Boston Puerto Rican Health Study - CVD Risk Factors

波士顿波多黎各健康研究 - CVD 危险因素

• 批准号: 8238332
• 负责人: Katherine L Tucker
• 金额: $ 214.09万
• 依托单位: NORTHEASTERN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-20 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8238332
• 关键词: Adult; Affect; Aging; Air Pollution; Ankle; Behavioral; Belief; Biochemical; Biological; Biometry; Boston; Cardiovascular Diseases; Cells; Characteristics; Cohort Effect; Communities; Complex; Diet; Dietary intake; Disadvantaged; Disease; Ensure; Environmental Risk Factor; Evaluation; Exposure to; Funding; Future; Genetic; Genetic Variation; Goals; Health; Heart Diseases; High Prevalence; Hispanics; Impaired cognition; Intervention; Interview; Investigation; Laboratories; Life; Measures; Modeling; Neighborhoods; Outcome Measure; Pattern; Physical environment; Physiological; Policies; Population; Poverty; Prevalence; Psychosocial Stress; Puerto Rican; Reaction; Recording of previous events; Research; Risk; Risk Factors; Role; Social Environment; Social Network; Societies; Stress; Structure; Subgroup; Techniques; Testing; Thick; Vulnerable Populations; Work; aged; allostatic load; base; cardiovascular disorder risk; cohort; diet and exercise; disability; effective intervention; expectation; follow-up; food environment; health disparity; heart disease risk; indexing; innovation; insight; intima media; mortality; population health; social; social health determinants; stressor; success

Puerto Rican adults living on the mainland US have documented health disparities; however, little research has been conducted with this second largest Hispanic subgroup. Our long-term goal is to understand the complex interactions of diet and other behavioral and environmental factors, genetics, and psychosocial stress on the high and apparently increasing prevalence of cardiovascular disease (CVD) risk factors in Puerto Rican adults. As this group is rapidly growing, understanding the reasons for this risk is of great importance. Our initial funding period for the Boston Puerto Rican Center on Population Health and Health Disparities (BPR-CPHHD, 2003-08) focused on the role of stress on physical disability and cognitive decline, through physiological dysregulation or "allostatic load." During that investigation, it became clear that risk factors for CVD were highly prevalent. These findings are in contrast to the commonly held belief that there is a Hispanic paradox¿lower heart disease and mortality despite greater poverty. Importantly, the Puerto Rican population differs considerably in ancestral genetic history and in exposures to known risk factors from other Hispanic groups. They have unique dietary intake patterns, as well as social, cultural and environmental structures that contribute and affect reaction to stressors. During our initial funding period, we successfully assembled a cohort of 1450 Puerto Rican adults, aged 45-75 years at baseline, and have completed (to date) more than 900 two-year follow-up interviews¿we are continuing, with the expectation of completing at least 1150. As this population is aging and growing rapidly, the high prevalence and apparent cohort effect of increased heart disease risk factors suggest that 1) this population has serious health disparities in heart disease risk factors and 2) heart disease will become an even greater problem for this group in the near future. Our overall aim for this renewal is, therefore, to extend follow-up and to measure and analyze relevant characteristics and CVD risk factors, and to add additional contextual and outcome measures for CVD risk in this established cohort of Puerto Rican adults, so that we may better understand the dynamics of these disparities. Our model follows the transdisciplinary "cells to society" concept developed jointly with our partner CPHHDs during the initial funding period, with consideration of genetic variation in relation to longitudinal change in allostatic load and biochemical indicators of risk, to more concrete indicators of disease (ankle brachial index (ABI) and intima media thickness (IMT)); with additional focus on social networks, neighborhood characteristics (physical space and access to food) and environment (air pollution) factors as social determinants of health. Finally, using community based participatory techniques, we will implement and test a multidimensional intervention that focuses on diet and exercise, but that also fully considers the social and physical environment to ensure success. With participation of our community partner. La Alianza Hispana, and the support of our administrative, biostatistics and laboratory cores, our team is efficiently poised to make significant contributions to understanding the factors that contribute to the apparent growing threat of heart disease in this highly disadvantaged group¿while providing insights that may be useful to other vulnerable groups. The continuation of our cohort, with its rich constellation of measures, will allow us to unravel some of the complex etiologic interactions which contribute to CVD risk, so that effective interventions maybe implemented.

生活在美国大陆的波多黎各成年人记录了健康差异;然而，很少有研究 在第二大西班牙裔亚组中进行了研究。我们的长期目标是了解饮食和其他行为和环境因素，遗传学和心理社会压力对波多黎各成年人心血管疾病（CVD）风险因素的高患病率和明显增加的复杂相互作用。随着这一群体的迅速增长，了解这种风险的原因非常重要。我们对波士顿波多黎各人口健康和健康差异中心（BPR-CPHHD，2003-08）的最初资助期集中在压力通过生理失调或“非稳态负荷”对身体残疾和认知能力下降的作用。“在调查过程中，很明显CVD的危险因素非常普遍。这些发现与人们普遍认为的西班牙裔悖论形成了鲜明对比：尽管贫困程度更高，但心脏病和死亡率却更低。重要的是，波多黎各人口在祖先遗传史和暴露于其他西班牙裔群体的已知危险因素方面有很大不同。他们有独特的饮食摄入模式，以及社会，文化和环境结构，有助于和影响对压力的反应。在我们最初的资助期间，我们成功地召集了一批1450名波多黎各成年人，年龄在45-75岁之间，并完成了（迄今为止）900多个为期两年的随访访谈-我们正在继续，预计至少完成1150个。随着这一人群的老龄化和快速增长，心脏病风险因素增加的高患病率和明显的队列效应表明：1）这一人群在心脏病风险因素方面存在严重的健康差异，2）心脏病将在不久的将来成为这一人群的一个更大的问题。因此，我们这次更新的总体目标是延长随访，测量和分析相关特征和CVD风险因素，并在这个已建立的波多黎各成年人队列中增加CVD风险的额外背景和结局指标，以便我们可以更好地 了解这些差异的动态。我们的模型遵循跨学科的“细胞到社会”的概念，与我们的合作伙伴CPHHD在最初的资助期间共同开发，考虑到遗传变异与非稳态负荷和风险生化指标的纵向变化，以更具体的疾病指标（踝臂指数（ABI）和内膜中层厚度（IMT））;另外还侧重于社交网络、邻里特征（实际空间和获得食物的机会）和环境（空气污染）因素作为健康的社会决定因素。最后，使用基于社区的参与技术，我们将实施和测试一个多层面的干预，重点是饮食和锻炼，但也充分考虑到社会和物理环境，以确保成功。在我们社区合作伙伴的参与下。拉阿利安萨Hispana，和我们的行政，生物统计学和实验室核心的支持，我们的团队是有效地准备作出重大贡献，以了解因素，有助于心脏病在这个高度弱势群体的明显日益增长的威胁？同时提供见解，可能是有用的其他弱势群体.我们队列的继续，其丰富的措施，将使我们能够解开一些复杂的病因相互作用，有助于心血管疾病的风险，使有效的干预措施可能会实施。