Working in fast-paced, high-pressure environments can wreak havoc on a woman’s cardiovascular health—raising her risk of heart attack as high as 90 percent—reported a recent study that may have posed as many questions as answers, explains Harold Amos Medical Faculty Development Program alum (2000-2004), Michelle Albert, M. D., M. P. H. “We know that stress causes disease, but the problem,” Albert says, is the lack of “multi-disciplinary research on the biological mechanisms of psychological stress, as it relates to chronic diseases like heart disease.”
While this recent study confirms that women suffer negative effects from job stress that are similar to those experienced by men, it does not address the mystery of how stress influences health in different types of people. “Not everyone develops disease from stress,” says Albert, a cardiologist at Brigham and Women’s Hospital and assistant professor of Medicine at Harvard Medical School in Boston. “Social support, hormones, certain biomarkers and others factors mediate the stress/disease connection.”
For her 2010 study—which was presented at the annual meeting of the American Heart Association—Albert looked at 17,415 women, ages 44 to 85, who were part of the Women’s Health Study. Most of them worked in the health care profession. The women were followed for 10 years. Among those who reported having high demand jobs, heart attack risk doubled and their chances of needing coronary heart procedures, such as bypass surgery, were 40 percent greater than women who had low demand jobs. Interestingly, the women with the highest risks were those in jobs with high pressure, where they also had high job control (such as physicians).
The work broke new ground in research on women and heart disease, but it’s just the beginning of Albert’s research in this area. Her broader focus includes the analysis of the impact of cumulative stress on cardiovascular disease, particularly in vulnerable populations. Her goal is to examine the biological impact of the social determinants of health by investigating the interplay between molecular and genetic biomarkers of cardiovascular disease risk, social factors and cardiovascular health. The objective is to understand and prevent the effects of adversity on longevity.
Unraveling the Puzzle of Stress & Culture
Albert’s extensive interest in the role of psychological stress on populations did not begin with medical school. “I came to the United States from Guyana, South America, when I was 14 years old,” she says. “Growing up in Guyana, I saw and experienced firsthand how poverty is reflected in medical problems,” Albert says.
“This is one of the reasons my work also looks at the links between socioeconomic status, discrimination and cardiovascular disease,” Albert explains. “There’s a great deal that’s missing in current research. Prior work about racial discrimination, for example, largely examines physical or mental health endpoints as well as hypertension, but not other hard disease endpoints or biological mechanisms.” To this end, some of Albert’s work has looked at the relationship between discrimination and subclinical [before symptoms can appear] cardiovascular disease, traditional heart disease risk factors and other surrogates for heart disease. In one of her previous studies, Albert found that no relationship was found between race or ethnic discrimination and cardiovascular disease, cancer or overall mortality, a finding that “may not be congruent with the actual risk of heart attack and begs for more evaluation,” she says.
“I want to understand what is really happening biologically when stressors produce different effects in different individuals. Is it something more than socioeconomic factors? Could it involve the immune system, the nervous system? These things are unclear, but incredibly important for developing new interventions to prevent and treat heart disease,” Albert says.
“Some of my previous work has also looked at levels of C-reactive protein, a marker for inflammation in black women. Many factors can increase C-reactive protein blood concentrations—including, high blood pressure, obesity, smoking and estrogen levels, but after you account for these factors, the inflammatory biomarker level is still 40 percent higher in African American women than women from other racial or ethnic backgrounds. “What explains this difference?” Albert asks. “This is a very important question because how inflamed you are relates to plaque rupture in the arteries. To better understand this, we need to answer larger questions about how social factors relate to biology.”
Role of Support and Collaboration
“In addition to providing protected time to allow me to develop my interests in this area, the other really important part of my Robert Wood Johnson Foundation experience was participating in the Harold Amos Medical Faculty Development Program. I found it really inspiring to go to the national meetings and interact with other minority professionals from the medical field,” Albert says. “If the program had not gotten us all together in the same room, we might not have met. I don’t think there’s any other program in the country that does this for minority physicians. It’s been very helpful to me. I’ve gotten great support.”
Albert is currently working on a large, federal grant to greatly expand her research. Perhaps her unique background—an international perspective on health, combined with a knowledge of diverse populations and the ability to analyze the interplay of stress and heart health—will yield answers that will significantly advance our knowledge of how to address longstanding cardiovascular health disparities.
The Robert Wood Johnson Foundation Harold Amos Medical Faculty Development Program (AMFDP) was created to make it possible for scientists and physicians from historically disadvantaged backgrounds to advance to senior positions in academic medicine. The four-year, AMFDP, post-doctoral research awards are offered to physicians who are not only committed to building careers in academic medicine, but who hope to serve as role models for other students and faculty members from disadvantaged backgrounds.
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
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