Sandra B. Dunbar

Objective: Examine the association between types of childhood maltreatment and surrogate markers of vascular function, and to test whether sex modifies these relationships. Methods: Childhood maltreatment and indices of vascular function were assessed in a cohort of healthy Black adults without known CVD (n=404). Maltreatment (physical, sexual, emotional, and general trauma) domains were assessed using the Early Trauma Inventory Short Form. A trauma severity index score was calculated by summing the indexes for each domain. Outcomes of central augmentation index (cAIx) corrected for a heart rate of 75 bpm, and carotid femoral pulse wave velocity were measured as indices of wave reflections and arterial stiffness, respectively, and central pulse pressure (CPP). Associations between each domain and outcomes were assessed using multivariate-adjusted (demographics, clinical, health behaviors, and depressive symptoms) and sex-stratified linear regression models. Results: The cohort had a mean age of 53±10.3 years, and 61% were women. After adjustments, emotional abuse (2.68 [95% CI: −4.78, −0.58, P =.013]) and physical abuse (−2.38 [−4.26, −0.50, P =<.001]) were associated with cAIx in the overall cohort. Significant sex interactions were identified for emotional ( P= .009) and physical abuse ( P= .001) with cAIx and for emotional abuse with CPP ( P =.021). Among women, physical abuse was associated with a higher cAIx (2.22 [95% CI: 0.70, 3.73, P =.004]), and among men, a lower cAIx (−2.59 [95% CI: −4.98, −0.19, P =.035]). Emotional abuse was also associated with higher CPP measures among women (1.31 [95% CI: 0.15, 2.46, P =.027]) with no associations identified in men. Conclusions: Physical and emotional abuse was associated with higher cAIx and CPP in women, but not men, suggesting sex-specific effects of early trauma on vascular function.

Background: Black adults face a higher prevalence of heart failure (HF), with greater symptom burden and earlier onset compared to other populations. Systemic inflammation and socioeconomic factors, including neighborhood deprivation, contribute to these disparities. Understanding the interplay between inflammation, HF symptoms, and social determinants of health is critical for addressing inequities in HF outcomes. Objectives: This study examines associations between inflammatory biomarkers and physical and psychological symptoms in Black adults with HF and explores the impact of neighborhood deprivation on these factors. Methods: Black adults with HF (N=41) were enrolled in this cross-sectional study. Blood samples were collected using Mitra Microsampling for biomarker analysis, including cytokines, chemokines, and xanthine oxidase (XO) activity. Symptoms were assessed using validated measures for dyspnea, fatigue, anxiety, depression, stress, and sleep disturbance. Neighborhood deprivation was evaluated using the Area Deprivation Index. Results: Elevated XO activity was significantly associated with dyspnea severity (β = 0.75, p < .001). Chemokines linked to T cell activation (e.g., C-C motif ligand[CCL]-11, CXC motif ligand[CXCL]-8) correlated with HF symptoms and psychological distress, including anxiety and perceived stress. Higher neighborhood deprivation scores were associated with increased stress, sleep disturbance, and inflammatory biomarkers (e.g., interleukin[IL]-4, vascular cell adhesion molecule[VCAM]-1). Conclusions: This study highlights the role of inflammation and neighborhood deprivation in HF symptomatology among Black adults. Targeting oxidative stress and inflammatory pathways, alongside addressing social determinants of health, may reduce symptom burden and improve outcomes in this population.

Cardiovascular nurses play a vital role in reducing the global burden of cardiovascular disease through their multiple leadership roles and focus on prevention. From serving as an informal or formal clinical leader, case manager, educator, mentor for emerging cardiovascular nurses or nurse leaders, champion for quality of care, or policy advocate, as examples, cardiovascular nurse leaders can have a profound impact on improving outcomes for individuals, families, and communities. As leaders, cardiovascular nurses must be prepared for their roles through development of leadership competencies to ultimately shape decisions in their settings, whether in clinical care, management, education, advanced practice, and research or through community and professional organizations. This article revisits the competencies required of nurse leaders to be effective in cardiovascular disease prevention and improving outcomes in a changing healthcare environment.

Background: Psychosocial stressors such as childhood trauma have been associated with an increased risk of hypertension. The impact of childhood trauma on vascular dysfunction in Black adults remains less clear. We examined the association between childhood trauma and vascular function in Black adults. Methods and Results: Childhood trauma exposure and vascular function were assessed in a cohort of healthy Black participants without known cardiovascular disease (n=404) from a large metropolitan city. Childhood trauma was assessed using the Early Trauma Inventory Short Form with higher scores indicative of higher traumatic life events assessed before age 18 years. Outcomes of central augmentation index (CAIx) and carotid femoral pulse wave velocity were measured as indices of wave reflections and arterial stiffness using applanation tonometry (Sphygmocor Inc.), and central pulse pressure (CPP) was calculated as the difference between the central aortic systolic and diastolic blood pressures. Relationships between Early Trauma Inventory Short Form and outcomes were assessed using multivariate‐adjusted and sex‐stratified linear regression models. The mean age of the cohort was 53 (SD=10.3), 61% women. Cumulative childhood trauma was not associated with CAIx, central pulse pressure, or carotid femoral pulse wave velocity in the minimal or fully adjusted models for sociodemographic, sex, clinical factors, medical history, health behaviors, and depression. Significant trauma × sex interactions were identified for CAIx ( P =0.003) and central pulse pressure ( P =0.025). Childhood trauma was associated with lower CAIx ( β =−0.55% [95% CI, −1.07 to −0.03] in men, but higher CAIx ( β =0.35% [95% CI, 0.08–0.63]) and central pulse pressure ( β =0.23 mm Hg [95% CI, 0.01–0.43]) in women. Conclusions: Childhood trauma is independently associated with impaired arterial compliance in Black women.

Background: Comorbidities such as Type 2 diabetes mellitus significantly and adversely influence heart failure outcomes, especially in Black adult populations. Likewise, heart failure has a negative effect on diabetes and cardiometabolic outcomes. Dyspnea, a common symptom of heart failure, often correlates with disease severity and prognosis. However, the relationship between comorbid diabetes, dyspnea severity, and cardiometabolic biomarkers in Black adults with heart failure remains understudied. Objectives: The purpose of this pilot study was to examine differences in the distressing heart failure symptom of dyspnea and in cardiometabolic and inflammatory biomarkers in Black adults living with heart failure with and without diabetes. Methods: Black adults with heart failure were enrolled in this cross-sectional pilot study. Cardiometabolic and inflammatory biomarkers were measured via multiplex immunoassay. Univariate general liner models were used to identify group differences between persons with heart failure with comorbid diabetes and those without, controlling for age, sex, and comorbid burden. Results: Participants were mostly female with a mean age of 55 years and mean left ventricular ejection fraction of 33%. Participants with diabetes exhibited higher dyspnea scores compared to those without diabetes, indicating greater symptom burden. Moreover, individuals with comorbid diabetes demonstrated higher levels of cardiometabolic and inflammatory markers. Discussion: Comorbid diabetes was associated with higher dyspnea severity and adverse cardiometabolic profiles in Black adults with heart failure. These findings underscore the importance of targeted interventions addressing diabetes management and cardiometabolic risk factors to improve symptom control and outcomes in this high-risk population. Further research is warranted to elucidate the underlying mechanisms and develop tailored therapeutic strategies for managing comorbidities in persons with heart failure, particularly in minoritized communities.

Background: In the United States, Black adults have the highest prevalence of obesity and hypertension, increasing their risk of morbidity and mortality. Caregivers of persons with dementia are also at increased risk of morbidity and mortality due to the demands of providing care. Thus, Black caregivers—who are the second largest group of caregivers of persons with dementia in the United States—have the highest risks for poor health outcomes among all caregivers. However, the physiological changes associated with multiple chronic conditions in Black caregivers are poorly understood. Objectives: In this study, metabolomics were compared to the metabolic profiles of Black caregivers with obesity, with or without hypertension. Our goal was to identify metabolites and metabolic pathways that could be targeted to reduce obesity and hypertension rates in this group. Methods: High-resolution, untargeted metabolomic assays were performed on plasma samples from 26 self-identified Black caregivers with obesity, 18 of whom had hypertension. Logistic regression and pathway analyses were employed to identify metabolites and metabolic pathways differentiating caregivers with obesity only and caregivers with both obesity and hypertension. Results: Key metabolic pathways discriminating caregivers with obesity only and caregivers with obesity and hypertension were butanoate and glutamate metabolism, fatty acid activation/biosynthesis, and the carnitine shuttle pathway. Metabolites related to glutamate metabolism in the butanoate metabolism pathway were more abundant in caregivers with hypertension, while metabolites identified as butyric acid/butanoate and R-(3)-hydroxybutanoate were less abundant. Caregivers with hypertension also had lower levels of several unsaturated fatty acids. Discussion: In Black caregivers with obesity, multiple metabolic features and pathways differentiated among caregivers with and without hypertension. If confirmed in future studies, these findings would support ongoing clinical monitoring and culturally tailored interventions focused on nutrition (particularly polyunsaturated fats and animal protein), exercise, and stress management to reduce the risk of hypertension in Black caregivers with obesity.

Background: Fatigue is a highly prevalent symptom for individuals with polycystic ovary syndrome (PCOS); however, characterization of fatigue and investigation into the gut microbiome—a pathway that may contribute to fatigue—remains inadequately explored in Black women with PCOS. Objectives: The purpose of this cross-sectional study was to examine fatigue and its relationship to the gut microbiome in adult Black women with PCOS. Methods: Adult Black women with a diagnosis of PCOS were recruited for this cross-sectional study. The Multidimensional Fatigue Inventory-20 (MFI-20) and the PROMIS Fatigue Short Form were used to measure fatigue. The V3/V4 region of the bacterial 16S rRNA gene was sequenced to investigate gut microbial composition. Relative abundance and diversity values were calculated. Results: We found that Black women with PCOS experience mild to moderate levels of fatigue. An inverse relationship between fatigue scores and alpha diversity values was found for the gut microbiome. We also found distinct beta diversity profiles based on fatigue. Lastly, when controlling for hypertension and body mass index, Ruminococcus bromii, Blautia obeum, Roseburia, and HT002 were associated with three subscales of the MFI-20. Discussion: Black women with PCOS experience mild to moderate fatigue. Clinicians should be cognizant of this population’s increased risk for fatigue to adequately address their healthcare needs. We also found that gut microbial composition was associated with fatigue in Black women with PCOS. Specifically, a higher relative abundance of certain gut bacteria involved in short-chain fatty acid production and anti-inflammatory pathways was correlated with lower fatigue levels. Future studies should further investigate the link between the gut microbiome and fatigue to determine whether this relationship is causal as better insight could inform tailored diet and exercise interventions to alter the gut microbiome and reduce fatigue.

Background: Black adults have a higher risk for heart failure (HF) than others, which may be related to higher cardiovascular risk factors and also inflammatory dietary patterns. The Western diet is associated with inflammation and contributes to HF. Trimethylamine N-oxide is a diet-linked metabolite that contributes to inflammation and is associated with higher tumor necrosis factor-alpha (TNF-α) levels, especially in HF populations. The dietary inflammatory index score measures a diet’s inflammatory potential and food’s inflammatory effects. Objective: The purpose of this pilot study was to explore associations between the Western diet, dietary inflammatory index, trimethylamine N-oxide, relevant covariates and variables, and TNF-α in Black persons with HF. Methods: Thirty-one Black participants (mean age = 55 years, 68% women) with HF were enrolled. Trimethylamine N-oxide and TNF-α levels were analyzed using immunoassays. A food frequency questionnaire was completed, and dietary inflammatory index scores and food groups were calculated. Analyses included correlations and I-test statistics. Results: Mean dietary inflammatory index score was −0.38, noting an anti-inflammatory diet with slightly higher inflammatory diet scores in men compared to women. The dietary inflammatory index score showed a negative association with dietary choline but not with trimethylamine N-oxide or TNF-α. Trimethylamine N-oxide and age were positively correlated, along with the correlation for TNF-α with a moderate effect size. No relationship was found among dietary inflammatory index, TNF-α, and trimethylamine N-oxide variables. Discussion: A greater understanding of intake of inflammatory foods and relationships with immune factors is warranted to inform intervention development. In Black adults with HF, it is important to consider the intake of inflammatory foods as increased age may affect the retention of dietary metabolites. Metabolites may also increase the levels of inflammation. Knowledge about these relationships could lead to tailored dietary interventions based on diet, age, and culture patterns.