Social Stressors and Atherosclerosis in African-American Women with Lupus

患有狼疮的非洲裔美国女性的社会压力和动脉粥样硬化

基本信息

批准号：
9767661
负责人：
Tené T Lewis
金额：
$ 65.5万
依托单位：
EMORY UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-09-20 至 2021-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9767661
关键词：
Affect African American Age of Onset Area Atherosclerosis Autoimmune Diseases Blood Pressure C-reactive protein Cardiovascular Diseases Cause of Death Cholesterol Chronic Chronic Disease Diabetes Mellitus Discrimination Disease Environment Ethnic group Event Financial Hardship Future Goals Health High Density Lipoproteins Immune Immunity Individual Inflammation Inflammatory Institute of Medicine (U.S.)Intercellular Adhesion Molecules Interleukin-10 Interleukin-17 Interleukin-18 Interleukin-6 Intervention Knowledge Leptin Life Link Lupus Lupus Nephritis Measures Mediating Migration Inhibitory Factor Pharmaceutical Preparations Physical activity Platelet Factor 4 Population Process Reporting Research Resources Risk Risk Factors Sampling Severities Smoking Social support Systemic Lupus Erythematosus TNF gene Time United States Ursidae Family Woman Women&apos s Health atherosclerosis risk cardiovascular disorder risk cohort depressive symptoms design early life adversity early onset experience follow-up inflammatory marker intima media molecular marker novel marker premature racial and ethnic social social stress stressor

项目摘要

Systemic lupus erythematosus (SLE) is a debilitating multisystem, chronic, inflammatory, autoimmune disease that impacts an estimated 1.5 million individuals in the United States alone. Almost 90% of those affected by SLE are women, and African-American women have rates of SLE that are 3 to 4 times higher than women from other racial/ethnic groups. Among women with SLE, premature Cardiovascular Disease (CVD) is a major cause of death and this is particularly true for African-Americans. Compared to African-American women without SLE, African-American women with SLE die from CVD-related causes almost 20 years earlier. This increased risk is not completely due to traditional CVD risk factors (e.g. blood pressure, diabetes, cholesterol, smoking), or SLE factors; thus, there remain major gaps in our understanding of why African American women with SLE bear such a strikingly high burden of early CVD. The proposed project is designed to determine whether aspects of the African-American lived experience-- i.e. social stressors, such as discrimination, financial strain, inadequate social support and early adversity—contribute to atherosclerotic progression and inflammation (markers of early CVD) among African-American women with SLE. Leveraging existing resources from a well-characterized cohort of women with SLE, we will examine the impact of social stressors on the atherosclerotic process and on molecular markers of immunity and inflammation (those linked to CVD in healthy populations and those implicated in SLE-related atherosclerosis) over a 2-year follow up. In order to determine whether these effects are unique to SLE, our sample will consist of 200 African-American women with SLE and 200 comparison women from similar environments. Because African-American women with SLE are already immune-compromised, it is hypothesized that social stressors will prove especially problematic for this group; by exacerbating the inflammatory processes associated with SLE to further increase their risk of atherosclerotic disease. Additionally, given the significant financial and social resources required to manage a chronic illness, we will examine whether certain social stressors (financial strain, inadequate social support) disproportionately impact women with (vs. those without) SLE. Finally, to determine whether some African-American women with SLE are more vulnerable to early CVD than others, we will also examine several SLE factors (e.g. age of onset, disease activity, lupus nephritis) as potential modifiers, among women with SLE only. This project will fill critical gaps in knowledge by examining several understudied, yet highly relevant risk factors for early CVD in a uniquely vulnerable, but frequently overlooked population of women. Findings from the proposed study will be used to identify targets for future intervention.

系统性红斑狼疮 (SLE) 是一种使人衰弱的多系统慢性、炎症性自身免疫性疾病仅在美国就有约 150 万人受到这种疾病的影响。受 SLE 影响的主要是女性，非裔美国女性的 SLE 发病率比女性高 3 至 4 倍。来自其他种族/族裔群体的女性在患有 SLE 的女性中，过早发生心血管疾病 (CVD) 是最常见的。一个主要原因，对于非裔美国人来说尤其如此。与未患 SLE 的女性相比，患有 SLE 的非洲裔美国女性大约早 20 年前就死于 CVD 相关原因。这种风险增加并不完全是由于传统的 CVD 危险因素（例如血压、糖尿病、因此，我们对为什么非洲人的理解仍然存在重大差距患有系统性红斑狼疮的美国女性承受着如此高的早期心血管疾病负担。旨在确定非裔美国人生活经历的各个方面（即社会压力源）是否例如歧视、经济压力、社会支持不足和早期的逆境——导致患有以下疾病的非洲裔美国女性的动脉粥样硬化进展和炎症（早期 CVD 的标志）我们将利用 SLE 女性患者群体的现有资源进行检查。社会压力源对动脉粥样硬化过程和免疫分子标记的影响炎症（与健康人群中的 CVD 相关的炎症以及与 SLE 相关的炎症）动脉粥样硬化）经过 2 年的随访，以确定这些影响是否是 SLE 所独有的。我们的样本将包括 200 名患有 SLE 的非洲裔美国女性和 200 名来自类似疾病的对比女性。由于患有系统性红斑狼疮的非裔美国女性的免疫力已经受损，因此认为社会压力因素将加剧这一群体的问题；与 SLE 相关的炎症过程进一步增加其患动脉粥样硬化疾病的风险。此外，考虑到管理慢性病所需的大量财政和社会资源，我们将检查某些社会压力因素（经济压力、社会支持不足）是否不成比例最后，确定一些非裔美国女性是否受到系统性红斑狼疮的影响。患有 SLE 的人比其他人更容易患早期 CVD，我们还将检查几个 SLE 因素（例如，发病率、疾病活动度、狼疮性肾炎）作为潜在的修饰因素，仅针对患有 SLE 的女性。将通过检查几个尚未充分研究但高度相关的风险因素来填补知识的关键空白拟议的调查结果显示，女性群体中的心血管疾病特别脆弱，但经常被忽视。研究将用于确定未来干预的目标。