DIABETES, DEPRESSION, & CORONARY HEART DISEASE

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。糖尿病和抑郁症都独立地增加了女性患冠心病的风险。因此，更好地了解这些风险因素是如何相互作用的，对于我们理解女性心脏病至关重要。抑郁症-糖尿病-冠心病关系的一个假设机制是HPA轴和皮质醇的产生。目前，还没有公布一致看待这些变量的数据。因此，尚不清楚它们是各自传递着一种个体风险，当它们结合在一起时，这种风险就会变得相加，或者它们是否相互作用，传递着乘性风险。这项建议的研究是对女性抑郁、糖尿病和冠心病风险的横断面研究。研究设计为2X2析因设计。样本将包括80名年龄匹配的绝经后女性。自变量为1)有无抑郁史(是或否)，以及2)T2 DM状态(是或否)。因变量为唾液皮质醇水平、血脂(总胆固醇、高密度脂蛋白亚组分和甘油三酯)、腰臀比、肱动脉血流介导的扩张、止血指标(VWF)、炎症标志物(C反应蛋白)、微量白蛋白尿和血压。可控制的变量包括体重指数、降脂药物、β受体阻滞剂、血管紧张素转换酶抑制剂、抗高血压药物以及吸烟史、体力活动史和饮酒史。将检验三个假说：1)对糖尿病有主要影响，有糖尿病的参与者将表现出比非糖尿病患者更高的腰围、血压、VWF、CRP、血脂异常、微量白蛋白尿和更多的EDBR受损；2)将有抑郁病史的主要影响，使有阳性病史的参与者比有阴性病史的参与者表现出更高的WHR、血压、VWF、CRP、微量白蛋白尿、更多的EDBR受损和更平坦的皮质醇昼夜节律；3)抑郁史与糖尿病史之间存在交互作用，与仅有抑郁史或糖尿病史的受试者相比，既有糖尿病又有抑郁史的受试者将表现出更高的腰围比、血压、VWF、CRP和更多的EDBR受损。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Diabetes and depression both independently put women at increased risk for coronary heart disease. Thus, a better understanding of how these risk factors interact is crucial to our understanding of heart disease in women. One hypothesized mechanism for the depression-diabetes-CHD relationship is the HPA axis and cortisol production. Currently, no data have been published that look at these variables in concert. Thus, it is unclear if they each convey an individual risk that becomes additive when combined, or if they interact to convey multiplicative risk. The study being proposed is a cross sectional study of depression, diabetes, and CHD risk in women. The research design is a 2X2 factorial design. The sample will consist of 80 age-matched postmenopausal women. The independent variables are 1) presence of a history of depression (yes or no), and 2) T2DM status (yes or no). The dependent variables are salivary cortisol levels, lipids (total cholesterol, HDL subfractions, and triglycerides), waist-to-hip ratio, brachial artery flow mediated dilation, hemostatic indicator (vWF), inflammatory marker (c-reactive protein), microalbuminuria, and blood pressure. Variables that will be controlled for include BMI, lipid lowering agents, beta blockers, ACE inhibitors, antihypertensive agents, and history of smoking, physical activity, and alcohol use. Three hypotheses will be tested: 1) There will be a main effect for diabetes, such that participants with diabetes will show higher WHR, blood pressure, vWf, CRP, dyslipidemia, microalbuminuria, and more impaired EDBR than those without diabetes; 2) There will be a main effect for history of depression, such that participants a positive history will show higher WHR, blood pressure, vWf, CRP, microalbuminuria, more impaired EDBR, and a flatter cortisol pulsatile circadian rhythm than those with a negative history; 3) there will be an interaction between history of depression and diabetes, such that participants with both diabetes and positive history of depression will show higher WHR, blood pressure, vWf, CRP, and more impaired EDBR, than those with only history of depression or diabetes.