BIOBEHAVIORAL BASES OF CHD RISK AND MANAGEMENT

先心病风险和管理的生物行为基础

• 批准号: 6183022
• 负责人: NEIL SCHNEIDERMAN
• 金额: $ 177.19万
• 依托单位: UNIVERSITY OF MIAMI CORAL GABLES
• 依托单位国家: 美国
• 财政年份: 1986
• 资助国家: 美国
• 起止时间: 1986-07-01 至 2001-08-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6183022
• 关键词: behavioral /social science research tag; behavioral medicine; cardiovascular function; hypertension

This Program Project continuation will consist of an integrated, multidisciplinary inquiry into biobehavioral bases of coronary heart disease (CHD) risk and management. Our working hypotheses are that: (1) a positive feedback loop, involving increases in sympathetic nervous system (SNS) activity, insulin resistance (IR) and hyperinsulinemia, increases CHD risk by promoting a constellation of variables (central obesity, hyperglycemia, hypertension, dyslipidemia) called the metabolic syndrome; and (2) emotional stressors, smoking, poor diet and lack of physical exercise influence th loop and exacerbate CHD risk. The Program Project would; (1) assess relationships among the behavioral risk promoting variables (psychosocial stress, smoking, poor diet, physical inactivity), presumed mediating variables (SNS activity and insulin metabolism) and CHD risk factors; and (2) determine if behavioral interventions can decrease SNS tone and insulin resistance (IR), thereby reducing CHD risk. Thr Program Project consists of 4 Projects with Core facilities supporting each project with technical/biomedical (e.g., biochemical assays, engineering) and statistical support. One project will compare adolescents with high vs. normal blood pressure (BP) in terms of fasting insulin, oral glucose tolerance, adiposity, aerobic fitness, diet, cardiac mass, autonomic reactivity, psychosocial characteristics and family medical history. (1) BP status notification, conditions. Another project will examine IR and CHD risk factors in post-MI patients receiving; (1) standard pharmacological treatment; or (2) standard pharmacological treatment plus behavioral treatment including stress management, dietary supervision and self-directed exercise. Subjects will be assessed (echocardiography, brachial ultrasound, euglycemic-hyperinsulinemic clamp, psychosocial and quality of life assessment) pre- and post-treatment. Because previous studies indicate the BP reactivity to the cold pressor test predicts future hypertension. Another project will explore possible links between IR and total peripheral resistance (TPR) as the basis for hyperreactivity and determine if hyperreactivity is related to the metabolic syndrome. Project 4 will provide a neurobiological framework for understanding reactivity by using a rabbit model to delineate the central efferent pathways mediating cardiovascular components of the defense (cardiac output) and vigilance (TPR) reactions.

本计划项目续展将包括一个集成的、 冠心病生物行为学基础的多学科探讨 疾病(CHD)风险和管理。我们的工作假设是：(1) 一个正反馈环，涉及交感神经系统的增加 (SNS)活动、胰岛素抵抗(IR)和高胰岛素血症会增加CHD 通过促进一系列变量(中心性肥胖， 高血糖、高血压、血脂异常)称为代谢综合征； 以及(2)情绪压力、吸烟、不良饮食和缺乏身体锻炼 运动影响循环，加剧冠心病风险。计划项目 将；(1)评估行为风险促进之间的关系 变量(心理社会压力、吸烟、不良饮食、缺乏运动)、 假定中介变量(SNS活性和胰岛素代谢)与CHD 风险因素；以及(2)确定行为干预是否可以减少 SNS音调和胰岛素抵抗(IR)，从而降低冠心病风险。苏氨酸 计划项目由4个项目组成，每个项目都有核心设施支持 技术/生物医学项目(如生化分析、工程学) 和统计数据支持。其中一个项目将比较青少年和高血压者 空腹胰岛素、口服血糖与正常血压(BP)比较 耐受性、肥胖症、有氧健身、饮食、心脏质量、自主神经 反应性、心理社会特征和家族病史。(1) BP状态通知、条件。另一个项目将检查IR和 心肌梗死后患者的冠心病危险因素：(1)标准 药物治疗；或(2)标准药物治疗加 行为治疗，包括压力管理、饮食监督和 自我指导的运动。将对受试者进行评估(超声心动图， 臂部超声、正常血糖-高胰岛素钳夹、心理社会和 生活质量评估)治疗前后。因为之前 研究表明，BP对冷加压测试的反应性可以预测未来 高血压。另一个项目将探索IR和 总外周阻力(TPR)作为高反应性和 确定高反应性是否与代谢综合征有关。项目 4将为理解反应性提供神经生物学框架，通过 用兔模型勾画中枢传出通路 心血管成分的防御(心输出量)和警觉 (TPR)反应。