The Impact of a Race-Based Stress Reduction Intervention on Well-Being, Inflammation, and DNA methylation in Older African American Women at Risk for Cardiometabolic Disease

项目总结 这项随机对照试验将评估一种新的基于种族的压力减轻计划对 高龄非裔美国人(AA)女性的幸福感、炎症负担和DNA甲基化(DNaM) 用于心脏代谢性疾病(CMD)。尽管与CMD有关的死亡人数继续下降，但 最近，随着美国汽车协会承担了不成比例的负担，下降速度有所放缓。此外，女性面临着更多的性行为- 肥胖增加的特定风险因素和再生障碍性贫血妇女肥胖率最高， 与所有其他种族和民族相比，高血压和糖尿病前期。慢性压力与 低级别炎症和增加CMD风险。越来越多的证据表明，诸如 种族主义和歧视是造成心理困扰的重要因素，低级别的慢性 少数民族之间的炎症和CMD健康差异，特别是在忍受 在他们的一生中，种族主义和性别歧视的交集。韧性、压力和种族(上升)是一种 以小组为基础，为期8周的干预，整合了专注于 种族主义、种族认同发展和赋权的生物心理社会影响。根据我们的初步调查 在工作中，我们预计参加RISE将减少心理痛苦和炎症。此外，我们的 先前的研究表明，感觉到高度歧视的女性有更大的 促炎症细胞因子对急性应激的反应和炎症相关基因dNaM的降低 高血压。DNaM是一种表观遗传过程，通过添加或移除来调节基因的表达 甲基转移到DNA对环境的反应。研究表明，高甲基化或低甲基化 慢性应激源引起的基因，包括种族主义和歧视，与CMD风险显著相关。 新出现的证据表明，心理行为干预可能会改变压力的甲基化 反应相关基因可能在分子水平上缓冲心理压力的影响。 然而，很少有研究研究心理行为干预对dNaM和dNaM变化的影响。 没有人解决老年再生障碍性贫血妇女的慢性压力问题。因此，具体目标是：(1)确定 老年再障患者参与RISE可降低应激相关症状和炎症负担的程度 有CMD风险的女性；(2)评估RISE在多大程度上增加了适应性应对方式的使用 有CMD风险的老年AA妇女的不适应应对策略；以及(3)确定以下方面的程度 RISE基因的参与改变了老年AA女性应激反应相关候选基因的dNaM 从基线到抬高干预后的CMD。50岁至70岁有患CMD风险的妇女将是 随机分为为期8周的RISE计划或健康教育计划。Rise是一种创新 在个人层面解决被认为的种族主义和歧视的干预。更进一步说，上涨有 改善受种族主义和歧视影响的少数群体妇女健康的潜力。

PROJECT SUMMARY This randomized controlled trial will evaluate the impact of a novel race-based stress reduction program on well-being, inflammatory burden, and DNA methylation (DNAm) in older African American (AA) women at risk for cardiometabolic disease (CMD). Although the number of deaths related to CMD continues to decline, that decline has slowed recently with AAs bearing a disproportionate burden. Furthermore, women face more sex- specific risk factors for increased adiposity and AA women have the highest prevalence of obesity, hypertension, and prediabetes compared to all other racial and ethnic groups. Chronic stress is associated with low-grade inflammation and increased CMD risk. Growing evidence demonstrates that stressors such as racism and discrimination are significant contributing factors to psychological distress, low-grade chronic inflammation, and CMD health disparities among minorities, particularly among older AA women who endure the intersection of both racism and sexism across their lifespan. Resilience, Stress, and Ethnicity (RiSE) is a group-based, 8-week intervention that integrates cognitive-behavioral strategies focused on the biopsychosocial impact of racism, racial identity development, and empowerment. Based on our preliminary work, we anticipate that participation in RiSE will reduce psychological distress and inflammation. Further, our previous work demonstrated that women with high levels of perceived discrimination have a greater proinflammatory cytokine response to acute stress and decreased DNAm of genes related to inflammation and hypertension. DNAm is one type of epigenetic process that modulates gene expression by adding or removing methyl groups to DNA in response to the environment. Studies demonstrate that hyper or hypo methylation of genes due chronic stressors, including racism and discrimination are significantly associated with CMD risk. Emerging evidence demonstrates that psychobehavioral interventions may modify methylation of stress response-related genes potentially buffering the impact of psychological stress at the molecular level. However, few studies have examined the impact of a psychobehavioral intervention on changes in DNAm and none have addressed chronic stress in older AA women.Therefore, the specific aims are: (1) Determine the extent to which participation in RiSE decreases stress-related symptoms and inflammatory burden in older AA women at risk for CMD; (2) Evaluate the extent to which RiSE increases the use of adaptive coping versus maladaptive coping strategies in older AA women at risk for CMD; and (3) Determine the extent to which participation in RiSE modifies DNAm of stress response- related candidate genes in older AA women at risk for CMD from baseline to post RiSE intervention. AA women 50 to 70 years of age who are at risk for CMD will be randomized into either an 8-week RiSE program or a health education program. RiSE is an innovative intervention that addresses perceived racism and discrimination at the individual level. Further, RiSE has the potential to improve the health of minority women impacted by racism and discrimination.