Social Stressors and Atherosclerosis in African-American Women with Lupus

系统性红斑狼疮(SLE)是一种慢性、炎症性、自身免疫性的多系统衰弱疾病。 据估计，仅在美国就有150万人感染这种疾病。几乎90%的人 受系统性红斑狼疮影响的是女性，非裔美国女性的系统性红斑狼疮发病率比 来自其他种族/民族的妇女。在系统性红斑狼疮的女性中，早产儿心血管疾病(CVD) 这是一个主要的死亡原因，对于非裔美国人来说尤其如此。与非裔美国人相比 没有系统性红斑狼疮的女性和患有系统性红斑狼疮的非裔美国女性早在20年前就死于心血管疾病相关的原因。 这种增加的风险并不完全是由于传统的心血管疾病危险因素(例如血压、糖尿病、 胆固醇、吸烟)或系统性红斑狼疮因素；因此，我们对非洲人为什么 患有系统性红斑狼疮的美国女性在早期心血管疾病方面承受着惊人的沉重负担。建议的项目是 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、经济压力、社会支持不足和早期逆境 非裔美国女性中动脉粥样硬化进展和炎症(早期心血管疾病的标志) SLE。利用一组具有良好特征的系统性红斑狼疮女性的现有资源，我们将研究 社会应激源对动脉粥样硬化过程及免疫和免疫相关分子标志物的影响 炎症(与健康人群心血管疾病有关的炎症和与系统性红斑狼疮相关的炎症 动脉粥样硬化)超过2年的随访期。为了确定这些效应是否是SLE独有的， 我们的样本将包括200名患有系统性红斑狼疮的非裔美国女性和200名来自类似地区的对照女性 环境。因为患有系统性红斑狼疮的非裔美国女性已经免疫受损，所以 假设社会压力源将被证明对这一群体特别有问题；通过加剧 与系统性红斑狼疮相关的炎症过程进一步增加了他们患动脉粥样硬化性疾病的风险。 此外，考虑到管理慢性病所需的大量财政和社会资源，我们将 检查某些社会压力来源(经济压力、社会支持不足)是否不成比例 对患有(与没有)系统性红斑狼疮的女性的影响。最后，为了确定一些非裔美国女性 系统性红斑狼疮患者比其他人更容易患早期心血管疾病，我们还将检查几个SLE因素(如年龄)。 发病、疾病活动性、狼疮性肾炎)作为潜在的修饰因素，仅在SLE女性中使用。这个项目 将通过检查几个未被研究但高度相关的早期风险因素来填补知识中的关键空白 心血管疾病是一种独特的弱势群体，但经常被忽视。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.