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。全国数据显示，非裔美国人承受着这种慢性疾病的过度负担，表明存在重大的健康差距。监测数据还显示了广泛的地理差异，其中大多数非洲裔美国人居住的南部各州，心脏病的年龄调整发病率和死亡率最高。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，但很少有研究考察它们在非裔美国人等主要高风险少数群体中的作用。而那些研究表明，社区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。饮食是心血管疾病（CVD）和冠心病（CHD）风险的重要预测因素，近年来，饮食模式的研究已成为营养学研究的一个有前景的领域。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，为了使营养干预措施有效，他们必须考虑目标人群遵循的现有饮食模式。非裔美国人的饮食摄入模式与普通美国人有很大不同。据我们所知，没有研究调查了大量南部非洲裔美国人的社区特征、饮食模式和心血管疾病风险之间的关系。在本研究中，我们建议通过开展一项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系。研究的社区特征包括社区的社会经济地位、快餐店、食品商店、公园和娱乐设施的可用性和邻近程度，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（因素分析得出）饮食模式；B)确定社区特征和个人饮食模式是否与亚临床动脉粥样硬化相关；c)描述社区特征与个体饮食模式之间的关系，包括：i)冠心病事件，ii)高血压，iii)血脂异常，iv)腹部皮下和内脏脂肪组织，这是美国国立卫生研究院支持的、最大的、基于人群的、前瞻性的、观察性的、全非裔美国人队列，位于密西西比州杰克逊，杰克逊心脏研究。我们计划使用基线时收集的社区和饮食数据，以及基线时评估的结果，对杰克逊心脏研究进行4年和5年随访，来检查这些关系。我们相信，这项研究的结果将填补这一重要的知识空白，并将帮助临床医生和政策制定者设计有效的、有针对性的干预方案和政策建议，以预防研究不足的高危少数人群心血管疾病的发生和延缓其进展。

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.