Autonomic function/insulin resistance/multiethnic popul

描述(由申请人提供)：糖尿病患者的自主神经系统对心跳变异性的调节经常被打乱。此外，在糖尿病和非糖尿病人群中，心率变异性降低与心血管疾病(CVD)死亡率增加相关。心血管疾病死亡率在许多民族之间差异很大。在夏威夷，夏威夷原住民的心血管疾病死亡率比亚洲人和高加索人高出不成比例的比例。夏威夷原住民健康研究项目的初步数据表明，与动脉粥样硬化相关的传统风险因素可能无法完全解释夏威夷心脏病和中风死亡率的种族差异。胰岛素抵抗与心血管疾病发病率和死亡率增加有关，也与心率变异性降低有关。这项拟议的研究将在多民族人群中调查胰岛素抵抗与心脏功能自主神经调节的关系。拟议的研究还将为未来的纵向研究提供基线数据，这些研究将调查这些新的风险因素在多大程度上解释夏威夷心血管疾病死亡率的种族差异。这项拟议的研究结果可能对将胰岛素抵抗作为一个独立的心血管疾病危险因素进行治疗具有重要意义。 具体目标：协作者部分(目标1)。在夏威夷建立一个协作实验室，用于评估多种族人口的自主神经功能。首席调查员部分(目标2)。研究胰岛素抵抗、体脂分布和自主神经功能之间的关系。(目标3)建立一个包含自主神经功能和胰岛素抵抗基线测量的队列，作为R01支持的纵向研究的研究人群。假设：通过实现这些具体目标，我们建议检验以下具体的研究假设：(1)在对年龄、性别、体重指数和中心性肥胖进行调整后，不同种族的自主神经功能将显著不同。(2)在对年龄、性别、体重指数和中心性肥胖进行调整后，胰岛素抵抗与自主神经功能独立相关。第二个问题：胰岛素抵抗和血糖对自主神经功能的影响是否相互作用？血浆脂类、血压、饮食和体力活动对解释观察到的自主神经功能的种族差异有什么作用？夏威夷多民族人群的综合自主神经症状量表(COMPASS)与自主神经功能是否相关？

DESCRIPTION (provided by the applicant): Autonomic nervous system regulation of heartbeat variability is often disrupted among patients with diabetes. Moreover, reduced heart rate variability has been associated with increased Cardiovascular Disease (CVD) mortality among diabetic and non-diabetic populations. CVD mortality rates differ greatly among many ethnic groups. In Hawaii, Native Hawaiians have been shown to have disproportionately higher CVD mortality than Asian and Caucasian groups. Preliminary data from the Native Hawaiian Health Research Project suggest that conventional risk factors associated with Atherosclerosis may not fully account for ethnic disparities in heart disease and stroke mortality rates in Hawaii. Insulin resistance has been associated with increased CVD incidence and mortality, and has also been associated with reduced heart rate variability. The proposed study will investigate the relationship between insulin resistance and autonomic regulation of cardiac function in a multi-ethnic population. The proposed research will also provide baseline data for future longitudinal studies that will investigate the extent to which these novel risk factors explain ethnic disparities in CVD mortality in Hawaii. The findings of the proposed study may have important implications with regards to the treatment of insulin resistance as an independent CVD risk factor. Specific Aims: Collaborator component (Aim #1). Establish a collaborative laboratory in Hawaii for the evaluation of autonomic function in a multiethnic population. Principal Investigator component (Aim #2). Investigate the relationship between insulin resistance, body-fat distribution, and autonomic function. (Aim #3) Establish a cohort with baseline measures of autonomic function and insulin resistance that will serve as a study population for R01-supported longitudinal studies. Hypotheses: By fulfilling these specific aims, we propose to test the following specific research hypotheses: (1.) Autonomic function will differ significantly by ethnicity, after adjustment for age, gender, body-mass index, and central obesity. (2.) Insulin resistance is independently associated with autonomic function, after an adjustment for age, gender, body-mass index, and central obesity. Secondary Questions: Does insulin resistance and plasma glucose interact, in their effects on autonomic function? What role do plasma lipids, blood pressure, diet, and physical activity have in explaining any observed ethnic disparities in autonomic function? Is the questionnaire-derived Composite Autonomic Symptom Scale (COMPASS) correlated with autonomic function in Hawaii's multiethnic population?