Multilevel determinants of cardiovascular disease risk in African Americans

描述（由申请人提供）：心血管疾病（CVD）是美国（US）死亡和残疾的主要原因。国家数据显示，非裔美国人在这一慢性病方面承受着不应有的负担，这表明存在着重大的健康差距。监测数据还显示了广泛的地理差异，其中大多数非裔美国人居住的南方州具有最高的心脏病发病率和死亡率。心血管疾病与大多数非传染性疾病一样，本质上是多因素的-由生物，行为和环境因素决定。虽然最近的许多研究都集中在社区特征对健康和健康相关行为的影响上，但很少有研究探讨它们在非裔美国人等主要高风险少数群体中的作用。而那些对邻里特征在健康和健康相关行为中的作用缺乏明确性和一致性的研究。饮食是心血管疾病和冠心病（CHD）风险的重要预测因子，最近，饮食模式的研究已成为营养研究中一个有前途的领域。饮食干预也强调了饮食模式在降低心血管疾病风险中的作用。然而，要使营养干预措施有效，就必须考虑到目标人口所遵循的现有饮食模式。非裔美国人的饮食摄入模式与一般美国人口有显着不同。据我们所知，还没有研究调查过社区特征和饮食模式与南部非洲裔美国人大规模人群心血管疾病风险之间的关系。在这项研究中，我们建议通过以下研究来解决这一重大差距：a）确定邻里特征与个人饮食模式之间的关联。邻里特征包括邻里的社会经济地位，快餐店，食品店，公园和娱乐设施的可用性和接近程度，而个人层面的饮食模式包括先验（2005年-健康饮食指数）和后验（因子分析得出的）饮食模式; B）确定邻居特征和个体饮食模式是否与亚临床动脉粥样硬化相关; c）在位于密西西比州杰克逊的NIH支持的、最大的单点、基于人群的、前瞻性、观察性、所有非洲裔美国人队列中，描述邻居特征和个体饮食模式之间的关系，其中：i）偶发CHD，ii）高血压，iii）血脂异常，和iv）腹部皮下和内脏脂肪组织，杰克逊心脏研究。我们计划使用在基线时收集的邻居和饮食数据，以及在杰克逊心脏研究的基线、4年和5年随访时评估的结果来检查这些关系。我们相信，拟议研究的结果将填补知识的关键空白，并将帮助临床医生和政策制定者设计有效和有针对性的干预计划和政策建议，以预防心血管疾病的发作和延迟进展在研究不足的高风险少数人群中。

DESCRIPTION (provided by applicant): Cardiovascular disease (CVD) is the leading cause of death and disability in the United States (US). National data show that African Americans carry an undue burden of this chronic disease, indicating the presence of significant health disparities. Surveillance data also show extensive geographical disparities, wherein Southern states, where a majority of African Americans reside, have the highest age-adjusted rates of morbidity and mortality from heart disease. CVD, like most non-communicable diseases, is multifactorial in nature- determined by biologic, behavioral and environmental factors. While much recent research has focused on the influences of neighborhood characteristics on health and health-related behaviors, few studies have examined their role in predominantly high-risk minority populations like African Americans. And those that have show a lack of clarity and consistency on the role of neighborhood characteristics in health and health-related behaviors. Diet is a significant predictor of CVD and coronary heart disease (CHD) risk and recently, the study of dietary patterns has emerged as a promising area in nutrition research. Dietary interventions have also emphasized the role of dietary patterns in reducing the risk of CVD. However, for nutritional interventions to be effective, they must consider existing dietary patterns followed by their target population. Dietary intake patterns of Africans Americans are significantly different from the general US population. No studies that we are aware have examined the relationship between neighborhood characteristics and dietary patterns and CVD risk in large southern African American populations. In this study, we propose to address this significant gap, by conducting a study to: a) determine the associations between neighborhood characteristics and individual dietary patterns. Neighborhood characteristics examined include neighborhood socio-economic status, availability of and proximity to fast food restaurants, food stores, and parks and recreational facilities, while individual-level dietary patterns include a priori (2005-Healthy Eating Index) and a posteriori (factor analysis derived) dietary patterns; b) determine whether neighborhood characteristics and individual dietary patterns are associated with sub-clinical atherosclerosis; c) describe the relationships between neighborhood characteristics and individual dietary patterns, with: i) incident CHD, ii) hypertension, iii) dyslipidemia, and iv) abdominal subcutaneous and visceral adipose tissue in an NIH-supported, largest single-site, population- based, prospective, observational, all African American cohort, located in Jackson, Mississippi, the Jackson Heart Study. We plan to examine these relationships using neighborhood and dietary data that have been collected at baseline, and outcomes assessed at baseline, 4- and 5- y follow-up of the Jackson Heart Study. We believe that the results of the proposed study will fill a critical gap in knowledge and will help clinicians and policymakers design effective and targeted intervention programs and policy recommendations to prevent the onset and delay the progression of CVD in an under-studied, high-risk minority population.