Impact of multilevel risk and resilience factors on cardiovascular health in racially/ethnically diverse men and women

项目总结/文摘

Project Summary/Abstract In the US, cardiovascular disease (CVD) remains the leading cause of death. African Americans (AAs), low- socioeconomic position (SEP) groups, southerners, and Hispanics are impacted disproportionately by CVD. In addition, compared to women, men have earlier onset of CVD and have had higher death rates attributable to CVD. These sex differences and racial/ethnic and SEP disparities are setbacks to achieving national health equity and CVD reduction goals. To reduce differences and disparities in CVD, it is critical to improve cardiovascular (CV) health. A 2015 AHA statement indicated that “the most significant opportunity” to improve CV health and reduce CVD lies in addressing the social determinants of health. Such determinants include psychosocial risks (e.g., racism, discrimination, and low SEP) operating at multiple levels. Emerging research indicates that resilience resources at the individual, interpersonal, and neighborhood levels may protect CV health in the face of multilevel psychosocial risks via indirect effects such as more positive health behaviors and buffering effects of psychosocial risks on physiological functioning. Resilience resources are defined as positive adaptation and display of positive behaviors/outcomes despite adversity. Compared to multilevel psychosocial risks, multilevel resilience resources represent novel and potentially more malleable intervention targets. Despite growing evidence supporting the protective effects of resilience resources on CV outcomes, critical research gaps remain. For example, the majority of resilience research has not been conducted with disparity populations, populations free of CVD, included multilevel psychosocial risks, or tested for differences between sex and racial/ethnic groups. Thus, the objective of this proposal is to examine if multilevel resilience resources are associated with CV outcomes and if multilevel psychosocial risks moderate these relationships. Specifically, longitudinal data on racially/ethnically diverse men and women enrolled in three CV health cohorts (i.e., JHS, MESA, MASALA) will be harmonized to create an integrated dataset. Using the integrated data we aim to: (a) determine whether the most reliable and valid measures of multilevel risk and multilevel resilience resources demonstrate measurement invariance across sex and diverse racial/ethnic groups; (b) determine if multilevel resilience resources are associated with ideal CV health over time and if multilevel psychosocial risks moderate observed relationships; (c) determine if multilevel resilience resources are prospectively associated with incident CVD events over time and if multilevel psychosocial risks moderate observed relationships; and (d) quantify the degree to which hypothetical interventions designed to build multilevel resilience resources reduce racial/ethnic and sex differences in ideal CV health and CVD events overall and by the level of multilevel psychosocial risks. This project responds to the NIH-wide, NHLBI, OBSSR, and AHA calls to fill critical gaps in psychosocial risk, resilience, and CV outcomes research.