Ethnicity, Stress, and Left Ventricular Mass

点击翻译按钮获取中文摘要

DESCRIPTION (provided by applicant): Dr. Carlos Jose Rodriguez is an adult cardiologist and Assistant Professor at Columbia University whose ultimate long term goal is to develop a career as an independent investigator. The candidate is particularly interested in hypertensive heart disease with a specific focus on the traditionally understudied Hispanic population, the largest and most rapidly growing minority ethnic group in the United States. The applicant has provided evidence that echocardiographic LVM is an independent predictor of cardiovascular morbidity and mortality in Hispanics and that Hispanics have higher LVM than whites. Blood pressure (BP) is one of the major determinants of LVM, and 24 hour ambulatory BP (ABP) levels have been found to predict LVM better than conventional clinic BP, however it is not known if the diurnal rhythm of BP in Hispanics resembles that of blacks or whites. The applicant has also shown that lower SES independently predicts higher LVM among non-Hispanic blacks but not among Hispanics despite Hispanics having a similar prevalence of increased LVM and lower SES as non-Hispanic blacks. These findings appear to be consistent with the 'Hispanic paradox.' However, our preliminary data also shows that the SES-LVM relationship may be influenced by psychosocial factors. Thus our central hypotheses are that: 1) Among Hispanics, physiologic abnormalities in the diurnal rhythm of ABP (higher nocturnal BP) are related to increased LVM; 2) Low social support, high perceived racism, and high depressive symptoms are measures of psychosocial stress associated with low SES and associated with higher levels of ABP non-dipping and LVM. The proposed career development plan will incorporate a multidisciplinary program designed to allow the candidate to acquire knowledge and expertise in the following four modules: (1) psychosocial and behavioral factors including perceived racism, SES, social support, and depressive symptoms; (2) physiologic mediating mechanisms including ABP monitoring and heart rate variability assessment (3) clinical epidemiological study design issues; and (4) medical research dissemination. The Columbia University Behavioral Cardiovascular Health and Hypertension Program and the Mailman School of Public Health will provide structured mentoring and didactic learning. Dr. Thomas Pickering is the sponsor for this award given his established track record as a mentor and renowned expertise in behavioral medicine and ABP measures. The proposed research study will recruit 200 Hispanic participants from within the Northern Manhattan Study (NOMAS). Subjects will undergo ABP monitoring and transthoracic echocardiograms as well as a psychosocial questionnaires focusing on assessment of SES, social support, depressive symptoms, and perceived racism. This research study will determine (1) the relationship of ABP measures to LVM among Hispanics and (2) whether psychosocial factors are mediators of the stress of low SES thus affecting LVM.