NURSE MODEL IN BLACK FAMILIES AT RISK FOR HEART DISEASE

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The primary goal of this proposed additional study is to track long-term (5-year) risk factors and the development of overt and occult coronary artery disease (CAD) in initially apparently healthy African American siblings of person with premature coronary disease. This is a complement to a newly awarded National Institutes of Health award to study this same population to determine impact of the original randomized trial of a nurse practitioner/community health educator model of lipid and blood pressure management (NURS TEAM) compared with usual primary care (UC) five years after the original intervention (1998-2001). At baseline in the original community intervention study, a complementary study was funded by the GCRC that allowed characterization of additional risk factors and markers of occult CAD and vascular disease that now serves baseline for the prospective complementary study being proposed. A family history of premature CHD has long been known to confer marked excess CHD risk, but it only recently noted in African Americans where the prevalence of CHD risk factors is extremely high and the trajectory of the disease is not well characterized. Thus, this study will follow all original 464 siblings screened (those with and without risk factors at baseline---those without risk factors did not enter the treatment trial but we wish to track them also for incidenct CHD, new occult CHD, and changes in risk factors). The main study of long-term intervention effects is designed to examine changes over five years in lipid levels, blood pressure, body mass index, diet, physical activity, fitness, medication use, stress, health care utilization, and general well being. The additional complementary study would track changes in plasma glucose, fibrinogen, serum insulin, serum creatinine, urinary microalbunin, homocysteine, plasminogen activator inhibitor-1 (PAI-1), and tissue plasminogen activator (tPA). In addition, left ventricular mass would again be characterized by echocardiography to prospectively examine the impact of risk factor status on increased in left ventricular mass, and the impact of left ventricular mass on clinical vascular outcomes. Importantly, incident coronary disease will be examined and occult disease will be examined using the same stress thallium scintigraphy methods used at baseline. Together, these appraisals will allow full prospective characterization of high-risk African Americans and ultimately will e the substrate for a long-term prospective epidemiologic study for which we have a matching white population of over 600 white siblings assessed using the same techniques.