Mindfulness Based Stress Reduction for Women at Risk for Cardiovascular Disease

描述（由申请人提供）： 有证据表明，慢性压力使心肌梗死的风险增加一倍，并有助于与冠状动脉疾病和中风有关的促炎过程。与非战斗退伍军人和非退伍军人相比，经历过战斗的退伍军人患心血管疾病（CVD）的风险更大。然而，以前的研究主要集中在男性退伍军人身上。然而，统计数据显示，惊人数量（81-92%）的女性退伍军人报告说，在她们的生活中至少有一次创伤事件，女性退伍军人经历了显着的前生活逆境，如性侵犯，身体暴力， 战斗暴露。令人信服的证据表明，在先前生活逆境的广度、促炎细胞因子和压力相关的炎症性疾病（如CVD）之间存在密切关系。帮助女性退伍军人减轻压力和制定应对策略可能会改善心理健康，降低心血管疾病的风险。基于正念的减压（MBSR）涉及正念的强化训练，促进对生活压力的积极适应。正念减压疗法被发现可以减少抑郁症状，改善经历创伤后应激障碍（PTSD）的退伍军人的生活质量。正念减压疗法的练习者对他们的思想、情绪和躯体反应之间的关系有了更多的认识和洞察力，这可以促进情绪反应的条件模式的改变。然而，只有很少的研究和没有随机对照试验（RCT）已经检查了MBSR作为一种干预措施，以减少女性退伍军人的心血管疾病风险。此外，以前的研究既没有使用成熟的CVD风险评分客观地检查CVD风险，也没有测量内皮功能障碍。内皮功能障碍被认为先于动脉粥样硬化，是CVD的一个强有力的预测因子。此外，研究表明，生活方式的改变，如运动和瑜伽，可以逆转内皮功能障碍。然而，没有研究发现，认为内皮功能与正念减压有关。此外，潜在的保护和风险因素，如先前的生活逆境，社会支持，健康行为，文化适应和昼夜皮质醇，假设缓和心理健康和炎症对MBSR的影响尚未被研究。 年龄在35岁至70岁之间的女性退伍军人，至少有两个CVD风险因素（根据Fragrance CVD风险量表定义），将被随机分为8周MBSR计划或健康教育对照计划。本研究的具体目标如下：（1）确定正念减压疗法（MBSR）训练在多大程度上改善了退伍军人的心理健康，（B）降低了炎症负担，（c）降低了退伍军人的心血管风险;（2）评估了正念减压疗法对退伍军人心理健康、炎症负担和心血管风险的保护性和风险性因素。年龄、体重指数（BMI）、月经状态、药物和社会经济状况（SES）将作为协变量进行评价。拟议的研究是创新的，因为MBSR尚未在有CVD风险的女性退伍军人中进行评估。我们期望正念减压疗法能改善心理健康，降低心血管疾病风险，并持续改善至少6个月。鉴于CVD是死亡的主要原因，这项研究可能对减少普通人群中的CVD有更广泛的意义。

DESCRIPTION (provided by applicant): Evidence demonstrates that chronic stress doubles the risk of myocardial infarction and contributes to proinflammatory processes implicated in coronary artery disease and stroke. Veterans who have experienced combat are at greater risk for cardiovascular disease (CVD) compared to noncombat Veterans and non-Veterans. However, previous research has focused primarily on male Veterans. Yet statistics reveal a startling number (81-92%) of women Veterans report at least one traumatic event sometime in their lives and women Veterans experience significant rates of prior life adversity such as sexual assault, physical violence, and combat exposure. Compelling evidence demonstrates a strong relationship between the breadth of prior life adversity, proinflammatory cytokines and stress-related inflammatory disease, such as CVD. Assisting women Veterans to reduce stress and develop coping strategies may improve psychological well-being and reduce CVD risk. Mindfulness Based Stress Reduction (MBSR) involves intensive training in mindfulness, which promotes positive adaptation to life stress. MBSR has been found to reduce symptoms of depression and improve quality of life in Veterans experiencing Post-Traumatic Stress Disorder (PTSD). Practitioners of MBSR gain increased awareness and insight into the relationship among their thoughts, emotions, and somatic reactivity which can facilitate change in conditioned patterns of emotional reaction. However, only minimal research and no randomized control trials (RCTs) have examined MBSR as an intervention for reducing CVD risk in women Veterans. Furthermore, previous studies have neither examined CVD risk objectively using a well-established CVD risk score nor measured endothelial dysfunction. Endothelial dysfunction is acknowledged to precede atherosclerosis and is a strong predictor of CVD. Furthermore, studies demonstrate that lifestyle changes, such exercise and yoga, can reverse endothelial dysfunction. However, no studies were found that considered endothelial function in relation to MBSR. Moreover, potential protective and risk factors, such as prior life adversity, social support, health behaviors, acculturation, and diurnal cortisol, posited to moderate the effect of psychological well- being and inflammation on MBSR have not been examined. Women Veterans between the ages of 35 and 70 years who have at least two CVD risk factors (as defined by Framingham CVD Risk Scale) will be randomized into either an 8-week MBSR program or health education control program. The following specific aims will be addressed: (1) Determine the extent to which training in MBSR (a) improves psychological well-being, (b) decreases inflammatory burden, and (c) reduces cardiovascular risk in women Veterans; and (2) Evaluate protective and risk factors posited to moderate the effect of MBSR on psychological well being, inflammatory burden and cardiovascular risk in women Veterans. Age, body mass index (BMI), menstrual status, medications, and socioeconomic status (SES) will be evaluated as covariates. The proposed research is innovative in that MBSR has not been evaluated in women Veterans at risk for CVD. We expect that MBSR will improve psychological well-being and reduce CVD risk with improvements sustained for at least 6 months. Given that CVD is a major cause of mortality, this research may have broader implications for reducing CVD in the general population.