Racial disparities in the maintenance of healthy lifestyles and their effect on cumulative blood pressure burden and left ventricular mass in African Americans and whites: data from the CARDIA study

 描述(申请人提供)：与白人相比，非裔美国人(AA)从童年开始就有更高的血压水平，成年后高血压的发病率更高，左心室(LV)肥厚的发生率更高，以及与高血压相关的结果(包括中风、心力衰竭和心脏病死亡)的风险更高。国家高血压教育计划的一项临床和公共健康咨询总结了6种有效的方法，如果保持下去，可能会预防高血压：(1)适度的体力活动，(2)正常的体重，(3)限制酒精摄入量，(4)限制钠摄入量，(5)充足的钾摄入量，(6)丰富的水果、蔬菜和低脂肪乳制品、饱和脂肪和总脂肪的饮食。然而，关于维持这些因素的长期数据很少公布。本研究的具体目的是(1)确定在25年内保持健康生活方式在AAS和白人中是否存在差异；(2)通过基于潜伏期组群的轨迹建模，确定AAS和白人保持“理想”健康生活方式与收缩和舒张期血压轨迹的关联；(3)评估AAS和白人保持“理想”健康生活方式与LV质量(LVm)变化的关系。此外，还将进行正式的中介分析，以估计与白人相比，较少的健康生活方式在多大程度上解释了AAS患者较高的BP轨迹和LVM。来自国家健康、肺和血液研究所赞助的青年冠状动脉风险发展多中心研究(CARDIA)的数据将用于解决这些目标。1985-1986年，5115名18-30岁的再生障碍性贫血和白人成年人完成了CARDIA基线研究访问；在随后的25年中完成了7次后续访问。建议的研究所需的所有CARDIA数据都是使用具有严格质量控制程序的标准方案收集的。UAB和CARDIA为完成这项研究提供了理想的研究和培训环境。UAB的健康科学研究和培训计划在全国范围内得到认可，特别是在心血管疾病方面。CARDIA调查人员在培训年轻研究人员方面有着长期的记录，这些年轻研究人员作为独立调查人员在科学生涯中取得了成功。这笔F31助学金包括一项量身定制的培训计划，重点是临床高血压和预防性心脏病学助理职位、课程作业和亲身实践的初级数据收集经验。与领先的学术心脏病专家进行临床观察将为将观察性研究转化为临床相关试验提供知识基础。在CARDIA，实践经验将帮助我获得基本数据收集的经验，培养领导技能，并学习负责任的研究方法。授课培训将包括高级生物统计学课程，以及完成UAB的健康差距研究培训计划和美国心脏协会的高BP研究暑期学校。通过这项提议获得的培训和经验将为设计预防高血压的多方面临床战略提供坚实的基础，这些战略可能有助于消除心血管疾病中的种族差异。

 DESCRIPTION (provided by applicant): Compared with whites, African Americans (AAs) have higher blood pressure (BP) levels beginning in childhood, higher incidence of hypertension through adulthood, higher prevalence of left ventricular (LV) hypertrophy, and higher risk of hypertension-related outcomes including stroke, heart failure, and heart disease death. A clinical and public health advisory from The National High BP Education Program summarized 6 efficacious methods that, if maintained, may prevent hypertension: (1) moderate physical activity, (2) normal body weight, (3) limited alcohol intake, (4) limited sodium intake, (5) adequate potassium intake, and (6) a rich diet of fruits, vegetables and low in high-fat dairy, saturated and total fat. However, few long-term data on the maintenance of these factors have been published. The specific aims of this study are to (1) determine whether the maintenance of healthy lifestyles over 25 years differs in AAs versus whites, (2) determine the association of maintaining "ideal" healthy lifestyles with systolic and diastolic BP trajectories using latent-clas group-based trajectory modeling in AAs and whites and (3) evaluate the association of maintaining "ideal" healthy lifestyles with change in LV mass (LVM) in AAs and whites. Also, formal mediation analyses will be performed to estimate the degree to which fewer healthy lifestyles explain the higher BP trajectories and LVM in AAs compared with whites. Data from the National Health, Lung and Blood Institute sponsored multicenter Coronary Artery Risk Development in Young Adults (CARDIA) Study will be used to address these aims. In 1985-1986, 5,115 AA and white adults 18-30 years old completed a baseline CARDIA study visit; 7 follow-up visits have been completed in the ensuing 25 years. All CARDIA data needed for the proposed study were collected using standard protocols with rigorous quality control procedures. UAB and CARDIA provide ideal research and training environments to complete this study. UAB is nationally recognized for its health sciences research and training programs, specifically in CVD. CARDIA investigators have a long track record of training young researchers who have achieved successful scientific careers as independent investigators. This F31 grant includes a tailored training program focused on clinical hypertension and preventative cardiology clerkships, coursework and hands-on primary data collection experience. Clinical observation with leading academic cardiologists will provide a knowledge base for translation of observational research into clinically relevant trials. In CARDIA, hands-on experience will help me gain experience in primary data collection, develop leadership skills, and learn responsible conduct of research. Didactic training will include advanced biostatistics coursework and completion of UAB's Health Disparities Research Training Program and the American Heart Association's High BP Research Summer School. The training and experience received through this proposal will provide a strong foundation for designing multifaceted clinical strategies for preventing hypertension that may help to eliminate racial disparities in CVD.