CHRONIC PSYCHOSOCIAL STRESS, METABOLIC SYNDROME, AND CHD

慢性心理社会压力、代谢综合征和冠心病

• 批准号: 2440408
• 负责人: PETER P. VITALIANO
• 金额: $ 44.15万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 1997
• 资助国家: 美国
• 起止时间: 1997-09-30 至 2002-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2440408
• 关键词: Alzheimer's disease; behavioral /social science research tag; blood chemistry; blood pressure; caregivers; chronic disease /disorder; clinical research; coronary disorder; human morbidity; human subject; longitudinal human study; metabolism disorder; psychological stressor; psychophysiology; racial /ethnic difference; social psychology; spouses; stress

DESCRIPTION (Adapted from the Applicant's Abstract): This study will use the chronic stress of caregiving as a natural experiment to examine relationships among psychobehavioral processes, race, the metabolic syndrome, and Coronary Heart Disease (CHD) that could not be ethically manipulated in a laboratory. Caregiving is associated with psychosocial (anger/hostility, hassles, depression) problems, which are, in turn, associated with metabolic, cardiovascular, and physical health problems. We have observed that insulin independently distinguishes spouse caregivers and controls (caregivers greater controls) better than other physiological variables and that caregivers greater controls on CHD prevalence. Accordingly, we will compare 130 spouse caregivers of persons with Alzheimer's disease (AD) (n=100 Caucasians, n=30 Blacks) to 130 spouses of non-demented controls matched on sex, race, age, and family history of cardiovascular disease. Assessments will occur at: Time 1, Time 2 (15-18 months after Time 1), and Time 3 (27-30 months after Time 1). We will focus on psychophysiological mediators to understand why chronic stress may increase metabolic problems and CHD in caregivers relative to controls. Our multiple measures will include: medical records (ICD-codes), physical exams, physiology and self reports. A biopsychosocial model will be used to examine 5 aims: Aim 1: To determine whether spouse caregivers of AD victims exhibit more: psychobehavioral, metabolic (greater intraabdominal fat (IAF), insulin, C-peptide, glucose), stress hormone (greater cortisol, catecholamines), plasma viscosity (greater hematocrit), and cardiovascular (greater blood pressure (BP) problems and higher rates of CHD relative to spouses of non-demented controls. Aim 2: To determine whether Blacks have greater problems than do Caucasians; and whether Black caregivers have greater problems than Caucasian caregivers. Aim 3: To determine whether BP differences in caregivers are greater at home than in the laboratory and whether race and psychosocial variables modify such differences. Aim 4: To determine whether psychophysiological changes in caregivers are greater when measured over a longer period (27-30 months) than we studied originally (15-18 months); and whether CHD at Time 1 amplifies these changes. Aim 5: To determine whether over 27-30 months, IAF trajectories are associated with changes in psychophysiological/health variables; and whether such relationships are mediated by insulin changes. This research should elucidate psychophysiological mediators of chronic stress and CHD and, therefore, have clinical implications.

描述（改编自申请人的摘要）：本研究将使用 将护理的慢性压力作为一个自然实验来检查 心理行为过程、种族、代谢之间的关系 综合征和冠心病 (CHD) 不符合伦理 在实验室中进行操作。照顾与心理社会有关 （愤怒/敌意、麻烦、抑郁）问题，反过来， 与代谢、心血管和身体健康问题有关。我们 观察到胰岛素独立区分配偶照顾者和 控制（护理人员更大的控制）优于其他生理 变量以及护理人员对冠心病患病率进行更大程度的控制。 因此，我们将比较 130 名患有此类疾病的人的配偶照顾者 阿尔茨海默氏病 (AD)（n=100 名白人，n=30 名黑人）的 130 名配偶 与性别、种族、年龄和家族史相匹配的非痴呆对照 心血管疾病。评估将在以下时间进行：时间 1、时间 2（15-18 时间 1 后的几个月）和时间 3（时间 1 后的 27-30 个月）。 我们将重点关注心理生理调节因素，以了解为什么慢性 相对于其他人，压力可能会增加护理人员的代谢问题和冠心病 控制。我们的多项措施包括：医疗记录（ICD 代码）、 体格检查、生理学和自我报告。生物心理社会模型将 用于检查 5 个目标： 目标 1：确定配偶照顾者是否 AD 受害者表现出更多：心理行为、代谢（更大 腹内脂肪（IAF）、胰岛素、C肽、葡萄糖）、应激激素 （更高的皮质醇、儿茶酚胺）、血浆粘度（更高的血细胞比容）、 和心血管（更严重的血压 (BP) 问题和更高的发病率） CHD 相对于非痴呆对照的配偶。目标 2：确定 黑人是否比白人面临更大的问题？以及是否为黑色 护理人员比白人护理人员面临更大的问题。目标 3： 确定看护者在家中的血压差异是否大于在家中的血压差异 实验室以及种族和心理社会变量是否会改变这种情况 差异。目标 4：确定心理生理变化是否 如果在较长时期内（27-30 个月）进行测量，照顾者的表现会更好 比我们最初学习的时间（15-18个月）；以及时间 1 是否患有 CHD 放大了这些变化。目标 5：确定是否在 27-30 个月内， IAF 轨迹与心理生理/健康的变化相关 变量；以及这种关系是否是由胰岛素变化介导的。 这项研究应阐明慢性病的心理生理介质 压力和冠心病，因此具有临床意义。