Boston Puerto Rican Health Study - CVD Risk Factors

生活在美国本土的波多黎各成年人已经记录了健康差异；然而，很少有研究 对这一第二大拉美裔亚群进行了调查。我们的长期目标是了解饮食和其他行为和环境因素、遗传和心理社会压力与波多黎各成年人心血管疾病(CVD)风险因素的高患病率和明显增加的复杂交互作用。随着这一群体的快速增长，了解这种风险的原因非常重要。我们为波士顿波多黎各人口健康和健康差异中心(BPR-CPHHD，2003-08)提供的最初资金期间，重点关注压力通过生理调节失调或“平衡负荷”对身体残疾和认知能力下降的作用。在那次调查中，很明显，心血管疾病的风险因素非常普遍。这些发现与普遍认为的拉美裔悖论形成了鲜明对比，即尽管贫困程度更高，但心脏病和死亡率却更低。重要的是，波多黎各人在祖先遗传史和暴露于其他拉美裔群体的已知风险因素方面存在很大差异。他们有独特的饮食摄入模式，以及社会、文化和环境结构，这些结构有助于并影响对应激源的反应。在我们最初的供资期间，我们成功地召集了1450名波多黎各成年人，他们的基线年龄为45-75岁，并(迄今)完成了900多次为期两年的后续访谈，我们正在继续，预计将至少完成1150次。随着这一人群的老龄化和快速增长，心脏病风险因素增加的高患病率和明显的队列效应表明，1)这一人群在心脏病风险因素方面存在严重的健康差距，2)心脏病在不久的将来将成为这一群体的更大问题。因此，我们这次更新的总体目标是延长后续行动，并衡量和分析相关特征和心血管疾病风险因素，并在这一已建立的波多黎各成年人队列中增加心血管疾病风险的额外背景和结果衡量标准，以便我们可以更好地 了解这些差异的动态。我们的模型遵循了在最初的资助期间与我们的合作伙伴CPHHD共同开发的跨学科“细胞到社会”的概念，考虑了与恒定负荷和风险生化指标的纵向变化相关的遗传变异，到更具体的疾病指标(踝臂指数(ABI)和内膜中层厚度(IMT))；另外还关注了社会网络、邻里特征(物理空间和食物获取)和环境(空气污染)因素作为健康的社会决定因素。最后，使用基于社区的参与式技术，我们将实施和测试一项多维干预措施，重点是饮食和锻炼，但也要充分考虑社会和物理环境，以确保成功。在我们社区合作伙伴的参与下。在La Alianza Hispana的支持下，以及我们行政、生物统计和实验室核心的支持下，我们的团队能够有效地做出重大贡献，了解导致这一高度弱势群体心脏病威胁明显增加的因素]，同时提供可能对其他弱势群体有用的见解。我们队列的继续，以及其丰富的措施星座，将使我们能够解开一些导致心血管疾病风险的复杂病因相互作用，以便实施有效的干预措施。

Puerto Rican adults living on the mainland US have documented health disparities; however, little research has been conducted with this second largest Hispanic subgroup. Our long-term goal is to understand the complex interactions of diet and other behavioral and environmental factors, genetics, and psychosocial stress on the high and apparently increasing prevalence of cardiovascular disease (CVD) risk factors in Puerto Rican adults. As this group is rapidly growing, understanding the reasons for this risk is of great importance. Our initial funding period for the Boston Puerto Rican Center on Population Health and Health Disparities (BPR-CPHHD, 2003-08) focused on the role of stress on physical disability and cognitive decline, through physiological dysregulation or "allostatic load." During that investigation, it became clear that risk factors for CVD were highly prevalent. These findings are in contrast to the commonly held belief that there is a Hispanic paradox¿lower heart disease and mortality despite greater poverty. Importantly, the Puerto Rican population differs considerably in ancestral genetic history and in exposures to known risk factors from other Hispanic groups. They have unique dietary intake patterns, as well as social, cultural and environmental structures that contribute and affect reaction to stressors. During our initial funding period, we successfully assembled a cohort of 1450 Puerto Rican adults, aged 45-75 years at baseline, and have completed (to date) more than 900 two-year follow-up interviews¿we are continuing, with the expectation of completing at least 1150. As this population is aging and growing rapidly, the high prevalence and apparent cohort effect of increased heart disease risk factors suggest that 1) this population has serious health disparities in heart disease risk factors and 2) heart disease will become an even greater problem for this group in the near future. Our overall aim for this renewal is, therefore, to extend follow-up and to measure and analyze relevant characteristics and CVD risk factors, and to add additional contextual and outcome measures for CVD risk in this established cohort of Puerto Rican adults, so that we may better understand the dynamics of these disparities. Our model follows the transdisciplinary "cells to society" concept developed jointly with our partner CPHHDs during the initial funding period, with consideration of genetic variation in relation to longitudinal change in allostatic load and biochemical indicators of risk, to more concrete indicators of disease (ankle brachial index (ABI) and intima media thickness (IMT)); with additional focus on social networks, neighborhood characteristics (physical space and access to food) and environment (air pollution) factors as social determinants of health. Finally, using community based participatory techniques, we will implement and test a multidimensional intervention that focuses on diet and exercise, but that also fully considers the social and physical environment to ensure success. With participation of our community partner. La Alianza Hispana, and the support of our administrative, biostatistics and laboratory cores, our team is efficiently poised to make significant contributions to understanding the factors that contribute to the apparent growing threat of heart disease in this highly disadvantaged group¿while providing insights that may be useful to other vulnerable groups. The continuation of our cohort, with its rich constellation of measures, will allow us to unravel some of the complex etiologic interactions which contribute to CVD risk, so that effective interventions maybe implemented.