NURSE MODEL IN BLACK FAMILIES AT RISK FOR HEART DISEASE

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。这项拟议的额外研究的主要目标是跟踪长期(5年)危险因素以及早期冠心病患者表面上看起来健康的非裔美国人兄弟姐妹中显性和隐匿性冠状动脉疾病(CAD)的发展。这是对新授予的美国国立卫生研究院奖的补充，该奖项旨在研究同一人群，以确定最初的随机试验：最初的护士从业者/社区健康教育者血脂和血压管理模式(NOS团队)与最初干预五年后(1998-2001)的普通初级保健(UC)相比的影响。。在最初的社区干预研究的基线上，GCRC资助了一项补充研究，该研究允许表征隐匿性CAD和血管疾病的额外风险因素和标记物，现在为拟议的前瞻性补充研究提供基线。早发冠心病家族史早已被认为具有明显的超额冠心病风险，但直到最近才在非裔美国人中被注意到，那里的冠心病危险因素的患病率极高，疾病的发展轨迹没有很好的特征。因此，这项研究将跟踪所有最初筛查的464名兄弟姐妹(那些在基线上有风险因素和没有风险因素的人--那些没有风险因素的人没有进入治疗试验，但我们希望也跟踪他们的发病率、新的隐匿性CHD和风险因素的变化)。长期干预效果的主要研究旨在检查五年来血脂水平、血压、体重指数、饮食、体育活动、健身、用药、压力、卫生保健利用和总体幸福感的变化。这项额外的补充研究将跟踪血糖、纤维蛋白原、血清胰岛素、血肌酐、尿微量白蛋白、同型半胱氨酸、纤溶酶原激活物抑制物-1(PAI-1)和组织纤溶酶原激活物(TPA)的变化。此外，超声心动图将再次表征左室质量，以前瞻性地检查危险因素状态对左室质量增加的影响，以及左室质量对临床血管预后的影响。重要的是，将使用与基线相同的应力铊闪烁照相方法来检查偶发冠心病和隐匿性疾病。总而言之，这些评估将允许对高危非裔美国人进行全面的前瞻性表征，并最终将为一项长期前瞻性流行病学研究奠定基础，我们有600多名白人兄弟姐妹使用相同的技术进行评估。

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.