STRESS REDUCTION AND ATHEROSCLEROTIC CVD IN BLACKS

1998年总统的种族和族裔健康差异倡议强调，与美国白人相比，非洲裔美国人患心血管疾病（CVD）的发病率和死亡率高得不成比例。大量对照研究表明，这种差异与慢性社会心理和环境压力有关。由于这些原因，NHLBI黑人冠心病研究工作组已将这一少数民族人口的行为和预防规定为国家研究重点。我们的研究小组先前在nhlbi支持的随机对照试验中证明，与对照程序相比，使用超越冥想（TM）程序减轻压力可以有效地治疗高血压高风险的非裔美国人。这些研究和其他研究也报告了其他心血管疾病危险因素，心理社会压力，心肌缺血，左心室质量和心血管疾病死亡率的临床显着改善，以及随机分配到主动减压的高风险受试者的全因死亡率。我们最近完成的由nhlbi支持的减轻压力在市中心非裔美国人预防高血压心脏病的临床试验的初步结果表明，与对照教育相比，通过颈动脉内膜-中膜厚度（IMT）评估的动脉粥样硬化性CVD在8个月的积极减轻压力干预后显着消退。这些结果与降脂疗法或广泛改变生活方式的效果相当。这个提议的继续项目将通过调查主动减压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名已知患有冠心病的非裔美国人。男性和女性受试者将在我们正在进行的现场，洛杉矶内城的马丁·路德·金·德鲁医疗中心登记。在基线测试后，受试者将被随机分配到积极减压TM或健康教育控制组，这两组都是在常规医疗护理之外进行的，并在12个月后进行后测。主要结果将是颈动脉粥样硬化（IMT）测量定量b超无创。次要措施将包括传统的心血管疾病危险因素（血压、血脂、吸烟、运动）、社会心理压力、生活质量和成本效益。这项临床试验的结果将为通过高危非裔美国人的行为手段预防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.