# Multidimensional Correlates of Atherosclerotic Resilience in Rural Communities

> **NIH NIH F32** · EMORY UNIVERSITY · 2024 · $61,630

## Abstract

PROJECT SUMMARY
At least 60 million (one in every five) Americans live in rural areas, among whom harbor a disproportionately
high burden of cardiovascular disease (CVD). The worsening disparity in CVD mortality between rural versus
urban America has created a need to improve our understanding of atherosclerotic resilience for the promotion
of cardiovascular health in rural communities. The absence of coronary artery calcium (CAC) is a highly
specific marker of atherosclerotic resilience, as CAC=0 is consistently associated with an exceedingly low risk
of future CVD events and mortality regardless of traditional risk factor burden. Despite the prognostic
importance of CAC=0, the risk factors underlying this protective phenotype are not well understood, especially
in rural populations. To address this knowledge gap, we propose the first epidemiologic study to determine the
prevalence and correlates of CAC=0 in rural communities. We will leverage clinical and socioeconomic
measures, as well as non-contrast cardiac computed tomography among 4,000 participants (44% White, 45%
Black, 10% Hispanic) enrolled in the Risk Underlying Rural Areas Longitudinal (RURAL) Cohort Study.
Notably, RURAL is a NHLBI-funded study that examines cardiovascular health in rural communities across the
Southeastern United States, providing an ideal setting for the proposed work. The primary definition of
atherosclerotic resilience will be CAC=0, but we will also examine absence of thoracic aortic calcium and a
normal ankle-brachial index for a more comprehensive definition of atherosclerotic resilience in secondary
analyses. In Aim 1, we will determine the prevalence of atherosclerotic resilience (CAC=0) according to age
(<45 versus >45 years old), sex (women versus men), and race (black versus non-black) in rural persons.
Regression models will calculate prevalence ratios for CAC=0. We will then use collected information on
clinical CVD risk factors, diet, physical activity, and psychosocial adversity, to determine their association with
CAC=0 in rural participants (Aim 2). Multivariable regression models with sophisticated adjustment strategies
(sequential, individual, and leave-one-out) will calculate prevalence ratios to study the individual and combined
relative impact of clinical, lifestyle, and psychosocial measures on differences in atherosclerotic resilience
across groups of age, sex, and race. We will then contrast prevalence ratios and the effect estimate
attenuation after performing the various adjustment strategies. In sub-aims of Aims 1 and 2, we will perform the
above analyses for CAC burden (CAC 1-99, CAC 100-299, CAC >300) and premature CAC (any CAC among
individuals <45 years old or >90th percentile according to age, sex, and race) to facilitate a better
understanding of atherosclerotic resilience. In total, the proposed research will provide important insights into
the biopsychosocial pathways underlying atherosclerotic resilience, and aid in understandin...

## Key facts

- **NIH application ID:** 10996506
- **Project number:** 1F32HL172499-01A1
- **Recipient organization:** EMORY UNIVERSITY
- **Principal Investigator:** Alexander C. Razavi
- **Activity code:** F32 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $61,630
- **Award type:** 1
- **Project period:** 2024-09-01 → 2025-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10996506

## Citation

> US National Institutes of Health, RePORTER application 10996506, Multidimensional Correlates of Atherosclerotic Resilience in Rural Communities (1F32HL172499-01A1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10996506. Licensed CC0.

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