Nurse Model in Black Families at Risk for Heart Disease

描述：（由申请人提供）家庭心脏研究将测试由执业护士/健康教育者团队（NURS团队）和通常的初级提供者护理（UC）的文化敏感社区模式一年的风险因素护理的短期影响，在366名明显健康的30-59岁非裔美国人兄弟姐妹中已知过早冠心病（<60岁）的指数患者。一年的结果显示，与常规护理相比，NURS TEAM模式有显著的好处。我们不知道这些影响是否会持续下去。维持长期的危险因素控制对于降低具有强烈冠心病家族史的非裔美国人的冠心病发病率至关重要。我们建议进行为期五年的随访，以确定NURS团队模式的长期影响。目的是：(1)比较NURS TEAM干预与UC对ldl -胆固醇水平、收缩压和舒张压的5年影响，(2)确定(a)生物学因素（肥胖和合并症）和(b)人口统计学和社会心理因素（年龄、性别、教育程度、总体幸福感得分）对LDL-C和血压水平的独立贡献，(3)描述过早冠心病事件的发生率和隐匿性冠心病的进展。次要结局包括HDL-C水平、甘油三酯、体重指数和戒烟率。五岁时的饮食和体育活动得分将按组进行比较。我们假设与UC相比，NURS团队将产生明显更好的长期LDL-C和血压水平。

DESCRIPTION: (provided by applicant) The family heart study will have tested the short-term impact of a culturally-sensitive community model of one-year of risk factor care by a nurse practitioner/health educator team (NURS TEAM) and usual primary provider care (UC) in 366 apparently healthy 30-59 year old African American siblings of index patients with known premature coronary disease (<60 years of age). One-year results show a significant benefit of the NURS TEAM model when compared with usual care. We do not know whether these effects will be sustained. Maintaining long-term risk factor control is of critical importance in reducing the notably high incidence of CHD in African Americans with a strong family history of CHD. We propose a five-year follow-up to determine the long-term impact of the NURS TEAM model. The aims are to: (1) compare the five year impact of the NURS TEAM intervention with UC, on levels of LDL-cholesterol, systolic blood pressure, and diastolic blood pressure, (2) determine the independent contribution of (a) biological factors (obesity and comorbidity) and (b) demographic and psychosocial factors (age, sex, education, general well-being scores) on levels of LDL-C and blood pressure, and (3) describe the incidence of premature CHD events and progression of occult CHD. Secondary outcomes include levels of HDL-C, triglycerides, body mass index, and smoking cessation rates. Diet and physical activity scores at five years will be compared by group. We hypothesize that the NURS TEAM will yield significantly better long-term levels of LDL-C and blood pressure compared with UC. We propose a MANCOVA analysis for a group-randomized trial, nested cohort design, with a single baseline, a one-year posttest and a five-year follow-up assessment. The effect of the treatment group contingency will be the difference between the two conditions at the last follow-up, with adjustment for differences in risk factor levels at baseline. Family-adjusted survival analyses will be used to examine the patterns of clinical and occult CHD over time in high-risk African American siblings. We also use standard qualitative techniques to gain a better understanding of barriers and enhancers to successful control of their risk factors over five years in African American families. The study provides an unparalleled virtually first opportunity to describe CHD incidence in African Americans and to determine the impact of NURS TEAM interventions in a seriously understudied high-risk population.