NURSE MODEL IN BLACK FAMILIES AT RISK FOR HEART DISEASE

这个子项目是许多利用 由NIH/NCRR资助的中心赠款提供的资源。子项目和 研究者（PI）可能从另一个NIH来源获得了主要资金， 因此可以在其他CRISP条目中表示。所列机构为 研究中心，而研究中心不一定是研究者所在的机构。 这项拟议的额外研究的主要目标是跟踪长期（5年）的危险因素和发展的显性和隐性冠状动脉疾病（CAD）在最初明显健康的非裔美国同胞的人过早冠状动脉疾病。 这是对美国国立卫生研究院新授予的一项研究的补充，该研究旨在研究同一人群，以确定最初干预五年后（1998-2001年），与普通初级保健（UC）相比，护士执业者/社区健康教育者血脂和血压管理模型（CIMIS TEAM）的原始随机试验的影响。在最初的社区干预研究的基线，GCRC资助了一项补充研究，该研究允许表征隐匿性CAD和血管疾病的其他风险因素和标志物，现在为拟定的前瞻性补充研究提供基线。 早发型冠心病的家族史长期以来一直被认为具有显著的冠心病风险，但最近才注意到在非裔美国人中，冠心病风险因素的患病率极高，并且疾病的轨迹没有得到很好的表征。因此，本研究将随访所有原始筛选的464名兄弟姐妹（基线时有和无风险因素的患者-无风险因素的患者未进入治疗试验，但我们希望跟踪他们的CHD发病率、新发隐匿性CHD和风险因素变化）。 长期干预效果的主要研究旨在检查五年内血脂水平，血压，体重指数，饮食，体育活动，健身，药物使用，压力，卫生保健利用和总体健康状况的变化。 额外的补充研究将跟踪血糖、纤维蛋白原、血清胰岛素、血清肌酐、尿微量白蛋白、同型半胱氨酸、纤溶酶原激活物抑制剂-1（派-1）和组织纤溶酶原激活物（tPA）的变化。此外，将再次通过超声心动图表征左心室质量，以前瞻性地检查风险因素状态对左心室质量增加的影响，以及左心室质量对临床血管结局的影响。重要的是，将使用基线时使用的相同负荷铊放射成像方法检查新发冠状动脉疾病和隐匿性疾病。 总之，这些评估将允许充分的前瞻性特征的高风险的非洲裔美国人，并最终将E基板的长期前瞻性流行病学研究，我们有一个匹配的白色人口超过600白色同胞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.