T32 Multidisciplinary Research Training to Reduce Inequalities in Cardiovascular Health (METRIC)

The overall objective of this program project grant is to generate novel data on the causal mechanisms of mental stress-induced myocardial ischemia (MSIMI), to identify vulnerable patient groups who are susceptible to MSIMI, and to determine the clinical importance of MSIMI in a diverse and contemporary patient population with stable coronary artery disease. Subprojects will assess brain imaging and vascular correlates of MSIMI to explore potential mechanisms underlying this phenomenon.

The purpose of this ongoing project is to:

• Evaluate whether young women who have recently had a myocardial infarction (MI) are more susceptible to myocardial ischemia due to psychological stress relative to men of similar age
• Examine the mechanisms underlying ischemia due to psychological stress in women relative to men
• Assess whether ischemia due to psychological stress is implicated in the worse prognosis of women with MI compared with men

The purpose of this ongoing project is to examine the longitudinal association between PTSD and ischemic heart disease by doing a follow up study of twins in the Vietnam Era Twin Registry 10 years after a baseline visit that involved assessments of ischemic heart disease with positron emission tomography myocardial perfusion imaging and other measures of cardiovascular risk.

The major goal of this project is to assess the role of possible mechanisms underlying the association of depression and posttraumatic stress disorder with cardiovascular disease using a twin design, and to examine subclinical indicators of myocardial perfusion measured with positron emission tomography and biomarkers of immune and autonomic dysregulation. The data collection has been completed and data are available for specific analyses.

The primary goals of the MECA collaborative are to:

1. Identify psychological and social factors at the community and individual level that promote cardiovascular "resilience" among African Americans in the metropolitan Atlanta area
2. Identify the vascular and molecular correlations of resilience in this population pre- and post-intervention

This prospective registry and biorepository was established to investigate the genetic basis of oxidative stress, vascular dysfunction, cardiovascular disease and stroke from patients undergoing cardiac catheterization at Emory University Hospital, Grady Memorial Hospital, and the Atlanta Veterans Administration Medical Center.

The Biobank contains over 5000 blood specimens that are stored for DNA, RNA, proteomics, metabolomics, and biomarker assays.  In addition subjects provide data regarding demographics, medications, alcohol/drug use, family history of cardiovascular disease, physical and emotional health status, sleep quality, and prior medical history. Subjects are followed annually for future adverse CVD events including deaths, MI, admissions of acute coronary syndromes or heart failure, revascularization, strokes and PAD events.

The META Health study is the result of a collaborative partnership between Morehouse School of Medicine and Emory University. The purpose was to characterize racial and ethnic differences in obesity-related cardiovascular disease through interdisciplinary and interrelated projects. 

Of particular interest are maladaptive behaviors,  social environment, psychological stressors, vascular dysfunction, and pathobiological pathways.

The design was operated in two stages:

1. A random-digit-dialing of African American and white residents of metropolitan Atlanta, aged 30-65 years, stratified by county median income
2. A clinical visit at both institutions on a subset

The psychosocial factors were centered race-based discrimination, financial hardship, and general stress. The measurements performed during the clinical visit included blood pressure, anthropometry (standards and bioimpedance), vascular function, salivary cortisol, blood, and urine biomarkers. Specimens, as well as DNA, were stored for future studies. Data collection is completed and is available for specific analyses.

The goal of this project is to perform a comprehensive analysis of the risk factors for heart failure readmission, including psychological, social, and physiologic. We will integrate mobile health technologies to detect changes in environment and health status over time.

Vagal nerve stimulation is a therapy for treatment resistant depression, but its effect on PTSD is unknown. This is a study of the brain effects of transcutaneous vagal nerve stimulation (vs. sham), as well as a comprehensive analysis of its effects on the autonomic nervous and immune systems in subjects with history of traumatic stress exposure.

The ARIC study is a prospective cohort that recruited 15,792 men and women from four communities in the U.S. in 1987-1989. The main goal of the ARIC study is to understand the determinants of atherosclerosis and atherosclerotic diseases (such as heart attacks and stroke) in the general population. We are using data collected in the ARIC study to investigate the epidemiology and risk factors of atrial fibrillation.

Using two large administrative health care databases (MarketScan, from Truven Health Analytics, and Clinformatics, from Optum), we are studying the risks and benefits of different treatments used in patients with atrial fibrillation.

Statewide survey of all (n=1,320) elementary schools in Georgia, conducted October 2013 - September 2014. The survey was used to provide:

• A state-wide baseline
• Personalized feedback for schools during training
• A comparison for formative evaluation

Respondents from each school were administrators, the lead classroom teacher from each grade level, and the PE teacher. Data collected included information about before, during, and afterschool physical activity (PA) time and integration, PA professional development and resource usage, staff engagement, staff wellness, and community and family engagement. Data linked to DOE demographic information. A survey in 2015 was conducted to assess impact of intervention.

One component of statewide standardized fitness assessment conducted on all students. Respondents were all students grades 4-12 in all Georgia elementary schools. Extensive data were collected physical fitness, including general fitness, cardiovascular fitness, BMI, and percent body fat.

Conducted May 2015, this survey was developed to provide:

1. A baseline of Georgia SNAP-Ed elementary school wellness policies, nutrition practices, and environments
2. Personalized reports containing data and recommendations for schools 

Respondents from schools included administrators, grade level chairs, and lunchroom/nutrition managers. The survey link was sent to 86 Georgia SNAP-Ed elementary schools by HMP health educators. Data included baseline information about school wellness policies, nutrition practices and environments, and staff suggestions for improvement to encourage student consumption of healthier foods and beverages. Linked to DOE data, PU30 survey, and fitnessgram.

A physical activity intervention in elementary schools provided to 29 schools (and 7 control schools).

Respondents were 4,000 intervention students and 1,000 control students. Data are available at the student level (compared to PU30 surveys which are at school level), fitnessgram, physical activity in classroom, student physical activity levels, student behavior and knowledge, school climate survey. Data linked to DOE data (including individual level education outcome data – e.g., test scores).

This study seeks to examine the role of childhood adversity on cardio-metabolic health among a cohort of Puerto Rican young adults living in the South Bronx, NY and the San Juan metro area, Puerto Rico. We furthermore seek to identify modifying factors, such as social support and positive coping among others that may buffer the effects of toxic stress on cardiometabolic health among young adults.

The goal of this study is to identify genomic and psychological components that can contribute to African American women and young children using an integrative genomic and epigenomic approach. Findings from our project can contribute to developing interventions, and thus promote health and prevent hypertension in children and their mothers who may have both genomic and psychological environmental risks.

As part of the MVP study, this project aims to identify genetic associations of common and rare variants with CVD risk factors such as cholesterols, triglycerides, body mass index, and CVD prevalence and incidence among 400,000 veterans.

This project uses innovative methodologies from public health and psychology to determine whether, in what contexts, and how “expectations” of discrimination contribute to early CVD risk in a cohort of healthy African American women over a two-year follow up.  Early CVD risk is assessed via changes in carotid intima media thickening (IMT), a measure of atherosclerosis, and 48-hour ambulatory blood pressure (ABP), a measure of autonomic physiologic arousal and a potential mechanism linking expectations of racism to IMT.

This project is designed to examine the impact of social stressors (e.g. financial stress, discrimination, early adversity, inadequate social support) on two distinct inflammatory phenotypes (SLE-related vs. CVD-related) and atherosclerosis in African American women with Systemic Lupus Erythematosus (SLE), relative to healthy African American comparison women.