HEARTS FOR HUMANITY

仁爱之心

• 批准号: 7720621
• 负责人: Elizabeth O. Ofili
• 金额: $ 17.57万
• 依托单位: MOREHOUSE SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-08-01 至 2009-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7720621
• 关键词: Access to Information; Accounting; Address; Adherence; Adipose tissue; Adult; Africa; African; African American; Age of Onset; Alabama; American; Antioxidants; Behavior; Behavioral; Biochemical; Blood; Blood Glucose; Blood Pressure; Body Weight; Body Weight decreased; Body mass index; Carbohydrates; Cardiovascular Diseases; Cardiovascular system; Caribbean natives; Caribbean region; Caring; Carotenoids; Caucasians; Caucasoid Race; Cause of Death; Censuses; Cessation of life; Cholesterol; Clinical Research; Communities; Community Health; Community based prevention; Computer Retrieval of Information on Scientific Projects Database; Coronary Arteriosclerosis; Coronary artery; Coronary heart disease; Daily; Dairy Products; Data; Diet; Diet Habits; Dietary Fiber; Discrimination; Education; Educational Materials; Event; Experimental Designs; Family; Fatty acid glycerol esters; Female; Fiber; Flavanones; Focus Groups; Food; Funding; General Population; Generations; Glucose Intolerance; Goals; Grant; Habits; Health; Health Services Accessibility; Healthcare; Heart; Heart Diseases; High Blood Pressure; High Density Lipoprotein Cholesterol; High Prevalence; Home environment; Humanities; Hypertension; Hypertriglyceridemia; Hypotension; Immigrant; Individual; Institution; Insulin Resistance; Intake; Intervention; Intervention Studies; Knowledge; LDL Cholesterol Lipoproteins; Language; Latino; Learning; Life Style; Lipids; Louisiana; Maryland; Mediating; Mid-Atlantic Region; Mississippi; Modeling; Morbidity - disease rate; Motivation; Myocardial Infarction; Nomads; Not Hispanic or Latino; Numbers; Nurse Practitioners; Nuts; Obesity; Operative Surgical Procedures; Patient Care; Patients; Perception; Personal Satisfaction; Physical activity; Physiological; Phytochemical; Phytosterols; Population; Prevalence; Prevention program; Primary Health Care; Primary Prevention; Race; Randomized; Rate; Recommendation; Recording of previous events; Research; Research Personnel; Resources; Risk; Risk Factors; Risk Reduction; Severities; Site; Smoke; Smoker; Smoking; Source; South Carolina; Standards of Weights and Measures; Stress; Stroke; Surveys; Testing; Tobacco; USA Georgia; United States; United States National Institutes of Health; Visceral; Waist-Hip Ratio; West Indies; Western Asia Georgia; Woman; base; blood glucose regulation; cardiovascular disorder prevention; cardiovascular disorder risk; cardiovascular risk factor; cigarette smoking; community based care; day; design; diabetic; disability; fitness; flavanone; follow-up; fruits and vegetables; health disparity; health organization; heart disease risk; improved; intervention program; lifestyle intervention; male; medical schools; medically underserved; men; migration; mortality; non-smoker; prevent; programs; saturated fat; tool; waist circumference

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. A culturally- designed community -based prevention program will be effective in reducing risk of cardiovascular disease in African Americans. This hypothesis applies to the following study aims. Aims, specific hypotheses and rationale are described in detail below. Specific Aim 1: To reduce physiological risk factors for cardiovascular disease by decreasing blood pressure, waist circumference, and body mass index. Hypothesis: Reduction in obesity through lifestyle changes in diet and physical activity will result in decreased blood pressure, body mass index, waist circumference and cardiovascular disease risk. Rationale: Obesity is associated with increased cardiovascular disease morbidity and mortality apparently mediated through its effect on insulin resistance, glucose intolerance, hypertriglyceridemia, HDL cholesterol and hypertension. More specifically, visceral adiposity appears to be the most hazardous and atherogenic. Waist circumference provides an excellent tool for assessing visceral adipose tissue and correlates better with cardiovascular disease than both body mass index (BMI) and waist/hip ratio (1-5). Regular physical activity has been shown to improve blood cholesterol, blood glucose and blood pressure, in addition to promoting weight loss. Specific Aim 2: To reduce biochemical risk factors for cardiovascular disease by decreasing total and LDL cholesterol. Hypothesis: Adherence to a diet high in fiber and low in total and saturated fat (DASH diet) will result in a decrease in total and LDL cholesterol and cardiovascular risk. Rationale: Elevated triglycerides, small dense LDLc and low HDLc are important risk factors for cardiovascular disease. The beneficial effects of high dietary fiber on cardiovascular disease have been previously demonstrated by Liu and associates (6-7). It has been suggested that adequate amounts of fiber-rich carbohydrates will prevent carbohydrate-induced hypertriglyceridemia. The DASH diet is rich in fruits, vegetables and whole grains, which provide a substantial amount of phytochemicals and dietary fiber. In particular, the DASH diet is significantly higher in phytosterols, carotenoids, and flavanones than the typical US diet. These bioactive phytochemicals may reduce the risk of cardiovascular disease through antioxidant activities (8). The DASH diet also features a high carbohydrate, low fat plan. The carbohydrate sources in the DASH diet are from high dietary fiber rich foods. At 31 grams dietary fiber, the DASH diet meets the current recommendation for fiber intake of 25-35 grams per day, exceeding the typical daily U.S. diet, which contains only nine grams of fiber. Specific Aim 3: To reduce sociological risk factors for cardiovascular disease by decreasing or eliminating habitual smoking and by increasing regular physical activity. Hypothesis: Reduction of cigarette smoking through education will decrease risk of coronary artery disease and stroke in African Americans. Increased physical activity will improve the efficiency of the heart, promote weight loss and reduce stress associated with the urge to smoke. Rationale: A smoker's risk of heart attack is more than double that of nonsmokers. Taylor and co-workers found in the Coronary Artery Surgery Study (CASS) that during 16 years of follow-up, cigarette smoking alone accounted for a higher mortality rate among African Americans, regardless of type of therapy (9). B. Background and Significance: Disparities in healthcare in the Black or African American U.S. population, including recent immigrants from Africa, the Caribbean and the West Indies, are well-documented and cardiovascular disease remains the number one killer, claiming 37% of deaths each year. About four in every 10 non-Hispanic black adults have cardiovascular disease. Some 41% of non-Hispanic black males and 40% of black females have cardiovascular disease compared to 30% of non-Hispanic white men and 24% of white women (10). The rate of high blood pressure in U.S. blacks is among the highest in the world. African Americans have both a greater prevalence and severity of hypertension, and an earlier age of onset compared with whites (11, 12). Recent data have demonstrated a decrease in cardiovascular events in diabetic patients through primary prevention with lipid lowering and aggressive blood pressure-lowering therapy in the African American population (13). The U.S. Census Bureau projects that the African American population will increase from 12% in 2000 to 14.3% in 2035, representing more than 50 million individuals. Health disparities between African Americans and other racial groups, due to discrimination, cultural barriers and lack of access to health care continue to contribute to the disproportionate level of death and disability from cardiovascular disease. Goals set for eliminating disparities by 2010 include a reduction in deaths among African Americans from heart disease by 30 percent and deaths from strokes by 47 percent. Reducing risk factors such as high blood pressure, high cholesterol, smoking tobacco, blood glucose control, excessive body weight and physical inactivity offer the greatest potential strategies for reducing cardiovascular disease mortality. Community- based prevention programs such as the NHLBI "Salud Para Su Corazon" aimed at Latino Americans have recently proven successful in educating the Latino community about lifestyle changes that can improve their health. Recent testing of "Salud Para Su Corazon" in 223 families at seven sites (n=320) resulted in heart-healthy behavioral changes among the families (14). A similar program aimed at the African American community could provide like results. Developed materials could be disseminated to health organizations, and primary care practices in the African American community (15). An abundance of information exists concerning positive effects of behavioral change on heart disease morbidity and mortality (16). However, there have been health disparities in access to this information. When educational materials are developed to serve the general population, language and cultural differences can impact the ability of cardiovascular disease prevention messages from being understood and providing benefit. Sheats and colleagues found that even when healthcare treatment intensity was similar for Caucasians and African Americans in a medically underserved healthcare setting, higher prevalence and less control of hypertension still exist in African Americans (17). In addition, perception of heart disease as a cause of death may not be well understood, especially in African American females. Mosca and associates determined that less than 33% of U.S. females surveyed (13% African American) identified heart disease as the leading cause of death (18). Some community-based programs aimed at eliminating barriers to care for African Americans have previously been shown to be effective. A community-based multiple risk factor intervention program designed for black families with a history of premature coronary heart disease was recently conducted by Becker and co-workers. When compared with "enhanced" primary care (EPC), the community-based care (CBC), consisting of a nurse practitioner and community health worker in a community setting, resulted in the CBC group achieving a significant reduction in coronary heart disease risk (p0.0001). No risk reduction was found in the EPC group (19). The proposed "Hearts of Humanity Project" cultural- based lifestyle intervention program to reduce cardiovascular disease risk in African Americans will be centered around the effect of migration to the United States on dietary habits and lifestyle behavior of present day African Americans. The majority of the African American population has the greatest concentration in the Southeast and mid-Atlantic regions, such as Louisiana, Mississippi, Alabama, Georgia, South Carolina and Maryland. Georgia could serve as a representative testing site for piloting the program. In particular, metro-Atlanta Georgia is home to a large number of immigrants from Africa, the Caribbean and the West Indies, which present unique migratory acculturating habits in diet and lifestyle that have not been previously addressed in African American prevention programs. The adaptation to westernized lifestyles of the present, second and third generations of these migrants needs to be determined in relationship to its potential impact on cardiovascular disease risk. Cultural specific strategies and African/African American history incorporated into the African American intervention model can help break barriers to learning, may enhance knowledge and facilitate motivation to reduce risk of cardiovascular disease in this high risk population. The study will be conducted in the Clinical Research Center at Morehouse School of Medicine. The study is a randomized experimental design intervention study comparing the effect of a culturally- enriched intense educational program with standard care for patients at risk for cardiovascular disease. Subjects participating in a focus group to assess existing educational materials will be randomized to receive either continued standard care at their primary care facility or the intense education program. The program components of increased fruits, vegetables, low fat dairy products and nuts (DASH diet) will result in improved blood pressure and decreased total and LDL cholesterol (Aim 1 and 2). Increase in physical activity and decreased or cessation of habitual smoking will result in improvement in cardiovascular fitness (Aim 3).

该副本是利用众多研究子项目之一 由NIH/NCRR资助的中心赠款提供的资源。子弹和 调查员（PI）可能已经从其他NIH来源获得了主要资金， 因此可以在其他清晰的条目中代表。列出的机构是 对于中心，这不一定是调查员的机构。 一项以文化设计的社区预防计划将有效降低非裔美国人心血管疾病的风险。该假设适用于以下研究的目的。 目的，特定的假设和基本原理将在下面进行详细描述。 具体目标1： 通过减少血压，腰围和体重指数来减少心血管疾病的生理危险因素。 假设： 通过饮食和体育锻炼的生活方式改变肥胖症的减少将导致血压降低，体重指数，腰围和心血管疾病风险。 理由： 肥胖与心血管疾病发病率的增加和死亡率有关，显然是通过对胰岛素抵抗，葡萄糖不耐症，高甘油三酸酯，HDL胆固醇和高血压的影响而介导的。 更具体地说，内脏肥胖似乎是最危险和动脉粥样硬化的。 腰围为评估内脏脂肪组织评估并与心血管疾病更好的工具比体重指数（BMI）和腰围/髋关节比（1-5）更好。除了促进体重减轻外，还显示出常规的体育活动可改善血液胆固醇，血糖和血压。 具体目标2： 通过降低总胆固醇和LDL胆固醇，减少心血管疾病的生化危险因素。 假设： 遵守高纤维的饮食，总脂肪和饱和脂肪（dash饮食）含量低，将导致总LDL胆固醇和心血管风险降低。 理由： 甘油三酸酯升高，小型LDLC和低HDLC是心血管疾病的重要危险因素。 Liu and Associates先前已经证明了高饮食纤维对心血管疾病的有益作用（6-7）。 有人提出，足够量的富含纤维的碳水化合物可以防止碳水化合物诱导的高甘油三酯血症。 破折号饮食富含水果，蔬菜和全谷物，可提供大量的植物化学物质和饮食纤维。 特别是，植物固醇，类胡萝卜素和黄酮酮的仪表板饮食明显高于典型的美国饮食。 这些生物活性植物化学物质可以通过抗氧化活性降低心血管疾病的风险（8）。 破折号饮食还具有高碳水化合物，低脂计划。破折号饮食中的碳水化合物来自高饮食纤维富含食物。 在31克饮食纤维时，破折号饮食符合当前每天25-35克纤维摄入的建议，超过了典型的美国饮食，其中仅包含9克纤维。 具体目标3： 通过减少或消除常规体育锻炼，减少心血管疾病的社会学风险因素。 假设： 通过教育减少吸烟将减少非洲裔美国人的冠状动脉疾病和中风的风险。体育锻炼的增加将提高心脏的效率，促进体重减轻并减轻与吸烟冲动有关的压力。 理由： 吸烟者患心脏病的风险是非吸烟者的两倍。 泰勒（Taylor）和同事在冠状动脉手术研究（CASS）中发现，在随访的16年中，仅香烟吸烟就占非裔美国人的死亡率较高，而不论治疗类型如何（9）。 B.背景和意义： 黑人或非裔美国人人口的医疗保健差异，包括来自非洲，加勒比海和西印度群岛的最近移民，有据可查，心血管疾病仍然是杀手的头号杀手，每年占死亡人数的37％。 每10个非西班牙裔黑人成年人中大约有四个患有心血管疾病。 约有41％的非西班牙裔黑人男性和40％的黑人女性患有心血管疾病，而30％的非西班牙裔白人男性和24％的白人女性（10）。美国黑人的高血压率是世界上最高的。 与白人相比，非洲裔美国人的高血压患病率和严重程度更高，而且发病年龄较早（11，12）。 最近的数据表明，糖尿病患者的心血管事件通过初次预防而减少，非洲裔美国人群的脂质降低和侵略性降低血压疗法（13）。 美国人口普查局预计，非裔美国人人口将从2000年的12％增加到2035年的14.3％，代表超过5000万个人。 由于歧视，文化障碍和缺乏医疗保健的机会，非裔美国人与其他种族群体之间的健康差异继续导致心血管疾病的死亡和残疾水平不成比例。 到2010年消除差距的目标包括将非裔美国人从心脏病中减少30％的死亡以及中风死亡47％。 减少危险因素，例如高血压，高胆固醇，吸烟烟草，血糖控制，体重过大和身体不活动，为降低心血管疾病死亡率提供了最大的潜在策略。 针对拉丁裔美国人的NHLBI“ Salud para su Corazon”等基于社区的预防计划最近已证明成功地教育了拉丁裔社区有关可以改善其健康的生活方式的改变。 最近在223个家庭中对“ Salud Para su Corazon”进行了“ Salud Para su Corazon”的测试（n = 320），导致家庭之间的心脏健康行为变化（14）。针对非裔美国人社区的类似计划可以像结果一样提供。 开发的材料可以传播给卫生组织和非裔美国人社区的初级保健实践（15）。 关于行为变化对心脏病发病率和死亡率的积极影响的信息存在大量信息（16）。 但是，访问此信息存在健康差异。 当开发教育材料以服务于普通人群时，语言和文化差异可能会影响预防心血管疾病信息的能力，从而无法理解并提供利益。 Sheats和同事发现，即使在医疗服务不足的医疗保健环境中，高加索人和非洲裔美国人的医疗保健治疗强度相似，在非裔美国人中仍然存在较高的患病率和对高血压的控制较小（17）。 此外，对心脏病作为死亡原因的看法可能无法得到充分的理解，尤其是在非裔美国女性中。 Mosca and Associates确定，不到33％的美国女性（13％的非裔美国人）将心脏病确定为死亡的主要原因（18）。 一些旨在消除护理非裔美国人的障碍的社区计划以前已被证明是有效的。 贝克尔和同事最近为具有早产冠心病病史的黑人家庭设计的一个基于社区的多重危险因素干预计划。 与“增强”初级保健（EPC）相比，由社区的护理人员和社区卫生工作者组成的基于社区的护理（CBC）导致CBC组可显着降低冠心病风险（P0.0001）。 EPC组没有发现降低风险（19）。 拟议的“人类心脏计划”基于文化的生活方式干预计划，以降低非裔美国人的心血管疾病风险，将集中在移民到美国对当今非裔美国人饮食习惯和生活方式行为的影响。 大多数非裔美国人人口在东南和中大西洋地区的集中度最高，例如路易斯安那州，密西西比州，阿拉巴马州，乔治亚州，南卡罗来纳州和马里兰州。 佐治亚州可以用作代表性测试地点，以试行该计划。特别是，佐治亚州大都市是来自非洲，加勒比海和西印度群岛的大量移民的所在地，这些移民呈现出独特的饮食和生活方式中独特的迁徙习惯习惯，这些习惯以前尚未在非裔美国人预防计划中解决。 需要确定这些移民的第二代和第三代西方生活方式的适应，需要确定其对心血管疾病风险的潜在影响。 文化特定的策略和非裔美国人干预模型中纳入的非洲/非裔美国人历史可以帮助打破学习障碍，可以增强知识并促进在这种高风险人群中降低心血管疾病风险的动机。 该研究将在莫尔豪斯医学院的临床研究中心进行。 这项研究是一项随机实验设计干预研究，将富含文化的强度教育计划与有心血管疾病风险的患者进行标准护理进行了比较。 参与焦点小组评估现有教育材料的受试者将被随机分配，以在其初级保健设施或激烈的教育计划中继续进行标准护理。 增加水果，蔬菜，低脂乳制品和坚果（仪表式饮食）的计划成分将导致血压提高，总胆固醇和LDL胆固醇降低（AIM 1和2）。 体育锻炼的增加，习惯吸烟的减少或停止将导致心血管健康的改善（AIM 3）。