Ethnicity, Stress, and LV Mass

描述（由申请人提供）： 博士卡洛斯何塞罗德里格斯是一个成人心脏病专家和助理教授在哥伦比亚大学的最终长期目标是发展职业生涯作为一个独立的研究者。候选人对高血压心脏病特别感兴趣，特别关注传统上未充分研究的西班牙裔人口，这是美国最大和增长最快的少数民族群体。申请方提供的证据表明，超声心动图左心室质量是西班牙裔美国人心血管发病率和死亡率的独立预测因子，西班牙裔美国人的左心室质量高于白人。血压（BP）是左心室质量的主要决定因素之一，24小时动态血压（ABP）水平已被发现预测左心室质量比传统的诊所血压，但它是不知道，如果在西班牙裔的血压昼夜节律类似于黑人或白人。申请人还表明，较低的SES独立预测非西班牙裔黑人中较高的LVM，但在西班牙裔中并非如此，尽管西班牙裔与非西班牙裔黑人具有相似的LVM增加和较低SES的患病率。这些发现似乎与“西班牙裔悖论”相一致。“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）在西班牙裔美国人中，ABP昼夜节律的生理异常（较高的夜间BP）与左心室质量增加有关; 2）低社会支持，高感知种族主义和高抑郁症状是与低SES相关的心理社会压力的指标，并与较高水平的ABP非浸渍和左心室质量相关。拟议的职业发展计划将包括一个多学科方案，旨在使候选人获得以下四个模块的知识和专业知识：（1）心理社会和行为 因素包括种族歧视、社会经济地位、社会支持和抑郁症状;（2）生理调节机制，包括ABP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指导和教学式学习。托马斯皮克林博士是该奖项的赞助商，因为他作为导师的良好记录和在行为医学和ABP测量方面的知名专业知识。这项拟议中的研究将从北方曼哈顿研究（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社会心理问卷调查，重点评估SES、社会支持、抑郁症状和感知的种族主义。本研究将确定（1）西班牙裔美国人ABP指标与LVM的关系，以及（2）社会心理因素是否是低SES压力的中介，从而影响LVM。

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.