BIOBEHAVIORAL BASES OF CHD RISK AND MANAGEMENT

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PROPOSED PROGRAM (provided by applicant): This program project competitive renewal consists of an integrated, multidisciplinary program including 3 closely related projects examining the progression of atherosclerosis and/or its amelioration, which is supported by 4 core units. Project 1, which would be conducted upon adolescents with persistently elevated blood pressure, would examine the effects of a behavioral intervention involving diet, exercise and stress management counseling. This project would assess the impact of the intervention on cardiovascular risk factors (e.g., lipid profiles, adiposity, inflammatory markers) and putative subclinical markers of disease (e.g., left ventricular mass, endothelial function). Project 2 would examine the effects of individual and group based cognitive behavior therapy (CBT) in acute myocardial infarction (AMI) patients who are at increased risk for medical morbidity and mortality after AMI because they are socially isolated or clinically depressed. Participants randomized into a CBT or usual care condition will be assessed in terms of biological risk factors (e.g., lipids, adiposity, coagulation factors) and possible subclinical markers of disease (e.g., carotid intima-media thickness, coronary calcification). The third project, which will be conducted on Watanabe Heritable Hyperlipidemic Rabbits (WHHL) will assess the role of: (a) the sympathetic nervous system (SNS) in behaviorally-related atherosclerosis; (b) corticotropin-releasing hormone in regulating SNS activity and progression of atherosclerosis during chronic social stress; (c) oxytocin (OT) in the hypothalamus as a function of social environment; and (d) OT in the regulation of hypothalamic pituitary adrenocortical and SNS activity in relation to the progression of behaviorally-related atherosclerosis. These 3 projects will each be supported by Administrative, Endocrinology and Metabolism, Cardiovascular Management and Statistics/Data Management units.