DIET AND VITAMIN STATUS, ALLOSTATIC LOAD, AND CVD RISK IN PUERTO RICAN ADULTS

项目总结（见说明）： 心血管疾病（CVD）是居住在美国的西班牙裔美国人的主要死亡原因， 每四个人中就有一个死于此大多数关于西班牙裔的研究都集中在墨西哥人身上。 美国人和，除了波多黎各心脏研究，这是在岛上进行的， 波多黎各几十年前;很少有人探讨心血管疾病的危险因素在波多黎各人。重要的是 波多黎各人口在祖先遗传史和已知风险暴露方面差异很大 这些重要的流行病的因素从其他西班牙：民族群体。不同的风险因素包括 独特的饮食摄入和体育活动模式，以及社会、文化和环境结构 这会导致和影响CVD风险。高贫困率和大多数城市环境造成了 这些过程以未知的方式进行：由于这一群体是美国人口中快速增长和老龄化的一部分， 人口，了解患病率高得多的原因的重要性， 在这一高危人群中，心血管危险因素的发生率至关重要。理由是，这些 关联是复杂的，可能是反复的，需要纵向分析，以了解因果关系 方向，全面实施多层次分析。我们对这个项目的总体目标是前瞻性地 跟踪波士顿波多黎各健康研究的参与者5年，以测量CVD风险的进展 因素和亚临床标志物的心血管疾病，使我们可以明确的因果方向，确定 协会.我们的目的是评估五年的前瞻性相互关系（3个时间点）之间的饮食 模式和维生素（叶酸、维生素B6、维生素B12、维生素D、总类胡萝卜素）摄入量和血浆状态 和CVD风险因素的进展（脉压、高血压和心脏病风险评分（FRS））; 评估CVD患者三个时间点的饮食摄入模式与维生素状态之间的相关性 5年时间点的指标（ABI和IMT）;测量非稳态负荷与FRS之间的相关性 ABI和IMT在5年;测量邻里环境的措施之间的关联， 健康食物的可获得性和步行能力与饮食摄入模式、肥胖指标、非稳态负荷、CVD 危险因素和CVD指标。初步数据显示，波多黎各人合并症的患病率很高， 特别是高血压、抑郁症和糖尿病。我们还记录了多个社会 环境差异和独特的遗传背景。纵向研究， 对于解开多种CVD危险因素及其进展的复杂性至关重要 对健康的影响。我们提出的项目是至关重要的，因为了解独特的 疾病的贡献者和这一庞大的高风险群体的需求将允许有针对性的公共卫生行动 降低心血管疾病和改善这一人群的整体健康状况。我们的研究可以提供见解， 作为今后在其他弱势群体中采取多学科办法的模式。

PROJECT SUMMARY (See instructions): Cardiovascular disease (CVD) is the leading cause of death among Hispanics residing in the U.S., contributing to nearly one of every four deaths. Most studies on Hispanics have focused on Mexican Americans and, with the exception of the Puerto Rico Heart Study, which was conducted on the island of Puerto Rico several decades ago; few have explored CVD risk factors in Puerto Ricans. Importantly, the Puerto Rican population differs considerably in ancestral genetic history, and in exposures to known risk factors for these important prevalent conditions from other Hispa:nic groups. Differing risk factors include unique dietary intake and physical activity patterns, as well as social, cultural and environmental structures that contribute to and affect CVD risk. The high poverty rates and majority urban environment contribute to these processes in unknown ways: As this group is both a rapidly growing and aging subset ofthe US population, the significance of understanding the reasons for the considerably higher prevalence and incidence of cardiovascular risk factors in this high risk population is critical. The rationale is that these associations are complex and likely iterative, requiring longitudinal analyses in order to understand causal direction and to fully implement multilevel analyses. Our overall aim for this project is to prospectively follow participants ofthe Boston Puerto Rican Health Study for 5 years to measure progression of CVD risk factors and of sub-clinical markers of CVD, so that we may clarify the causal direction of identified associations. We aim to assess five year prospective interrelationships (3 time points) between dietary pattern and vitamin (folate, vitamin B6, vitamin B12, vitamin D, total carotenoids) intake and plasma status and progression of CVD risk factors (pulse pressure, hypertension, and Framingham Risk score (FRS)); assess associations between dietary intake pattern and vitamin status across three time points with CVD indicators, (ABI and IMT) at the 5-year time point; measure associations between allostatic load and FRS with ABI and IMT at 5 years; measure associations between measures of neighborhood environment for healthy food availability and walkability with dietary intake pattern, obesity measures, allostatic load, CVD risk factors, and CVD indicators. Preliminary data show that Puerto Ricans have a high prevalence of comorbidities, particularly hypertension, depression and diabetes. We have also documented multiple social and environmental disparities and a unique genetic background for this ethnic group. Longitudinal studies, as proposed, are critical to untangle the complexities ofthe multiple CVD risk factors and their progression toward health outcomes. Our proposed project is of paramount importance, as understanding the unique contributors to disease and the needs of this large, high-risk group will allow for targeted public health action toward decreasing CVD and improving overall health in this population. Our study may provide insights and serve as a model for future multidisciplinary approaches in other vulnerable groups.