The Cardiovascular Cost of Silence: Funding: Relationships Between - PowerPoint PPT Presentation

9/17/2019 Funding & Disclosures The Cardiovascular Cost of Silence: Funding: Relationships Between Self-Silencing and National Institutes of Health Carotid Plaque in Midlife Women National Heart Lung and Blood Institute: R01HL105647, K24HL123565 (Thurston) National Institute on Aging: RF1AG053504 (Thurston, Maki) National Institute of Mental Health: T32MH018269 (Jakubowski, PI: Karen Jakubowski, PhD 1 , Yue-Fang Chang, PhD 1 , Emma Barinas-Mitchell, PhD 1 , Karen Goldstein) Matthews, PhD 1 , Pauline Maki, PhD 2 , & Rebecca C. Thurston, PhD 1 1 University of Pittsburgh, 2 University of Illinois at Chicago Disclosures: None to report North American Menopause Society 2019 Annual Meeting, Chicago, IL Self-Silencing and Women’s Health Self-Silencing • Social relationships are important for women’s health. • Associated with: – Depression • How women express themselves and assert their needs in – Disordered eating symptoms intimate relationships may be related to health. – Irritable bowel syndrome • In some relationships, women learn to inhibit self-expression to avoid conflict or loss of relationship: self-silencing. • Has not been examined with cardiovascular health. Example “Caring means “In order for my items: putting the other partner to love me, I person’s needs in cannot reveal certain front of my own.” things about myself.” Jack & Dill, 1992; Grant 2011; Shouse & Nilsson, 2011; Norwood et al. 2011; Ali et al. 2000 1

9/17/2019 Subclinical Cardiovascular Disease (CVD) Study Aim • Vascular imaging is used to measure  To test cross-sectional associations between self-silencing and underlying vascular health among people carotid plaque in a community sample of midlife women. without clinical CVD. • Carotid plaque: an indicator of subclinical CVD that is known to predict later CVD events. Self- Carotid silencing plaque Indicators of subclinical CVD are useful for studying the development of CVD among midlife women. MsHeart Study Silencing the Self Scale (Jack 1991; Jack & Dill, 1992) MS Heart (R01HL105647; PI: Thurston) • Measures self-silencing in one’s current/prior intimate Questionnaires • 304 peri/post women relationship. - Silencing the Self Scale (12 items, • Age 40-60 4 subscales, rated on 5-pt scale) Presenting an outer self Inhibiting self- - Center for Epidemiologic Studies • Nonsmoking Silencing compliant with feminine expression and action Depression (CES-D ≥16) Divided Self role standards while the • Free of clinical CVD the Self to avoid conflict and Physical Measures inner self grows angry. loss of relationship. • No SSRI/SNRI or hormone therapy - Height, weight, blood pressure Phlebotomy Judging the self by Placing the needs of Externalized - Lipids, glucose, insulin, CRP Care as Self- external standards. others before the self Self- Carotid ultrasound Sacrifice in relationships. Perception - Plaque index (scored as 0, 1, ≥2) 2

9/17/2019 Sample characteristics (N=295) Self-silencing subscale is associated with plaque M (SD), unless noted Plaque Index Silencing the Age 54.1 (4.0) Self 60% Race, N (%) Non-White 84 (27.4) 50% Externalized Postmenopausal, N (%) 248 (84.1)  40% Carotid plaque Self-Perception BMI 29.0 (6.7) 30%  (0, 1, ≥2) SBP 119.9 (14.6) 20% Care as Self- DBP 70.2 (9.2)  10% Sacrifice LDL 130.7 (33.3) 0% Divided Self 0 1 ≥2 Depressive symptoms, 41 (13.9) CES-D ≥ 16, N (%) Multinomial logistic regressions adjusted for age, race, education, SBP, DBP, BMI, LDL cholesterol, medications (blood pressure, lipids, diabetes), depressive symptoms High self-silencing is related to increased odds Self-silencing subscale is associated with plaque of plaque index ≥2 * OR (95%CI) = 1.14 (1.02-1.28), 40% “I rarely express my anger at % with Plaque Index ≥ 2 Silencing the p=.02 those close to me.” Self 30% “I speak my feelings with my Externalized  partner, even when it leads to Carotid plaque Self-Perception 20% problems or disagreements.”  (0, 1, ≥2) Care as Self- “When my partner’s needs or 10%  opinions conflict with mine, Sacrifice Low Medium High rather than asserting my own point of view I usually end up Divided Self Self-silencing agreeing.” *p<.05, OR (95%CI) = 1.14 (1.02-1.28); Adjusted for age, race, education, SBP, DBP, BMI, LDL cholesterol, Multinomial logistic regressions adjusted for age, race, education, SBP, DBP, BMI, LDL medications (blood pressure, lipids, diabetes), depressive symptoms cholesterol, medications (blood pressure, lipids, diabetes), depressive symptoms 3

9/17/2019 Clinical Implications Summary • Social relationships are important for women’s  Emotional power dynamics in intimate cardiovascular health. relationships may be important for cardiovascular health in midlife women. • Self-silencing of emotional expression in intimate relationships was related to greater carotid plaque  Clinicians can support women toward in midlife women. greater self-expression and assertion. • Association persisted beyond adjustment for demographics, CVD risk factors, and depressive symptoms. 4