As a part of our “Meet Yale Internal Medicine” series, today’s feature is on Allison Gaffey, PhD, assistant professor (cardiovascular medicine).
As an undergraduate at the University of Connecticut, Allison Gaffey, PhD, assistant professor (cardiovascular medicine), first became interested in reciprocal mind, body, and biological behavioral connections. That interest led her to pursue a career in research – first as a research assistant for studies of health behavior in survivors of physical and psychological trauma, then as a research fellow at the National Institutes of Health (NIH) focused on bio-behavioral interactions within the scope of risk of cancer, and later at Harvard, where she supported investigations of psychosocial stress, emotion, and related autonomic nervous system and endocrine activity.
Altogether these experiences honed her appreciation for how stress and related social circumstances beget poor health, as well as which factors may be protective, and led her to pursue doctoral studies at the University of Notre Dame.
“A PhD in clinical psychology was the ideal way to investigate the effects of stress on related physiology and psychological health, and to also maintain the patient's perspective,” said Gaffey.
Beginning in residency at the Alpert School of Medicine at Brown University, Gaffey says her choice to pursue this work within cardiovascular medicine just made sense.
“Cardiology is an ideal setting for pursuing questions about how stress and other adverse aspects of our daily lives and lifetime experiences ‘get under the skin’ to affect our health,” said Gaffey. “Many people don’t think of psychosocial stress as a risk factor for heart disease, but the data are abundant. This includes examinations of cardiovascular reactivity to short-term, mental stress tasks in a research laboratory or scientific evidence bridging chronic stressors from work, relationships, or discrimination with a greater and earlier incidence of cardiovascular diseases. Stress also directly affects our sleep, another lesser-known cardiovascular risk factor. As cardiovascular disease remains the leading cause of death in the U.S., working in this area is immediately impactful.”
Gaffey came to Yale in 2018, where she trained with Matthew Burg, PhD, professor of medicine (cardiovascular medicine), a preeminent expert in cardiovascular behavioral medicine who investigates the effects of mental stress on cardiovascular physiology. At the same time, she completed an Advanced Research Fellowship in Women’s Health through the VA Connecticut Healthcare System in West Haven, where she trained with Sally Haskell, MD, MS, and Cynthia Brandt, MD, MPH.
“It was the perfect opportunity to simultaneously extend my expertise in cardiovascular medicine and women's health, both in the general population and among Veterans more specifically,” said Gaffey. “It has been estimated that our knowledge of cardiovascular disease in women is about 50 years behind the literature concerning men. There’s an immense need to better understand women, their health, and the exposures that are unique to their lived experiences – as called for by President Biden’s recent executive order for women. Doing this work can also help us to learn about cardiovascular disease in men as well.”
Gaffey, who was promoted to assistant professor earlier this year, recently received a K23 grant, a patient-oriented, mentored career development award, from the National Heart, Lung, and Blood Institute (NHLBI) to support research exploring associations between high blood pressure among younger adults, who are beginning to show high blood pressure earlier in the lifespan.
Gaffey’s research will investigate how stress, childhood trauma, discrimination, and other social vulnerabilities, together influence the increase of blood pressure among younger men and women and may predict the onset of hypertension. She will also examine the role of poor sleep in these associations.
“Many studies have looked at specific types of stress or adversity across the lifespan in relation to cardiovascular risk. In this project, we hope to aggregate those adverse experiences under the umbrella of social vulnerability to see if those who experience greater cumulative vulnerability are more likely to show early increases in blood pressure over time. By doing so, we may learn which men and women need earlier or additional support to manage their blood pressure and when to provide those resources,” said Gaffey.
She is working with data from the CARDIA, a nationwide, prospective cohort study that has been in progress for more than 30 years. Gaffey is conducting a secondary analysis of blood pressure data from that study to determine which factors predict early blood pressure elevations amongst women and men, respectively.
“Although men are diagnosed with hypertension earlier in their lifespan, women show a steeper incline in the rate at which blood pressure increases over their lifespan. Besides certain health conditions and complications associated with pregnancy, we really don't know what social factors are important and implicated in that early risk,” said Gaffey.
As she continues her career, Gaffey hopes to model and identify opportunities for earlier patient-centered prevention and how to test and implement those models in the current healthcare system. She recently co-authored a perspective with Burg and Bruce Rollman, MD, MPH (University of Pittsburgh Medical Center), encouraging the American Heart Association to include psychological health – particularly depression and anxiety – as one of their risk factors for cardiovascular disease in the next update to their Life’s Essential 8 heart health metric.
“Depression, post-traumatic stress disorder, trauma, anxiety, life stress, and other social vulnerabilities are associated with risk for cardiovascular disease,” said Gaffey. “In line with the U.S. Preventive Services Task Force recommendations, screening for depression and anxiety alone would be a meaningful first step towards better addressing these risk factors and more holistic, patient-centered care.”
Gaffey tells her trainees that it is important to surround yourself with people who have varied backgrounds and interests, who can offer different types of support while allowing the freedom needed to develop your unique scientific, clinical, educational, and policy-focused interests.
“In academic medicine, it’s vital to recognize the value of your unique expertise and the power of your voice, but also to use your voice to reflect the patient’s perspective – their lived experiences and motivations,” said Gaffey. “There’s fulfillment in giving voice to our patients.”
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