Ethnicity, Stress, and LV Mass

种族、压力和 LV 质量

• 批准号: 7137460
• 负责人: Carlos Jose Rodriguez
• 金额: $ 12.89万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-07-15 至 2011-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7137460
• 关键词: Hispanic Americans; behavioral /social science research tag; blood pressure; cardiovascular disorder epidemiology; circadian rhythms; clinical research; heart dimension /size; heart ventricle; human subject; low socioeconomic status; patient oriented research; prejudice; prognosis; psychological stressor; racial /ethnic difference; social support network

DESCRIPTION (provided by applicant): Dr. Carlos Jose Rodriguez is an adult cardiologist and Assistant Professor at Columbia University whose ultimate long term goal is to develop a career as an independent investigator. The candidate is particularly interested in hypertensive heart disease with a specific focus on the traditionally understudied Hispanic population, the largest and most rapidly growing minority ethnic group in the United States. The applicant has provided evidence that echocardiographic LVM is an independent predictor of cardiovascular morbidity and mortality in Hispanics and that Hispanics have higher LVM than whites. Blood pressure (BP) is one of the major determinants of LVM, and 24 hour ambulatory BP (ABP) levels have been found to predict LVM better than conventional clinic BP, however it is not known if the diurnal rhythm of BP in Hispanics resembles that of blacks or whites. The applicant has also shown that lower SES independently predicts higher LVM among non-Hispanic blacks but not among Hispanics despite Hispanics having a similar prevalence of increased LVM and lower SES as non-Hispanic blacks. These findings appear to be consistent with the 'Hispanic paradox.' However, our preliminary data also shows that the SES-LVM relationship may be influenced by psychosocial factors. Thus our central hypotheses are that: 1) Among Hispanics, physiologic abnormalities in the diurnal rhythm of ABP (higher nocturnal BP) are related to increased LVM; 2) Low social support, high perceived racism, and high depressive symptoms are measures of psychosocial stress associated with low SES and associated with higher levels of ABP non-dipping and LVM. The proposed career development plan will incorporate a multidisciplinary program designed to allow the candidate to acquire knowledge and expertise in the following four modules: (1) psychosocial and behavioral factors including perceived racism, SES, social support, and depressive symptoms; (2) physiologic mediating mechanisms including ABP monitoring and heart rate variability assessment (3) clinical epidemiological study design issues; and (4) medical research dissemination. The Columbia University Behavioral Cardiovascular Health and Hypertension Program and the Mailman School of Public Health will provide structured mentoring and didactic learning. Dr. Thomas Pickering is the sponsor for this award given his established track record as a mentor and renowned expertise in behavioral medicine and ABP measures. The proposed research study will recruit 200 Hispanic participants from within the Northern Manhattan Study (NOMAS). Subjects will undergo ABP monitoring and transthoracic echocardiograms as well as a psychosocial questionnaires focusing on assessment of SES, social support, depressive symptoms, and perceived racism. This research study will determine (1) the relationship of ABP measures to LVM among Hispanics and (2) whether psychosocial factors are mediators of the stress of low SES thus affecting LVM.

描述(由申请人提供)： 卡洛斯·何塞·罗德里格斯博士是一名成年心脏病专家，也是哥伦比亚大学的助理教授，他的最终长期目标是发展自己的独立研究事业。这位候选人对高血压心脏病特别感兴趣，特别关注传统上未得到充分研究的拉美裔人口，这是美国规模最大、增长最快的少数族裔。申请人提供的证据表明，超声心动图左心室是拉美裔心血管发病率和死亡率的独立预测指标，而且拉美裔左心室比白人高。血压(BP)是LVM的主要决定因素之一，24小时动态血压(ABP)水平被发现比传统的临床血压更好地预测LVM，但尚不清楚拉美裔人的血压昼夜节律是否类似于黑人或白人。申请人还表明，较低的SES独立预测非西班牙裔黑人的LVM较高，但不会在西班牙裔中预测较高的LVM，尽管西班牙裔与非西班牙裔黑人的LVM增加和SES较低的发病率相似。这些发现似乎与“拉美裔悖论”是一致的。然而，我们的初步数据也表明，SES-LVM关系可能受到心理社会因素的影响。因此，我们的中心假设是：1)在拉美裔美国人中，ABP(夜间血压较高)昼夜节律的生理异常与LVM增加有关；2)低社会支持、高种族主义和高抑郁症状是与低SES相关的心理社会压力的衡量标准，并与较高的ABP非下降和LVM水平相关。拟议的职业发展计划将纳入一个多学科方案，旨在使应聘者获得以下四个模块的知识和专业知识：(1)心理社会和行为 这些因素包括感知到的种族主义、社会支持、社会支持和抑郁症状；(2)生理调节机制，包括动脉血压监测和心率变异性评估；(3)临床流行病学研究设计问题；(4)医学研究传播。哥伦比亚大学行为心血管健康和高血压项目和梅尔曼公共卫生学院将提供结构化的指导和授课学习。托马斯·皮克林博士是这一奖项的赞助商，因为他在行为医学和ABP测量方面拥有公认的导师记录和著名的专业知识。这项拟议的研究将从曼哈顿北部研究(NOMAS)中招募200名西班牙裔参与者。受试者将接受ABP监测和经胸超声心动图，以及侧重于评估SES、社会支持、抑郁症状和感受到的种族主义的心理社会问卷。这项研究将确定(1)拉美裔人的ABP测量与LVM的关系，以及(2)心理社会因素是否是低SES应激的中介因素，从而影响LVM。