STRESS REDUCTION IN AFRICAN AMERICANS

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。与美国白人相比，非洲裔美国人的男性和女性患有过高的心血管疾病(CVD)。高水平的心理社会和社会环境压力导致了这一人群中不成比例的心血管疾病和死亡率。目前的合作团队此前在NHLBI支持的随机对照试验中证明，采用一种选定的减压方法--超验冥想计划--的干预与显著减少心血管疾病风险因素和临床心血管疾病的替代标记物有关。这些包括高血压、心肌缺血和颈动脉粥样硬化的减少，以及生活质量的改善。虽然这些短期结果令人鼓舞，但拟议的单一地点研究将允许对这一样本进行长期跟踪，以评估对硬性心血管疾病结果的影响，并再资助五年。这将使研究和干预的总时间达到九年，这将有足够的能力发现更严格的“硬”心血管终点的显著差异，同时评估行为干预在这一高危人群中的效果的可持续性。因此，具体目标是：A.具体目标1.评估与健康教育对照相比，减压对死亡、心肌梗死和中风等“硬”事件的主要结局的长期影响。2.评价与健康教育对照相比，减压对作为次要结果的“硬”和“软”临床心血管事件的长期影响。3.评价减压与健康教育对照对传统心血管危险因素、心理社会应激因素及生活质量的远期影响。4.评估基线人口学、传统心血管危险因素和心理社会因素与心血管疾病发病率和死亡率的主要结局之间的关系；以及这些风险相关因素的变化在干预对主要临床结局的中介作用中的潜在作用。5.评价减压与健康教育在高危非裔美国人心血管疾病二级预防中的长期成本效益。

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. African American men and women suffer from excessive rates of cardiovascular disease (CVD) compared to white Americans. High levels of psychosocial and socioenvironmental stress contribute to the disproportionate CVD and death rates in this population. The present collaborative team has previously demonstrated in NHLBI-supported randomized controlled trials that intervention with a selected stress reduction approach, the Transcendental Meditation program, was associated with significant reductions in CVD risk factors and surrogate markers for clinical CVD. These include decreases in hypertension, myocardial ischemia, and carotid atherosclerosis, as well as improvements in quality of life. While these short-term results are encouraging, the proposed single site study will allow long-term follow-up of this sample to evaluate effects on hard CVD outcomes with an additional five funded years. This will bring the total study and intervention time to nine years which will have sufficient power to detect significant differences in more rigorous "hard" CVD endpoints and at the same time assess the sustainability of the effects of behavioral intervention in this high risk population. Therefore, the specific aims are: A. SPECIFIC AIMS 1. To evaluate the long-term effects of stress reduction compared to health education control on the primary outcome of 'hard' events of mortality, myocardial infarction, and stroke. 2. To evaluate the long-term effects of stress reduction compared to health education control on combined 'hard' and 'soft' clinical CVD events as a secondary outcome. 3. To evaluate the long-term effects of stress reduction compared to health education control on traditional cardiovascular risk factors, psychosocial stress factors and quality of life. 4. To assess the associations of baseline demographics, traditional CVD risk factors, and psychosocial factors with the primary outcome of CVD morbidity and mortality; and the potential role of changes in these risk-related factors in mediating effects of intervention on the primary clinical outcome. 5. To evaluate the long-term cost effectiveness of stress reduction compared to health education in the secondary prevention of CVD in high-risk African Americans.