STRESS REDUCTION AND ATHEROSCLEROTIC CVD IN BLACKS

1998年总统的种族和民族健康差异倡议强调，与美国白人相比，非裔美国人的心血管疾病发病率和死亡率高得不成比例。许多对照研究表明，这种差异与慢性心理社会和环境压力有关。出于这些原因，NHLBI黑人冠心病研究工作组已将这一少数群体的行为和预防作为国家研究重点。我们的研究团队此前在NHLBI支持的随机对照试验中证明，与对照程序相比，使用先验冥想(TM)计划可以有效地治疗高危非裔美国人的高血压，减轻压力。这些研究和其他研究还报道，在随机接受积极应激治疗的高危受试者中，其他心血管危险因素、心理社会应激、心肌缺血、左心室重量和心血管疾病死亡率以及所有原因的临床显著改善。我们最近完成的、由NHLBI支持的关于在内城非裔美国人中减轻压力以预防高血压心脏病的临床试验的初步结果表明，通过颈动脉内中膜厚度(IMT)评估的动脉粥样硬化性心血管疾病，在经过8个月的积极减压干预后，与对照教育相比显著退化。这些结果与降脂疗法或广泛改变生活方式的效果相当。这项拟议的延续项目将通过研究主动应激减轻在非裔美国人动脉粥样硬化性心血管疾病二级预防中的有效性来扩展这些发现。这项为期五年的研究将是一项随机、单盲、对照、基于社区的试验，涉及184名患有已知冠心病的非裔美国人受试者。男性和女性受试者将在我们正在进行的实地考察地点洛杉矶市中心的马丁·路德·金-德鲁医疗中心登记。在基线测试后，受试者将被随机分为TM主动减压组或健康教育对照组--这两组都是在常规医疗的基础上--并在12个月后进行后测。主要结果将是定量B型超声非侵入性测量颈动脉粥样硬化(IMT)。次要措施将包括传统的心血管疾病风险因素(血压、血脂、吸烟、锻炼)、心理社会压力、生活质量和成本效益。这项临床试验的结果将为通过行为手段预防高危非裔美国人心血管疾病提供有价值的新知识。

The President's Racial and Ethnic Health Disparities Initiative of 1998 emphasizes that African Americans suffer from disproportionately high rates of cardiovascular disease (CVD) morbidity and mortality compared to white Americans. Numerous controlled studies suggest that this disparity is associated with chronic psychosocial and environmental stress. For these reasons, the NHLBI Working Group on Research in Coronary Heart Disease in Blacks has mandated behavior and prevention in this minority population as a national research priority. Our research team has previously demonstrated in NHLBI-supported randomized controlled trials that hypertension can be effectively treated in high risk African Americans with stress reduction using the Transcendental Meditation (TM) program compared to control procedures. These and other studies have also reported clinically significant improvements in other CVD risk factors, psychosocial stress, myocardial ischemia, left ventricular mass and mortality rates from CVD and all-causes in high risk subjects randomized to active stress reduction. Preliminary findings from our recently completed, NHLBI-supported clinical trial of stress reduction in the prevention of hypertensive heart disease in inner city African Americans has indicated that atherosclerotic CVD, assessed by carotid artery intima-media thickness (IMT), significantly regresses after eight months of active stress reduction intervention compared to control education. These results were comparable to effects of lipid lowering therapies or extensive lifestyle modification. This proposed continuation project will extend these findings by investigating the effectiveness of active stress reduction in the secondary prevention of atherosclerotic CVD in African Americans. This five year study will be a randomized, single-blind, controlled, community-based trial involving 184 African American subjects with known coronary heart disease. Male and female subjects will be enrolled at our on-going field site, Martin Luther King-Drew Medical Center in inner city Los Angeles. After baseline testing, subjects will be randomized to either active stress reduction with TM or health education control-both in addition to usual medical care-and posttested after 12 months. The primary outcome will be carotid artery atherosclerosis (IMT) measured non-invasively by quantitative B-mode ultrasonography. Secondary measures will include traditional CVD risk factors (blood pressure, lipids, smoking, exercise), psychosocial stress, quality of life and cost effectiveness. The results of this clinical trial will yield valuable new knowledge for the prevention of CVD through behavioral means in high risk African Americans.