Yoga and Indices of Cardiovascular Risk in Older Women

描述（由申请人提供）：心血管疾病（CVD）仍然是女性死亡的主要原因。CVD风险随着绝经而急剧上升，这可能是由于胰岛素抵抗和相关致动脉粥样硬化变化的同时上升，这些变化共同构成胰岛素抵抗综合征（IRS），这是一组与CVD的发病机制和进展密切相关的代谢和血流动力学异常。越来越多的证据表明，瑜伽练习可以提供一种安全且具有成本效益的策略，以减少与CVD相关的IRS风险因素。然而，在西方人群中进行的严格研究很少，瑜伽对健康绝经后妇女心血管疾病风险状况的影响尚未研究。这项GCRC批准的随机对照试验将研究8周强化lyengar瑜伽计划对该人群中CVD风险的IRS相关指数的影响。参与者将是60名年龄在50-75岁之间的健康、久坐的绝经后女性，她们超重和/或有2型糖尿病或原发性高血压的一级亲属。非裔美国女性将被过度抽样。我们的主要目的是评估莱因加瑜伽对QUICKI估计的胰岛素敏感性变化的影响，QUICKI是一种结合了出色的可靠性和有效性以及最小受试者负担的指标。我们的次要目标是：1）评估瑜伽对胰岛素抵抗其他标志物的影响（空腹血糖、胰岛素、糖化血红蛋白）和CVD风险的相关指标，包括交感神经激活、血脂异常、内皮功能、炎症、凝血病、内脏肥胖、胰岛素样生长因子生物利用度、心率变异性、心理发病率和睡眠障碍的测量;和2）评估和优化总体方案设计，包括招募和保留率、方案依从性以及少数和非少数受试者的仪器负担。干预将包括8周的结构化lyengar瑜伽训练，包括每周两次90分钟的课程，以及每天在家进行的瑜伽练习。对照组将完成一个为期8周的标准化教育电影计划，该计划旨在易于复制，并确保时间，员工注意力和社会互动的可比性。这两个小组还将收到美国心脏协会关于妇女更年期、衰老和心脏病的标准材料。在8周治疗期之前和之后，将收集空腹血液样品，并测量胰岛素抵抗的特异性标志物和CVD风险的相关生理、人体测量和心理指标。这项初步研究将产生重要的信息，瑜伽在降低绝经后妇女心血管疾病风险的潜在效用，这是一个心血管疾病和相关慢性疾病风险增加的人群。这项研究的结果还将提供关键的初步和可行性数据，以支持一个更大的，3臂，多种族的随机对照试验，调查瑜伽练习对绝经后妇女心血管疾病风险的IRS相关指数的影响。

DESCRIPTION (provided by applicant): Cardiovascular disease (CVD) remains the leading cause of death in women. CVD risk rises sharply with menopause, likely due to the coincident rise in insulin resistance and related atherogenic changes that together comprise the insulin resistance syndrome (IRS), a cluster of metabolic and hemodynamic abnormalities strongly implicated in the pathogenesis and progression of CVD. There is growing evidence that the practice of yoga may offer a safe and cost-effective strategy for reducing IRS-related risk factors for CVD. However, rigorous studies in Western populations are few and the effects of yoga on CVD risk profiles in healthy postmenopausal women have not been studied. This GCRC-approved randomized controlled trial will investigate the effects of an 8 week intensive lyengar yoga program on IRS-related indices of CVD risk in this population. Participants will be 60 healthy, sedentary postmenopausal women aged 50-75 years who are overweight and/or have a first degree relative with type 2 diabetes mellitus or essential hypertension. African American women will be oversampled. Our primary aim is to evaluate the effects of lyengar yoga on change in insulin sensitivity as estimated by the QUICKI, a measure that combines excellent reliability and validity with minimal subject burden. Our secondary aims are: 1) to assess the effects of yoga on other markers of insulin resistance (fasting glucose, insulin, glycated hemoglobin), and related indices of CVD risk, including measures of sympathetic activation, dyslipidemia, endothelial function, inflammation, coagulopathy, visceral adiposity, insulin-like growth factor bioavailability, heart rate variability, psychological morbidity, and sleep disturbance; and 2) to evaluate and optimize the overall protocol design, including recruitment, and retention rates, protocol adherence, and instrument burden in both minority and non-minority participants. The intervention will comprise 8 weeks of structured lyengar yoga training, including two 90 minute classes/week in addition to daily directed yoga practice at home. The control group will complete an 8 week standardized educational film program designed to be easily replicable and to assure comparability of time, staff attention, and social interaction. Both groups will also receive standard American Heart Association materials regarding menopause, aging, and heart disease in women. Before and after the 8 week treatment period, fasting blood samples will be collected, and specific markers of insulin resistance and related physiological, anthropometric, and psychological indices of CVD risk will be measured. This pilot study will yield important information on the potential utility of yoga in reducing CVD risk in postmenopausal women, a population at increased risk for CVD and related chronic disorders. Findings of this study will also provide critical preliminary and feasibility data to support a larger, 3-arm, multi-ethnic RCT investigating the influence of yoga practice on IRS-related indices of CVD risk in women post-menopause.