Examining associations of sexual identity, life experiences, and cardiovascular disease risk in sisters

项目摘要。尽管在预防和治疗方面有所改进，但心血管疾病（CVD） 仍然是妇女死亡和残疾的主要原因。目前的证据，主要基于自我报告 数据显示，性少数妇女（法定最低工资;女同性恋和双性恋）表现出明显高于 与异性恋女性相比，CVD的可改变风险因素（包括压力、吸烟、饮酒和 肥胖症）。然而，关于性少数身份与女性CVD风险之间的联系因素知之甚少， 限制了有针对性的预防工作的发展。虽然不良的生活经历（例如，人际创伤 和歧视）被认为是导致法定最低工资中心血管疾病风险的原因，很少有研究探讨了 不良生活经历对心血管的影响。该职业发展奖将 为比利卡塞雷斯博士提供开展独立项目所需的培训和研究技能， 研究的重点是确定和减轻压力对性少数群体的影响， 身份和心血管健康。本K 01应用程序的总体目标是使用同级设计来估计 性少数身份对女性CVD风险的贡献，以及这种关联是否受到以下因素的影响： 不良的生活经历。拟议的研究是基于科学前提，通过占 未观察到的与CVD风险相关的家族混杂因素（遗传学、父母因素和儿童期） 环境），生物异性恋姐妹篇将提供一个强有力的比较组，研究心血管疾病的风险， SMW。在一个跨学科的导师团队的支持下，卡塞雷斯博士将延长芝加哥健康与生活 女性的经验（CHLEW; R 01 AA 13328）研究，SMW健康的最长运行研究，以比较 参加CHLEW研究的SMW（N=65）及其生物学上的异性姐妹篇（N=65）的CVD风险。 这项建议将审查性少数身份与以下方面的关联：目标1：心理（抑郁， 焦虑和创伤后应激症状）;目标2：行为（烟草使用，酗酒，身体 活动、饮食和睡眠质量）;目标3：生理（心脏代谢[体重指数，糖基化 血红蛋白和脂质]和炎症[C-反应蛋白和白细胞介素-6]）CVD的风险因素。通过 课程，研讨会，体验式培训，会议和指导会议，卡塞雷斯博士将解决 之前在培养技能的培训方面存在差距：1）妇女健康研究，2）行为心血管健康，3） 社会流行病学; 4）二元分析的定量方法。这些研究和培训活动 将告知R 01应用程序，该应用程序将全面检查将性行为联系起来的生理机制， 少数民族身份和不良生活经历对女性心血管疾病风险的影响。调查结果将确定可修改的 心理、行为和生理风险因素可作为CVD预防工作的目标 适合SMW。这项工作提供了一个独特的机会，研究心血管疾病的危险因素，一个主要的健康问题 在美国，在一个不同种族的法定最低工资及其生物学上的异性姐妹篇的样本中。

PROJECT SUMMARY. Despite improvements in prevention and treatment, cardiovascular disease (CVD) remains the leading cause of death and disability in women. Current evidence, primarily based on self-reported data, indicates that sexual minority women (SMW; lesbian and bisexual) demonstrate significantly higher modifiable risk factors for CVD than heterosexual women (including stress, tobacco use, alcohol use, and obesity). However, little is known about factors that link sexual minority identity with CVD risk in women, which limits development of tailored prevention efforts. Although adverse life experiences (e.g., interpersonal trauma and discrimination) are posited to contribute to CVD risk in SMW, few studies have examined the potential cardiovascular effects of adverse life experiences in this population. This Career Development Award will provide Dr. Billy Caceres with the training and research skills needed to launch an independent program of research focused on identifying and mitigating the effects of stress on the association of sexual minority identity and cardiovascular health. The overall aim of this K01 application is to use a sibling design to estimate the contribution of sexual minority identity on CVD risk in women and whether this association is impacted by adverse life experiences. The proposed research is based on the scientific premise that, by accounting for unobserved familial confounding associated with CVD risk (genetics, parental factors, and childhood environment), biological heterosexual sisters will provide a strong comparison group to study CVD risk in SMW. Supported by an interdisciplinary team of mentors, Dr. Caceres will extend the Chicago Health and Life Experiences of Women (CHLEW; R01AA13328) study, the longest running study of SMW's health, to compare CVD risk among SMW enrolled in the CHLEW study (N=65) and their biological heterosexual sisters (N=65). This proposal will examine the association of sexual minority identity with: Aim 1: psychological (depressive, anxiety, and post-traumatic stress symptoms); Aim 2: behavioral (tobacco use, heavy drinking, physical activity, diet, and sleep quality); and Aim 3: physiological (cardiometabolic [body mass index, glycosylated hemoglobin, and lipids] and inflammatory [C-reactive protein and interleukin-6]) risk factors for CVD. Through coursework, seminars, experiential training, conferences, and mentored meetings, Dr. Caceres will address prior gaps in training to develop skills in: 1) women's health research, 2) behavioral cardiovascular health, 3) social epidemiology, and 4) quantitative methods for dyadic analyses. These research and training activities will inform an R01 application that will comprehensively examine physiological mechanisms that link sexual minority identity and adverse life experiences to CVD risk in women. Findings will identify modifiable psychological, behavioral, and physiological risk factors that can serve as targets for CVD prevention efforts tailored to SMW. This work provides a unique opportunity to study risk factors for CVD, a major health problem in the U.S., in a racially diverse sample of SMW and their biological heterosexual sisters.