Posttraumatic Stress and Stress Reactivity After Myocardial Infarction

PROJECT SUMMARY/ABSTRACT In the US, an adult suffers a myocardial infarction (MI) every 40 seconds. Over 35% of MI patients develop posttraumatic stress disorder (PTSD) symptoms within 1 month, increasing risk of 1-year rehospitalization and mortality in a dose-response manner. However, biobehavioral pathways whereby PTSD symptoms lead to rehospitalization and mortality have yet to be identified. Given PTSD symptoms potentiate stress reactivity and patients show greater stress reactivity after a MI, stress reactivity is a promising mechanism to study in the association between PTSD symptoms and proximal cardiovascular health outcomes such as ambulatory blood pressure (ABP). The objective of this Mentored Patient-Oriented Research Career Development Award (K23) is to provide Dr. Sharon Lee, the candidate, with necessary training to become an independent clinical scientist with expertise in the biobehavioral mechanisms linking PTSD symptoms and cardiovascular disease risk. To prepare Dr. Lee to become an independent investigator by the completion of this award, mentored training will address four domains: (1) psychophysiology of cardiovascular stress reactivity, (2) methodologies in ecological momentary assessment and ABP monitoring, (3) epidemiology of MI and post-MI clinical outcomes, and (4) professional development into an independent clinical scientist in cardiovascular behavioral medicine. The proposed intensive longitudinal study focuses on the potential mechanistic role of psychological and physiological stress reactivity in the association between PTSD symptoms and 24-hour ABP in MI patients. Dr. Lee will leverage ecological momentary assessment including ABP monitoring to examine the association between PTSD symptoms and stress reactivity (momentary perceived stress and ABP reactivity) as it unfolds during the 6-month post-MI adjustment period. Data collection will occur at three time points, each consisting of a gold-standard clinical assessment of PTSD symptoms followed by a 7-day ecological momentary assessment with a 24-hour period of ABP monitoring. The following specific aims will be achieved: (1) Test the intraindividual association between PTSD symptoms and stress reactivity and (2) test the role of stress reactivity in the intraindividual association between PTSD symptoms and 24-hour ABP. Dr. Lee has assembled an expert mentorship team of leading scientists in the fields of clinical psychology, experimental medicine, behavioral cardiology, preventive cardiology, cardiovascular epidemiology, and intensive longitudinal modeling. The Miriam Hospital and Alpert Medical School of Brown University are ideally resourced environments for Dr. Lee to successfully carry out the proposed training and study. Dr. Lee’s K23 training plan and project align with the NHLBI Research Priority regarding mechanisms whereby psychosocial stress contributes to ischemic heart disease progression. To this end, Dr. Lee will emerge from this five-year mentored award as an independent investigator who will contribute to our knowledge about stress reactivity as a modifiable mechanism for disrupting the relationship between PTSD symptoms and poor cardiovascular health in MI patients.