CHRONIC PSYCHOSOCIAL STRESS, METABOLIC SYNDROME, AND CHD

描述（改编自申请人摘要）：本研究将使用 作为一个自然的实验， 心理行为过程、种族、代谢 综合征和冠心病（CHD），不能道德地 在实验室中操作。照顾与心理社会有关 （愤怒/敌意，争吵，抑郁）问题，这是，反过来， 与代谢、心血管和身体健康问题相关。我们 已经观察到胰岛素独立区分配偶照顾者和 控制（照顾者更大的控制）比其他生理 变量和照顾者对CHD患病率的更大控制。 因此，我们将比较130个配偶照顾者的人， 阿尔茨海默病（AD）（n=100名白人，n=30名黑人）的130名配偶， 在性别、种族、年龄和家族病史上匹配的非痴呆对照组 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27- 30个月）和时间3（时间1后27-30个月）。 我们将集中在心理生理介质，以了解为什么慢性 压力可能会增加代谢问题和冠心病的照顾者相对于 对照我们的多项措施将包括：医疗记录（ICD代码）， 体检生理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 的AD受害者表现出更多的：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（更高的血压（BP）问题和更高的 冠心病相对于非痴呆对照组的配偶。目标2：确定 黑人是否比白人有更大的问题;黑人是否 照顾者比白人照顾者有更大的问题。目标3： 确定照顾者在家中的血压差异是否大于 实验室以及种族和心理社会变量是否会改变这种情况 差异目的4：确定是否有心理生理变化， 在较长时期（27-30个月）内测量时，照顾者的作用更大 比我们最初研究的（15-18个月）;以及时间1时的CHD是否 放大了这些变化。目标5：确定在27-30个月期间， IAF轨迹与心理生理/健康变化相关 变量;以及这种关系是否由胰岛素变化介导。 这项研究应该阐明慢性炎症的心理生理介质， 压力和冠心病，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.