Searching for Early Signs of Adult Disease
In her clinical practice at Brigham and Women’s Hospital (BWH) in Boston, Center-affiliated faculty member Michelle Albert treats adult cardiovascular patients. In her research, Albert studies how to assess the risk of cardiovascular disease in different racial and ethnic groups and the role chronic psychological stress may play. So why is she interested in childhood?
“Disease starts early in life, basically prenatally,” says Albert, the director of behavioral and neurocardiovascular cardiology at BWH and an assistant professor of medicine at Harvard Medical School. “I think understanding the risk factors, the biological mechanisms, and their interplay with social mechanisms…is extremely important.” That’s why she believes research on the lives of women who are pregnant or not yet pregnant could aid in understanding why their children might be at increased risk for vascular disease—including hypertension, which is prevalent around the world and especially widespread in the U.S. African-American population, where it can strike as early as the mid-20s to early 30s.
“Looking at what happens in childhood and what happens to mothers, fathers, family members, is just as important a part of the process of understanding adult disease as just studying adults,” she says. “You have to study the environment in which a child exists. And that child exists in an environment of various adults.”
The Center on the Developing Child’s emphasis on how brain development affects lifelong health meshes well with her approach to research questions, Albert says. “In order to successfully develop interventions that actually work, the whole concept of understanding why the brain develops in a particular way is key. We have very little work on how the brain and the heart interact with each other… at the biological level.”
In collaboration with other Center affiliates and faculty members, Albert is proposing a research project examining the biology of adversity and racial/ethnic disparities in health that would, in part, look at the biological impact of children’s family environments. “Traditional genetic studies have been family or twin studies looking at how disease moves in a particular family or communities,” Albert says, “but traditional research hasn’t actually looked at how family environments—or neighborhood environments—affect genetic processes and outcomes.”
Albert is interested in looking at what stressors are present in, for example, a lower socioeconomic household and how to measure them through the presence or absence of certain indicators, or biomarkers, in the blood. Stressful situations for such a family could include unemployment, underemployment, or other social issues, such as peer pressure on children to underachieve academically or parental pressures to overachieve. By examining the interaction between different kinds of biomarkers associated with chronic disease and social determinants of health, she hopes to gain invaluable insight into the biology of disadvantage.
Indeed, in a study published in 2010 in Psychosomatic Medicine, Albert and her co-authors found just such a link between childhood adversity and blood biomarkers of cardiovascular risk among adults at midlife, including African-Americans and whites. The research was conducted with two other Center affiliates, Natalie Slopen, a postdoctoral fellow and the first author on the paper, and David Williams, who is the Florence Sprague Norman and Laura Smart Norman Professor of Public Health at the Harvard School of Public Health and Professor of African and African American Studies in the Faculty of Arts and Sciences.
“We found that childhood adversity is associated with elevated levels of inflammatory markers that are involved in the development of atherosclerosis,” Albert says—but the link was only true for the African-Americans. What those findings may mean, she says, is that early childhood stress, possibly including high poverty and discrimination, may increase the substances in the blood that can turn out to be promoters of cardiovascular disease.
In additional work related to adversity, Albert has examined the association between socioeconomic status and discrimination on health. In 2006, she was the lead author on a study in Circulation that found that, although higher socioeconomic status is associated with a lower risk of such cardiovascular problems as heart attack or stroke, the relationship could not be fully explained by traditional cardiovascular risk factors or certain common biomarkers in the blood that predict risk of heart disease. That leads to the conclusion that other factors, which could include social stressors, may be contributing, she says. More recently, Albert conducted the largest study on discrimination (a form of chronic psychological stress) and mortality in black women in the United States.
Albert is also examining the notion that stress may accumulate over time, leading to a buildup of risk factors for disease. This fall, Albert received a 5-year grant from the National Institutes of Health to study cumulative stress and cardiovascular disease risk in middle-aged and older women.
In related research projects, Albert is also delving into the effects of cumulative stress on brain function and the implications for behavior and health. For example, much effort, money, and time has been spent nationally trying to educate adults and children about the importance of nutrition and exercise in combating obesity.
“Usually, the results are very short-term in terms of their effectiveness,” Albert notes. “We don’t have a good sense of why they can’t sustain the behavior over a longer term, besides the fact that this stuff is hard to do. We also don’t know if there are biological processes that have gone awry or that we can manipulate [in a way that] may help them to sustain more healthy behavior patterns.”
Could a stressful environment cause hormonal changes that promote obesity? Albert would like to find out. If stress acts on hormones that way, it may work something like the influence of nicotine on the brain, Albert says, “where nicotine actually changes the expression of certain receptors … that makes it harder for you to quit smoking and increases your need for nicotine.” Albert adds: “I think similar processes may occur in the context of chronic stress.”
Albert originally entered medicine, she says, “to help understand why disease is more aggressive” in populations of color—beyond the longstanding explanations of poverty or a lack of access to care. The more she learned about what may cause such health disparities, she says, the more she realized that “it’s really important to look at biology in all populations, regardless of race/ethnicity, and across socioeconomic classes as well. The factors that are affiliated with these social determinants may actually account for differences in aggressiveness of disease and health outcomes.”
—Millicent Lawton
Photo by Fred Field
