Nurse Model in Black Families at Risk for Heart Disease

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DESCRIPTION: (provided by applicant) The family heart study will have tested the short-term impact of a culturally-sensitive community model of one-year of risk factor care by a nurse practitioner/health educator team (NURS TEAM) and usual primary provider care (UC) in 366 apparently healthy 30-59 year old African American siblings of index patients with known premature coronary disease (<60 years of age). One-year results show a significant benefit of the NURS TEAM model when compared with usual care. We do not know whether these effects will be sustained. Maintaining long-term risk factor control is of critical importance in reducing the notably high incidence of CHD in African Americans with a strong family history of CHD. We propose a five-year follow-up to determine the long-term impact of the NURS TEAM model. The aims are to: (1) compare the five year impact of the NURS TEAM intervention with UC, on levels of LDL-cholesterol, systolic blood pressure, and diastolic blood pressure, (2) determine the independent contribution of (a) biological factors (obesity and comorbidity) and (b) demographic and psychosocial factors (age, sex, education, general well-being scores) on levels of LDL-C and blood pressure, and (3) describe the incidence of premature CHD events and progression of occult CHD. Secondary outcomes include levels of HDL-C, triglycerides, body mass index, and smoking cessation rates. Diet and physical activity scores at five years will be compared by group. We hypothesize that the NURS TEAM will yield significantly better long-term levels of LDL-C and blood pressure compared with UC. We propose a MANCOVA analysis for a group-randomized trial, nested cohort design, with a single baseline, a one-year posttest and a five-year follow-up assessment. The effect of the treatment group contingency will be the difference between the two conditions at the last follow-up, with adjustment for differences in risk factor levels at baseline. Family-adjusted survival analyses will be used to examine the patterns of clinical and occult CHD over time in high-risk African American siblings. We also use standard qualitative techniques to gain a better understanding of barriers and enhancers to successful control of their risk factors over five years in African American families. The study provides an unparalleled virtually first opportunity to describe CHD incidence in African Americans and to determine the impact of NURS TEAM interventions in a seriously understudied high-risk population.