It’s well documented that the rural South has some of the worst rates of morbidity and mortality in the country, including for heart disease. It not only lags behind urban regions, but other rural parts of the U.S. as well. Starting around 2009, this trend took an alarming new turn: Younger women in rural communities began experiencing increased rates of premature coronary heart disease, while rates were declining for other groups.
Prof. Amit Shah
He suspects the culprit is the stress of contemporary rural poverty, which affects women’s cardiovascular systems. “It’s the environment where they live, including education, income and food choices, that can affect their health,” he adds. “If someone is struggling to feed their family, that will affect their physiology.”
Shah and his collaborators are in the midst of a five-year, NIH-funded project to find the answers, tracking 3,800 people between the ages of 25 and 64 from 10 rural southern counties. They’re using smartphone apps and wrist wearable devices to measure daily stress, sleep patterns and heart functioning under real-world conditions.
Study subjects will also keep a one-week electronic diary of their everyday thoughts and behaviors, including their moods and stressful life events to see how these affect the body’s heart and vascular systems.
“The electronic diary is programmed to randomly ask the participants how they're feeling in that moment,” Shah says. “It asks questions about anxiety, depression, calmness and different dimensions of their stress experience to get as close as possible to the moment in which the stressors or other life events occur. We will look at the relationship of day-to-day changes in mood with day-to-day changes in wearable outcomes such as heart rate variability to understand how much their cardiovascular systems react to daily stressors.”
An innovative approach to cardiovascular research
Because cardiovascular research has often focused on older men, Shah says much about the younger demographic, particularly women, remains unknown. The physiological pathways that lead to heart disease may not be the same.
“We see a different kind of cardiovascular disease in young women who typically don’t get the same types of heart attacks that older men would get,” he says. “There's more microvascular disease, where the smaller blood vessels don't transmit blood as well. As a result, there's less blood flowing to the heart. Reducing cholesterol doesn't necessarily help in those cases. Stress reduction, exercise and healthy eating might actually be more effective. I have a strong hunch that there is some neurobiological basis that make women more susceptible to stress, both in terms of higher levels of PTSD, but also vulnerable physiology.”
Measuring the complex relationship between moment-by-moment feelings and heart health is a challenge because there’s no easy relationship between the way people feel and what’s happening to their bodies.
“If someone feels poorly emotionally,” Shah says, “They may not even realize how their body is feeling the stress. They might just think, ‘Wow, I'm tired. I feel kind of sluggish,’ and may not even be able to say that that might cause harm. So measuring the stress in the body independently of the stress that they report, gives us important information on the bigger factors and their impact.”
The Rollins commitment to improving rural health
Data for Shah’s research is being collected from four southern states, but what he learns will produce important insights for rural Georgians’ heart health. It’s part of Rollins’s goal to give priority to the rural parts of the state.
“As we see these fires, so to speak,” Shah says, “I think that our attention goes there, to try to put them out. And I do think that the high rate of cardiovascular disease events in certain rural populations is a fire that we need to put out.”