STRESS REDUCTION IN AFRICAN AMERICANS

该子项目是利用NIH/NCRR资助的中心赠款提供的资源的许多研究子项目之一。子项目和研究者（PI）可能从另一个NIH来源获得主要资金，因此可以在其他CRISP条目中表示。所列机构为中心，不一定是研究者所在机构。与白色美国人相比，非洲裔美国人男性和女性患有心血管疾病（CVD）的比率过高。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。目前的合作团队先前已经在NHLBI支持的随机对照试验中证明，采用选定的减压方法进行干预，即超越冥想计划，与CVD风险因素和临床CVD替代标志物的显着减少相关。这些包括降低高血压、心肌缺血和颈动脉粥样硬化，以及改善生活质量。虽然这些短期结果令人鼓舞，但拟议的单中心研究将允许对该样本进行长期随访，以评估对硬CVD结局的影响，并额外提供五年资助。这将使总的研究和干预时间达到9年，这将有足够的能力检测更严格的“硬”CVD终点的显著差异，同时评估行为干预在这一高危人群中的影响的可持续性。因此，具体目标是：A.具体目标1.评价减压与健康教育对照对死亡率、心肌梗死和卒中等“硬”事件主要结局的长期影响。2.评价减压与健康教育控制相比对合并的“硬”和“软”临床CVD事件的长期影响，作为次要结局。3.评价减压与健康教育控制对传统心血管危险因素、心理社会应激因素和生活质量的长期影响。4.评估基线人口统计学、传统CVD风险因素和心理社会因素与CVD发病率和死亡率主要结局的相关性;以及这些风险相关因素的变化在介导干预对主要临床结局的影响中的潜在作用。5.在高危非裔美国人中，评估与健康教育相比，减压在CVD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.