Ethnicity, Stress, and LV Mass

种族、压力和 LV 质量

• 批准号: 7137460
• 负责人: Carlos Jose Rodriguez
• 金额: $ 12.89万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-07-15 至 2011-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7137460
• 关键词: Hispanic Americans; behavioral /social science research tag; blood pressure; cardiovascular disorder epidemiology; circadian rhythms; clinical research; heart dimension /size; heart ventricle; human subject; low socioeconomic status; patient oriented research; prejudice; prognosis; psychological stressor; racial /ethnic difference; social support network

DESCRIPTION (provided by applicant): Dr. Carlos Jose Rodriguez is an adult cardiologist and Assistant Professor at Columbia University whose ultimate long term goal is to develop a career as an independent investigator. The candidate is particularly interested in hypertensive heart disease with a specific focus on the traditionally understudied Hispanic population, the largest and most rapidly growing minority ethnic group in the United States. The applicant has provided evidence that echocardiographic LVM is an independent predictor of cardiovascular morbidity and mortality in Hispanics and that Hispanics have higher LVM than whites. Blood pressure (BP) is one of the major determinants of LVM, and 24 hour ambulatory BP (ABP) levels have been found to predict LVM better than conventional clinic BP, however it is not known if the diurnal rhythm of BP in Hispanics resembles that of blacks or whites. The applicant has also shown that lower SES independently predicts higher LVM among non-Hispanic blacks but not among Hispanics despite Hispanics having a similar prevalence of increased LVM and lower SES as non-Hispanic blacks. These findings appear to be consistent with the 'Hispanic paradox.' However, our preliminary data also shows that the SES-LVM relationship may be influenced by psychosocial factors. Thus our central hypotheses are that: 1) Among Hispanics, physiologic abnormalities in the diurnal rhythm of ABP (higher nocturnal BP) are related to increased LVM; 2) Low social support, high perceived racism, and high depressive symptoms are measures of psychosocial stress associated with low SES and associated with higher levels of ABP non-dipping and LVM. The proposed career development plan will incorporate a multidisciplinary program designed to allow the candidate to acquire knowledge and expertise in the following four modules: (1) psychosocial and behavioral factors including perceived racism, SES, social support, and depressive symptoms; (2) physiologic mediating mechanisms including ABP monitoring and heart rate variability assessment (3) clinical epidemiological study design issues; and (4) medical research dissemination. The Columbia University Behavioral Cardiovascular Health and Hypertension Program and the Mailman School of Public Health will provide structured mentoring and didactic learning. Dr. Thomas Pickering is the sponsor for this award given his established track record as a mentor and renowned expertise in behavioral medicine and ABP measures. The proposed research study will recruit 200 Hispanic participants from within the Northern Manhattan Study (NOMAS). Subjects will undergo ABP monitoring and transthoracic echocardiograms as well as a psychosocial questionnaires focusing on assessment of SES, social support, depressive symptoms, and perceived racism. This research study will determine (1) the relationship of ABP measures to LVM among Hispanics and (2) whether psychosocial factors are mediators of the stress of low SES thus affecting LVM.

描述（由申请人提供）： 卡洛斯·何塞·罗德里格斯 (Carlos Jose Rodriguez) 博士是一名成人心脏病专家，也是哥伦比亚大学的助理教授，其最终的长期目标是发展成为一名独立研究者的职业生涯。该候选人对高血压心脏病特别感兴趣，特别关注传统上未被充分研究的西班牙裔人口，这是美国最大且增长最快的少数族裔群体。申请人提供的证据表明，超声心动图 LVM 是西班牙裔心血管发病率和死亡率的独立预测因子，并且西班牙裔的 LVM 高于白人。血压 (BP) 是 LVM 的主要决定因素之一，已发现 24 小时动态血压 (ABP) 水平比传统诊所血压更好地预测 LVM，但尚不清楚西班牙裔人的血压昼夜节律是否与此相似。黑人或白人。申请人还表明，较低的 SES 在非西班牙裔黑人中独立预测较高的 LVM，但在西班牙裔中则不然，尽管西班牙裔与非西班牙裔黑人的 LVM 增加和 SES 较低的患病率相似。这些发现似乎与“西班牙悖论”一致。然而，我们的初步数据也表明SES-LVM关系可能受到社会心理因素的影响。因此，我们的中心假设是： 1) 在西班牙裔中，ABP 昼夜节律的生理异常（夜间血压较高）与 LVM 增加有关； 2) 低社会支持、高感知种族主义和高抑郁症状是与低 SES 相关的心理社会压力的衡量标准，并与较高水平的 ABP 非下降和 LVM 相关。拟议的职业发展计划将纳入一个多学科计划，旨在让候选人获得以下四个模块的知识和专业知识：（1）心理社会和行为 因素包括感知到的种族主义、社会经济地位、社会支持和抑郁症状； （2）生理调节机制，包括ABP监测和心率变异性评估（3）临床流行病学研究设计问题； (4) 医学研究传播。哥伦比亚大学行为心血管健康和高血压项目和梅尔曼公共卫生学院将提供结构化的指导和教学学习。鉴于 Thomas Pickering 博士作为导师的良好记录以及在行为医学和 ABP 测量方面享有盛誉的专业知识，他成为该奖项的赞助商。拟议的研究将从北曼哈顿研究 (NOMAS) 中招募 200 名西班牙裔参与者。受试者将接受动态血压监测和经胸超声心动图以及社会心理问卷调查，重点评估社会经济地位、社会支持、抑郁症状和感知的种族主义。这项研究将确定 (1) 西班牙裔人的 ABP 测量值与 LVM 的关系，以及 (2) 心理社会因素是否是低 SES 压力的中介因素，从而影响 LVM。