Reducing Cardiovascular Risk in Perimenopausal Latinas: Pilot Study of a Multi-Component Intervention

项目摘要/摘要 心血管疾病(CVD)仍然是女性死亡的主要原因。心血管疾病风险增加 基本上是在围绝经期，这是女性最后一次月经前6-8年的关键时间段。 越来越多的证据表明，拉美裔比非西班牙裔有明显更差的心血管疾病危险因素 妇女，这可归因于多种社会文化和环境因素(例如，较低的社会经济水平 职位、歧视、压力)。这些因素通过对健康行为的影响与心血管疾病有关， 以及涉及炎症和神经内分泌途径的潜在机制。尽管行为 针对围绝经期心血管疾病风险的干预研究在过去十年中出现，没有研究 旨在干预行为影响，以降低围绝经期生物心血管疾病的风险 拉丁裔。利用国家少数民族健康和健康差距研究所(NIMHD)框架，我们将 应对社会文化和建筑环境，干预行为影响，以减少生物 围绝经期拉丁裔妇女的心血管疾病风险。这项调查的目的是检查可行性和初步 由社区卫生工作者领导的行为干预的有效性：a)减少 生物心血管危险因素(血压、动脉僵硬、血脂、血糖)；b)改善继发性 结果(健康行为：营养、体力活动、睡眠、应对策略)和其他生物因素 (肥胖、炎症和应激生物标志物、血管舒缩症状)从基线到6个月和12个月 后续行动。我们将从两个社区小组招募参与者：一个小组将被随机分配到 完成干预；另一个将是等待名单控制。这项干预分为3个阶段：每周12次 会议(第一阶段：教育、体力活动、压力管理、应对技能培训)，然后是3 每月的持续支持课程(第二阶段)；最后是6个月的独立技能维护 (第三阶段)。该奖项的长期目标是发展S博士作为一名研究员的独立性，领导 致力于改善女性心血管健康并实施干预措施的研究计划 用于围绝经期妇女，特别是拉丁裔妇女心血管疾病的预防和自我管理。建议数 K23将通过以下方面的指导和培训支持她的发展：1)社区参与研究；2) 临床试验设计、实施和评价；3)行为干预对生物学的影响 结果；以及4)领导力、出版物和资质方面的专业发展技能。至 为了实现她的研究目标和培训目标，S博士组建了一支跨学科的团队 具有社区参与、干预设计、临床试验分析、社会文化和 生物测量和职业发展指导。这项研究具有极大的加速潜力 围绝经期拉美妇女心血管疾病风险相关知识的获得及其对行为的影响 在这一服务不足的人群中降低心血管疾病风险的干预措施。

PROJECT SUMMARY / ABSTRACT Cardiovascular disease (CVD) remains the leading cause of death among women. Risk of CVD increases substantially during perimenopause, the critical window of 6-8 years before a woman’s final menstrual period. Increasing evidence suggests that Latinas have a significantly worse CVD risk factor profile than non-Hispanic women, which can be attributed to multiple sociocultural and environmental factors (e.g., lower socioeconomic position, discrimination, stress). These factors are related to CVD through their influence on health behaviors, as well as potential mechanisms involving inflammatory and neuroendocrine pathways. Although behavioral intervention research targeting CVD risk during perimenopause emerged over the past decade, no studies were designed to intervene on behavioral influences to decrease biological CVD risk among perimenopausal Latinas. Using the National Institute of Minority Health and Health Disparities (NIMHD) Framework, we will address the sociocultural and built environments and intervene on behavioral influences to decrease biologic CVD risk among perimenopausal Latinas. The aim of this investigation is to examine feasibility and initial efficacy of a behavioral intervention led by community health workers to a) decrease the primary outcomes of biologic CVD risk factors (blood pressure [BP], arterial stiffness, lipids, blood glucose); b) improve secondary outcomes (health behaviors: nutrition, physical activity, sleep, coping strategies) and other biological factors (adiposity, inflammatory and stress biomarkers, vasomotor symptoms) from baseline to 6- and 12-month follow-up. We will recruit participants from two community groups: one group will be randomly assigned to complete the intervention; the other will be a wait-list control. This intervention has 3 phases: 12 weekly sessions (Phase I: education, physical activity, stress management, coping skills training) followed by 3 monthly sessions of continued support (Phase II); and finally 6 months of skill maintenance on their own (Phase III). The long-term goal of this award is to develop Dr. Cortés’ independence as an investigator, leading a program of research dedicated to improving women’s cardiovascular health, and to implement interventions for prevention and self-management of CVD in perimenopausal women, particularly Latinas. The proposed K23 will support her development through mentorship and training in: 1) community-engaged research; 2) clinical trial design, implementation, and evaluation; 3) the effect of behavioral interventions on biologic outcomes; and 4) professional development skills in leadership, publication, and grantsmanship. To accomplish her research aims and training goals, Dr. Cortés has assembled an interdisciplinary team of scientists with expertise in community engagement, intervention design, clinical trial analysis, sociocultural and biological measures, and career development mentorship. This research holds potential to accelerate greatly the acquisition of knowledge related to CVD risk among perimenopausal Latinas, and the impact of behavioral interventions to reduce CVD risk in this underserved population.