Social Stressors and Atherosclerosis in African-American Women with Lupus

系统性红斑狼疮（SLE）是一种使人衰弱的多系统、慢性、炎症性、自身免疫性疾病， 这种疾病仅在美国就影响了大约150万人。几乎90%的人 受SLE影响的是女性，非裔美国女性的SLE发病率比非裔美国女性高3至4倍。 其他种族/民族的妇女。在患有SLE的女性中，早发心血管疾病（CVD） 一个主要的死亡原因，这对非洲裔美国人来说尤其如此。与非裔美国人相比 非裔美国女性SLE患者死于CVD相关原因的时间比非裔美国女性SLE患者早了近20年。 这种增加的风险并不完全是由于传统的CVD风险因素（例如血压，糖尿病， 胆固醇，吸烟），或SLE因素;因此，在我们理解为什么非洲人， 患有SLE的美国女性承受着如此高的早期CVD负担。拟建项目 旨在确定非裔美国人生活经历的各个方面--即社会压力源， 例如歧视、财政紧张、社会支助不足和早期逆境，都助长了 非裔美国妇女中动脉粥样硬化进展和炎症（早期CVD的标志物） SLE。利用现有的资源，从一个良好的特点与SLE妇女队列，我们将研究 社会压力对动脉粥样硬化过程和免疫分子标志物的影响， 炎症（健康人群中与CVD相关的炎症和SLE相关的炎症） 动脉粥样硬化）超过2年的随访。为了确定这些效应是否是SLE独有的， 我们的样本将包括200名患有SLE的非裔美国妇女和200名来自类似地区的对照妇女。 环境.因为患有SLE的非洲裔美国妇女已经免疫受损， 假设社会压力将证明对这一群体特别有问题;通过加剧 与SLE相关的炎症过程进一步增加了他们患动脉粥样硬化疾病的风险。 此外，鉴于管理慢性病需要大量的财政和社会资源，我们将 检查某些社会压力因素（财政紧张，社会支持不足）是否不成比例 影响SLE患者（与非SLE患者相比）。最后，为了确定一些非洲裔美国妇女 SLE患者比其他人更容易发生早期CVD，我们还将检查几个SLE因素（如年龄 发病、疾病活动、狼疮性肾炎）作为潜在的调节因子。这个项目 将通过检查几个研究不足但与早期癌症高度相关的风险因素，填补知识的关键空白。 CVD在一个独特的脆弱，但经常被忽视的妇女群体。建议的调查结果 研究将用于确定未来干预的目标。

Systemic lupus erythematosus (SLE) is a debilitating multisystem, chronic, inflammatory, autoimmune disease that impacts an estimated 1.5 million individuals in the United States alone. Almost 90% of those affected by SLE are women, and African-American women have rates of SLE that are 3 to 4 times higher than women from other racial/ethnic groups. Among women with SLE, premature Cardiovascular Disease (CVD) is a major cause of death and this is particularly true for African-Americans. Compared to African-American women without SLE, African-American women with SLE die from CVD-related causes almost 20 years earlier. This increased risk is not completely due to traditional CVD risk factors (e.g. blood pressure, diabetes, cholesterol, smoking), or SLE factors; thus, there remain major gaps in our understanding of why African American women with SLE bear such a strikingly high burden of early CVD. The proposed project is designed to determine whether aspects of the African-American lived experience-- i.e. social stressors, such as discrimination, financial strain, inadequate social support and early adversity—contribute to atherosclerotic progression and inflammation (markers of early CVD) among African-American women with SLE. Leveraging existing resources from a well-characterized cohort of women with SLE, we will examine the impact of social stressors on the atherosclerotic process and on molecular markers of immunity and inflammation (those linked to CVD in healthy populations and those implicated in SLE-related atherosclerosis) over a 2-year follow up. In order to determine whether these effects are unique to SLE, our sample will consist of 200 African-American women with SLE and 200 comparison women from similar environments. Because African-American women with SLE are already immune-compromised, it is hypothesized that social stressors will prove especially problematic for this group; by exacerbating the inflammatory processes associated with SLE to further increase their risk of atherosclerotic disease. Additionally, given the significant financial and social resources required to manage a chronic illness, we will examine whether certain social stressors (financial strain, inadequate social support) disproportionately impact women with (vs. those without) SLE. Finally, to determine whether some African-American women with SLE are more vulnerable to early CVD than others, we will also examine several SLE factors (e.g. age of onset, disease activity, lupus nephritis) as potential modifiers, among women with SLE only. This project will fill critical gaps in knowledge by examining several understudied, yet highly relevant risk factors for early CVD in a uniquely vulnerable, but frequently overlooked population of women. Findings from the proposed study will be used to identify targets for future intervention.