DIABETES, DEPRESSION, & CORONARY HEART DISEASE

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 糖尿病和抑郁症都单独增加了女性患冠心病(CHD)的风险。因此，更好地了解这些风险因素是如何相互作用的，对于我们理解女性心脏病至关重要。抑郁症-糖尿病-冠心病关系的一个假设机制是下丘脑-垂体-肾上腺(HPA)轴和皮质醇的产生。目前，还没有公布一致看待这些变量的数据。因此，尚不清楚它们是各自传递着一种个体风险，当它们结合在一起时，这种风险就会变得相加，或者它们是否相互作用，传递着乘性风险。 这项建议的研究是对女性抑郁、糖尿病和冠心病风险的横断面研究。研究设计为2X2析因设计。样本将包括80名年龄匹配的绝经后女性。自变量为1)有无抑郁史(是或否)，以及2)T2 DM状态(是或否)。因变量为唾液皮质醇水平、血脂(总胆固醇、高密度脂蛋白亚组分和甘油三酯)、腰臀比、肱动脉血流介导的扩张、止血指标(VWF)、炎症标志物(C反应蛋白)、微量白蛋白尿和血压。可控制的变量包括BMI(骨量指数)、降脂剂、β受体阻滞剂、血管紧张素转换酶抑制剂、抗高血压药以及吸烟史、体力活动史和饮酒史。 将检验三个假说：1)对糖尿病有主要影响，糖尿病患者将表现出比无糖尿病患者更高的腰臀比、血压、VWF、C反应蛋白(CRP)、血脂异常、微量白蛋白尿和内皮依赖性臂部反应性(EDBR)受损；2)有抑郁史的患者将有主要影响，有抑郁病史的参与者将比有阴性病史的患者表现出更高的WHR、血压、VWF、CRP、微量白蛋白尿、EDBR受损和皮质醇搏动性昼夜节律平坦；3)抑郁史与糖尿病史之间存在交互作用，与仅有抑郁史或糖尿病史的受试者相比，既有糖尿病又有抑郁史的受试者将表现出更高的腰围比、血压、VWF、CRP和更多的EDBR受损。

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. Diabetes and depression both independently put women at increased risk for coronary heart disease (CHD). Thus, a better understanding of how these risk factors interact is crucial to our understanding of heart disease in women. One hypothesized mechanism for the depression-diabetes-CHD relationship is the Hypothalamic-Pituitary-Adrenal (HPA) axis and cortisol production. Currently, no data have been published that look at these variables in concert. Thus, it is unclear if they each convey an individual risk that becomes additive when combined, or if they interact to convey multiplicative risk. The study being proposed is a cross sectional study of depression, diabetes, and CHD risk in women. The research design is a 2X2 factorial design. The sample will consist of 80 age-matched postmenopausal women. The independent variables are 1) presence of a history of depression (yes or no), and 2) T2DM status (yes or no). The dependent variables are salivary cortisol levels, lipids (total cholesterol, HDL subfractions, and triglycerides), waist-to-hip ratio, brachial artery flow mediated dilation, hemostatic indicator (vWF), inflammatory marker (c-reactive protein), microalbuminuria, and blood pressure. Variables that will be controlled for include BMI (Bone Mass Index), lipid lowering agents, beta blockers, ACE inhibitors, antihypertensive agents, and history of smoking, physical activity, and alcohol use. Three hypotheses will be tested: 1) There will be a main effect for diabetes, such that participants with diabetes will show higher WHR, blood pressure, vWf, C-Reactive Protein (CRP), dyslipidemia, microalbuminuria, and more impaired endothelium dependent brachial reactivity (EDBR) than those without diabetes; 2) There will be a main effect for history of depression, such that participants a positive history will show higher WHR, blood pressure, vWf, CRP, microalbuminuria, more impaired EDBR, and a flatter cortisol pulsatile circadian rhythm than those with a negative history; 3) there will be an interaction between history of depression and diabetes, such that participants with both diabetes and positive history of depression will show higher WHR, blood pressure, vWf, CRP, and more impaired EDBR, than those with only history of depression or diabetes.