CHRONIC PSYCHOSOCIAL STRESS, METABOLIC SYNDROME, AND CHD

描述(改编自申请者摘要)：这项研究将使用 看护的长期压力作为一项自然的实验来检验 心理行为过程、种族、代谢之间的关系 综合症和冠心病(CHD)，这在伦理上是不可能的 在实验室里被操控。照顾他人与心理社会有关 (愤怒/敌意、麻烦、抑郁)问题，这些问题反过来又是， 与代谢、心血管和身体健康问题有关。我们 观察到胰岛素独立地区分配偶照顾者和 控制力(照顾者更强的控制力)比其他生理因素更好 变量和照顾者对冠心病患病率的更好控制。 因此，我们将比较130名配偶照顾者与 阿尔茨海默病(AD)(n=100名高加索人，n=30名黑人)与130名 在性别、种族、年龄和家族史上匹配的非痴呆症对照 心血管疾病。评估将在：时间1、时间2(15-18)进行 时间1之后的几个月和时间3(时间1之后的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 压力可能会增加照顾者的代谢问题和冠心病 控制。我们的多种措施将包括：医疗记录(ICD代码)， 体检、生理学和自我报告。一种生物心理社会模式将 用于审查5个目标：目标1：确定配偶照顾者是否 AD患者表现出更多：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 (较大的皮质醇、儿茶酚胺)、血浆粘度(较大的红细胞压积)、 和心血管疾病(更大的血压问题和更高的 冠心病与非痴呆对照配偶的关系。目标2：确定 黑人是否比高加索人有更大的问题；黑人是否 照顾者比白人照顾者有更大的问题。目标3：实现 确定照顾者在家中的血压差异是否比在家中大 实验室以及种族和心理社会变量是否会改变这种 不同之处。目的4：确定精神生理学改变是否在 如果从更长的时期(27-30个月)衡量，照顾者的人数会更多 比我们最初研究的时间长(15-18个月)；以及时间1的CHD 放大了这些变化。目标5：确定在27-30个月内， IAF的轨迹与心理生理/健康的变化有关 变量；以及这种关系是否由胰岛素变化所调节。 这项研究应该阐明慢性阻塞性肺疾病的心理生理调节因素 压力和CHD，因此，具有临床意义。

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.