our study examined psychosocial risk and protective features affecting cardiovascular and mortality disparities in American Indians, including stress, anger, cynicism, trauma, depression, quality of life, and social support.

METHODS

The Strong Heart Family Study cohort recruited American Indian adults from 12 communities over 3 regions in 2001-2003 (N = 2786). Psychosocial measures included Cohen Perceived Stress, Spielberger Anger Expression, Cook-Medley cynicism subscale, symptoms of post-traumatic stress disorder, Centers for Epidemiologic Studies Depression scale, Short Form 12-a quality of life scale, and the Social Support and Social Undermining scale. Cardiovascular events and all-cause mortality were evaluated by surveillance and physician adjudication through 2017.

RESULTS

Participants were middle-aged, 40% male, with mean 12 years formal education. Depression symptoms were correlated with anger, cynicism, poor quality of life, isolation, criticism; better social support was correlated with lower cynicism, anger, and trauma. Adjusted time-to-event regressions found that depression, (poor) quality of life, and social isolation scores formed higher risk for mortality and cardiovascular events, and social support was associated with lower risk. Social support partially explained risk associations in causal mediation analyses.

CONCLUSION

Altogether, our findings suggest that social support is associated with better mood and quality of life; and lower cynicism, stress, and disease risk-even when said risk may be increased by comorbidities. Future research should examine whether enhancing social support can prospectively reduce risk, as an efficient, cost-effective intervention opportunity that may be enacted at the community level.

Neighborhood Socioeconomic Disadvantage and Mortality Among Medicare Beneficiaries Hospitalized for Acute Myocardial Infarction, Heart Failure, and Pneumonia

BACKGROUND

The Centers for Medicare and Medicaid Services' Hospital Value-Based Purchasing program uses 30-day mortality rates for acute myocardial infarction, heart failure, and pneumonia to evaluate US hospitals, but does not account for neighborhood socioeconomic disadvantage when comparing their performance.

OBJECTIVE

To determine if neighborhood socioeconomic disadvantage is associated with worse 30-day mortality rates after a hospitalization for acute myocardial infarction (AMI), heart failure (HF), or pneumonia in the USA, as well as within the subset of counties with a high proportion of Black individuals.

DESIGN AND PARTICIPANTS

This retrospective, population-based study included all Medicare fee-for-service beneficiaries aged 65 years or older hospitalized for acute myocardial infarction, heart failure, or pneumonia between 2012 and 2015.

EXPOSURE

Residence in most socioeconomically disadvantaged vs. less socioeconomically disadvantaged neighborhoods as measured by the area deprivation index (ADI).

MAIN MEASURE(S)

All-cause mortality within 30 days of admission.

KEY RESULTS

The study included 3,471,592 Medicare patients. Of these patients, 333,472 resided in most disadvantaged neighborhoods and 3,138,120 in less disadvantaged neighborhoods. Patients living in the most disadvantaged neighborhoods were younger (78.4 vs. 80.0 years) and more likely to be Black adults (24.6% vs. 7.5%) and dually enrolled in Medicaid (39.4% vs. 21.8%). After adjustment for demographics (age, sex, race/ethnicity), poverty, and clinical comorbidities, 30-day mortality was higher among beneficiaries residing in most disadvantaged neighborhoods for AMI (adjusted odds ratio 1.08, 95% CI 1.06-1.11) and pneumonia (aOR 1.05, 1.03-1.07), but not for HF (aOR 1.02, 1.00-1.04). These patterns were similar within the subset of US counties with a high proportion of Black adults (AMI, aOR 1.07, 1.03-1.11; HF 1.02, 0.99-1.05; pneumonia 1.03, 1.00-1.07).

CONCLUSIONS

Neighborhood socioeconomic disadvantage is associated with higher 30-day mortality for some conditions targeted by value-based programs, even after accounting for individual-level demographics, clinical comorbidities, and poverty. These findings may have implications as policymakers weigh strategies to advance health equity under value-based programs.

Psychological Resilience, Cardiovascular Disease, and Metabolic Disturbances: A Systematic Review

Background

Positive psychosocial factors can play an important role in the development of cardiovascular disease (CVD). Among them, psychological resilience (PR) is defined as the capacity of responding positively to stressful events. Our aim was to assess whether PR is associated with CVD or metabolic disturbances through a systematic review.

Methods

We gathered articles from PubMed, Web of Science, PsycInfo, and Google Scholar up to October 28, 2021. We included articles that were in English, were observational, and had PR examined as exposure. The CVD outcomes were either clinical or metabolic outcomes (i.e., dyslipidemia, obesity, metabolic syndrome, hypertension, and diabetes).

Results

Our literature search identified 3,800 studies, of which 17 met the inclusion criteria. Of them, seven were longitudinal and 10 cross-sectional, and 13 were on adults and four on children. The exposure assessment was heterogeneous, i.e., 12 studies used different kinds of self-administered questionnaires and five used interviews with a psychologist. Regarding outcomes, five studies investigated CVD, seven obesity, one metabolic syndrome, two hypertension, four dyslipidemia, and four diabetes. In longitudinal studies, PR was found to have an inverse association with included outcomes in five studies from the Swedish military conscription cohort but had no association with CVD in a study on African-American women and was associated with slower progression of diabetes in a general population. The cross-sectional studies showed that the prevalence of disease was not associated with PR in many cases but the progression of disease was associated with PR.

Conclusion

PR seems to have a possibly favorable association with CVD and metabolic disturbances that differs according to the type of outcome and population. Our study limitations are given by the small number of studies available and the heterogeneity in PR measurement.

Systematic Review Registration

[https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=237109], identifier [CRD42021237109].

Association of Psychological Resilience with All-Cause and Cardiovascular Mortality in a General Population in Italy: Prospective Findings from the Moli-Sani Study

Psychological resilience (PR) is the capacity to adapt positively in face of adversity. Its role as an independent protective factor has been acknowledged in recent years. We aimed to test the association of PR with all-cause and cardiovascular disease (CVD) mortality in a general adult population. We performed longitudinal analyses on 10,406 CVD-free individuals from the Moli-Sani cohort (follow up = 11.2 year). PR was assessed by the 25-item Connor and Davidson resilience scale. PR factors were identified through polychoric factor analysis. Associations with mortality were tested using multivariable Cox regressions. Higher levels of PR were associated with reduced all-cause mortality in a model including sex and age (HR = 0.78; 95%CI 0.62-1.00). The association decreased after inclusion of socioeconomic, clinical, and behavioral factors into the model (HR = 0.80; 95%CI 0.62-1.03). No relation was observed with cardiovascular mortality in the fully adjusted model (HR = 0.89; 95%CI 0.56-1.39). An inverse association of Factor 1 (reflecting positive acceptance of change) with all-cause mortality (HR = 0.89; 95%CI 0.82-0.98; p value = 0.01) was found. However, at a borderline non-significant way, PR predicts all-cause mortality in a general population of Italian adults. This is supported by the findings demonstrating a significant association between the PR's domain reflecting a positive acceptance of change and all-cause mortality.