Allison E. Gaffey, PhD

Dr. Gaffey’s research program examines how psychological, behavioral, social, and contextual factors shape cardiovascular health across the life course. Her work is grounded in the premise that cardiovascular disease develops not only through traditional biological risk factors, but also through accumulated exposure to stress, disrupted sleep, adverse social conditions, mental health symptoms, and the environments in which people live and receive care. A central goal of her research is to identify when and for whom these factors become clinically meaningful—and to translate that knowledge into earlier, more personalized approaches to cardiovascular disease prevention.

Her research spans behavioral medicine, cardiovascular epidemiology, women’s cardiovascular health, sleep, stress physiology, health services research, and health equity. Across these areas, she integrates prospective cohort studies, large-scale electronic health record data, intensive longitudinal and ambulatory assessment, behavioral and psychosocial measurement, and intervention development. Her work includes both population-level investigations designed to identify patterns of cardiovascular risk in large and diverse populations and mechanistic studies that examine how everyday psychological and behavioral experiences contribute to changes in blood pressure and cardiovascular physiology.

Stress, Sleep, and Early Cardiovascular Risk

One major focus of Dr. Gaffey’s research is understanding how psychological stress and sleep contribute to the development of elevated blood pressure and cardiovascular risk before clinical cardiovascular disease is established. She is particularly interested in early and mid-adulthood, a period during which adverse cardiovascular trajectories may already be developing but remain amenable to prevention.

Her NIH-funded research examines the dynamic relationships among psychosocial stress, sleep, and blood pressure in younger adults. This work combines laboratory cardiovascular phenotyping with repeated assessments in participants’ natural environments, including ambulatory blood pressure, actigraphy-based sleep assessment, physiological measures of vascular function, and assessments of psychological and behavioral experiences. Rather than treating stress or sleep as isolated exposures, this work considers how they interact over time and how their cardiovascular effects may differ across individuals.

A related line of work examines sleep disorders as predictors of long-term cardiometabolic disease in U.S. Veterans. Using national Veterans Health Administration electronic health record data, Dr. Gaffey and collaborators have evaluated insomnia, obstructive sleep apnea, and their co-occurrence - often termed comorbid insomnia and sleep apnea, or COMISA - in relation to incident hypertension, cardiovascular disease, and diabetes. These studies leverage cohorts of more than one million post-9/11 Veterans and allow examination of clinically diagnosed sleep disorders over years of follow-up. This work seeks to clarify whether co-occurring sleep disturbances represent a particularly important cardiovascular risk phenotype and whether associations vary across women and men.

More broadly, Dr. Gaffey is interested in sleep as a modifiable component of cardiovascular health. Her research examines not only clinical sleep disorders but also sleep duration, continuity, efficiency, and multidimensional sleep health, with the longer-term goal of identifying sleep characteristics that may be useful targets for cardiovascular disease prevention.

Women’s Cardiovascular Health and the Life Course

Women’s cardiovascular health is another major emphasis of Dr. Gaffey’s research. Her work considers sex and gender not simply as covariates but as potentially important determinants of cardiovascular risk, disease recognition, treatment, and prevention. She is particularly interested in life stages and experiences that may reveal cardiovascular vulnerability well before older adulthood.

Several of her studies use pregnancy and the postpartum period as windows into later cardiovascular health. Using data from large prospective pregnancy cohorts, including nuMoM2b and related follow-up studies, she examines how psychological stress, depression, sleep, physical activity, adverse pregnancy outcomes, and social and neighborhood conditions during pregnancy relate to subsequent blood pressure and hypertension. This work is designed to better understand the pathways through which pregnancy experiences and social context may identify women at heightened risk for later cardiovascular disease.

Her work also addresses sex differences in cardiovascular risk and care within the Veterans Health Administration. In national cohorts of post-9/11 Veterans, she and collaborators have studied longitudinal blood pressure control among younger women and men with hypertension, as well as the contribution of behavioral, psychological, and social factors to cardiovascular outcomes. These studies are intended to identify both biological and health-care-related opportunities to improve cardiovascular prevention for women Veterans, a rapidly growing population whose cardiovascular health remains comparatively understudied.

Across these projects, Dr. Gaffey’s broader aim is to advance a life-course model of cardiovascular prevention in women: one that recognizes pregnancy, reproductive transitions, psychosocial experiences, sleep, and social conditions as clinically relevant components of cardiovascular risk rather than peripheral influences on it.

Psychosocial Stress, Mental Health, and Cardiovascular Disease

A longstanding theme of Dr. Gaffey’s work is the intersection of psychological health and cardiovascular disease. She studies how depression, anxiety, trauma, and chronic psychosocial stress relate to the development and progression of cardiovascular disease, and how psychological responses to cardiovascular illness can influence subsequent health and health-care utilization.

Her work in Veterans has examined depression severity and subsequent cardiovascular outcomes, including whether associations differ across women and men. Other research addresses trauma-related exposures—including experiences specific to military and Veteran populations—and their potential contributions to hypertension and cardiovascular risk.

Dr. Gaffey also studies psychological factors among patients who already have cardiovascular disease. This includes work on cardiac anxiety, health-care utilization, and recurrent cardiovascular outcomes. Her research in patients with atrial fibrillation, for example, has examined whether heightened anxiety about cardiac sensations is associated with emergency and hospital-based care after treatment. Related work evaluates psychological distress as a predictor of recurrent cardiovascular events and cardiovascular mortality, including potential differences between women and men.

Collectively, these studies seek to move beyond demonstrating that psychological distress and cardiovascular disease co-occur. Instead, Dr. Gaffey’s work aims to identify clinically actionable psychological phenotypes, understand the mechanisms connecting them with cardiovascular outcomes, and determine how behavioral medicine can be integrated more effectively into cardiovascular prevention and care.

Social Determinants, Health Equity, and Cardiovascular Risk

Dr. Gaffey’s research also examines how social and structural conditions contribute to cardiovascular risk. She is particularly interested in understanding how multiple social disadvantages accumulate within individuals and communities, how these exposures become reflected in cardiovascular risk factors, and whether routinely collected clinical data can be used to identify patients experiencing elevated social risk.

Using national VA electronic health record data, her work evaluates documented social determinants of health—including housing, financial, employment, transportation, social, and other forms of adversity—across millions of Veterans. These studies examine the accumulation of social risk in relation to cardiovascular disease, cardiovascular mortality, and intermediate cardiometabolic indicators such as blood pressure, glycemic control, and lipids.

Complementary studies use longitudinal epidemiologic cohorts to distinguish the potential contributions of individual-level social vulnerability from neighborhood-level deprivation. For example, her work examines whether social vulnerability and neighborhood disadvantage predict subsequent hypertension and blood pressure independently of conventional cardiovascular risk factors, and whether their associations differ among individuals with other markers of elevated cardiovascular vulnerability.

An important objective of this program is methodological as well as clinical: to improve how social determinants are conceptualized and measured in cardiovascular research. Rather than relying exclusively on single indicators of socioeconomic position, Dr. Gaffey is interested in cumulative and multidimensional approaches that better represent patients’ lived social environments.

Patient–Clinician Communication and Cardiovascular Prevention

Another developing area of Dr. Gaffey’s research concerns the interpersonal and health-system processes that shape cardiovascular prevention. She is interested in how patients understand cardiovascular risk, communicate with clinicians and family members about that risk, and translate risk information into preventive behavior.

This includes research examining patient-centered clinician communication across levels of cardiovascular vulnerability using national survey data. Her work considers whether people at elevated cardiovascular risk experience differences in communication with health-care professionals and how patterns of communication have changed over time.

A complementary program focuses on communication within families after cardiovascular disease occurs. Dr. Gaffey and collaborators are developing work that conceptualizes a parent’s cardiovascular event as a potential “teachable moment” for adult children who may share both familial risk and modifiable behavioral risk factors. This work examines how parents and adult children discuss cardiovascular risk, how autonomy-supportive versus controlling communication may affect motivation, and how family communication can potentially be leveraged to promote preventive behaviors. The longer-term goal is to develop and test a dyadic cardiovascular risk communication intervention that extends prevention beyond the individual patient to family members who may themselves be at elevated risk.