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).

该子项目是利用该技术的众多研究子项目之一 资源由 NIH/NCRR 资助的中心拨款提供。子项目及 研究者 (PI) 可能已从 NIH 的另一个来源获得主要资金， 因此可以在其他 CRISP 条目中表示。列出的机构是 对于中心来说，它不一定是研究者的机构。 基于文化设计的社区预防计划将有效降低非裔美国人患心血管疾病的风险。该假设适用于以下研究目标。 下面详细描述了目标、具体假设和基本原理。 具体目标1： 通过降低血压、腰围和体重指数来减少心血管疾病的生理危险因素。 假设： 通过改变饮食和身体活动等生活方式来减少肥胖将导致血压、体重指数、腰围和心血管疾病风险降低。 理由： 肥胖与心血管疾病发病率和死亡率增加有关，这显然是通过其对胰岛素抵抗、葡萄糖耐受不良、高甘油三酯血症、高密度脂蛋白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且最容易导致动脉粥样硬化的。 腰围是评估内脏脂肪组织的绝佳工具，与体重指数 (BMI) 和腰臀比 (1-5) 相比，腰围与心血管疾病的相关性更好。规律的体育活动已被证明可以改善血液胆固醇、血糖和血压，此外还可以促进减肥。 具体目标2： 通过降低总胆固醇和低密度脂蛋白胆固醇来减少心血管疾病的生化危险因素。 假设： 坚持高纤维、低总脂肪和饱和脂肪的饮食（DASH 饮食）将降低总胆固醇和低密度脂蛋白胆固醇以及心血管风险。 理由： 甘油三酯升高、小密度低密度脂蛋白胆固醇和高密度脂蛋白胆固醇低是心血管疾病的重要危险因素。 Liu 及其同事先前已证明高膳食纤维对心血管疾病的有益作用 (6-7)。 有人建议，充足的富含纤维的碳水化合物可以预防碳水化合物引起的高甘油三酯血症。 DASH 饮食富含水果、蔬菜和全谷物，提供大量的植物化学物质和膳食纤维。 特别是，DASH 饮食中的植物甾醇、类胡萝卜素和黄烷酮含量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)。 DASH 饮食还具有高碳水化合物、低脂肪的计划。 DASH 饮食中的碳水化合物来源来自富含膳食纤维的食物。 DASH 饮食含有 31 克膳食纤维，符合目前每天 25-35 克纤维摄入量的建议，超过了仅含有 9 克纤维的美国典型每日饮食。 具体目标 3： 通过减少或消除习惯性吸烟以及增加定期体育活动来减少心血管疾病的社会学危险因素。 假设： 通过教育减少吸烟将降低非裔美国人患冠状动脉疾病和中风的风险。增加身体活动将提高心脏的效率，促进减肥并减少与吸烟冲动相关的压力。 理由： 吸烟者心脏病发作的风险是不吸烟者的两倍多。 Taylor 及其同事在冠状动脉手术研究 (CASS) 中发现，在 16 年的随访期间，无论采用何种治疗类型，仅吸烟就导致非裔美国人的死亡率较高 (9)。 B. 背景和意义： 美国黑人或非裔美国人（包括来自非洲、加勒比海和西印度群岛的新移民）的医疗保健差异是有据可查的，心血管疾病仍然是头号杀手，每年导致 37% 的死亡。 大约每 10 个非西班牙裔黑人成年人中就有 4 人患有心血管疾病。 约 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，而非西班牙裔白人男性和白人女性的这一比例分别为 30% 和 24% (10)。美国黑人的高血压发病率是世界上最高的之一。 与白人相比，非裔美国人的高血压患病率和严重程度更高，而且发病年龄更早 (11, 12)。 最近的数据表明，通过对非裔美国人人群进行降脂和积极降压治疗等一级预防，糖尿病患者的心血管事件有所减少 (13)。 美国人口普查局预计，非洲裔美国人人口将从2000年的12%增加到2035年的14.3%，超过5000万人。 由于歧视、文化障碍和缺乏医疗保健机会，非裔美国人和其他种族群体之间的健康差异继续导致心血管疾病造成的死亡和残疾比例过高。 到 2010 年消除差距的目标包括将非裔美国人因心脏病死亡人数减少 30%，因中风死亡人数减少 47%。 减少高血压、高胆固醇、吸烟、血糖控制、体重过重和缺乏身体活动等危险因素是降低心血管疾病死亡率的最有潜力的策略。 以社区为基础的预防计划，例如针对拉丁裔美国人的 NHLBI“Salud Para Su Corazon”，最近已被证明在教育拉丁裔社区如何改变生活方式以改善他们的健康方面取得了成功。 最近对 7 个地点的 223 个家庭 (n=320) 进行的“Salud Para Su Corazon”测试导致这些家庭的心脏健康行为发生了变化 (14)。针对非裔美国人社区的类似计划也可以带来类似的结果。 开发的材料可以分发给卫生组织和非裔美国人社区的初级保健实践 (15)。 关于行为改变对心脏病发病率和死亡率的积极影响有大量信息 (16)。 然而，在获取这些信息方面存在健康差异。 当开发教育材料以服务于大众时，语言和文化差异可能会影响心血管疾病预防信息被理解和提供益处的能力。 Sheats 及其同事发现，即使在医疗服务不足的医疗保健环境中白种人和非裔美国人的医疗保健治疗强度相似，非裔美国人的高血压患病率仍然较高且控制较差 (17)。 此外，人们可能不太了解心脏病是导致死亡的原因，尤其是对于非裔美国女性。 Mosca 及其同事确定，在接受调查的美国女性中，只有不到 33%（13% 非裔美国人）认为​​心脏病是导致死亡的主要原因 (18)。 一些旨在消除非裔美国人护理障碍的社区计划此前已被证明是有效的。 贝克尔和同事最近开展了一项针对有早发冠心病史的黑人家庭的基于社区的多危险因素干预计划。 与“强化”初级保健 (EPC) 相比，社区护理 (CBC) 由一名执业护士和社区卫生工作者在社区环境中组成，使 CBC 组的冠心病风险显着降低。 p0.0001）。 EPC 组没有发现风险降低 (19)。 拟议的“人类之心项目”以文化为基础的生活方式干预计划旨在降低非裔美国人的心血管疾病风险，该计划将围绕移民到美国对当今非裔美国人的饮食习惯和生活方式的影响进行。 大多数非裔美国人主要集中在东南部和大西洋中部地区，如路易斯安那州、密西西比州、阿拉巴马州、佐治亚州、南卡罗来纳州和马里兰州。 乔治亚州可以作为该计划试点的代表性测试地点。特别是，佐治亚州亚特兰大都会区是大量来自非洲、加勒比海和西印度群岛的移民的家园，这些移民在饮食和生活方式方面呈现出独特的移民适应习惯，而这些习惯以前在非裔美国人的预防计划中尚未得到解决。 目前、第二代和第三代移民对西化生活方式的适应需要结合其对心血管疾病风险的潜在影响来确定。 将文化特定策略和非洲/非裔美国人历史纳入非裔美国人干预模型中可以帮助打破学习障碍，可以增强知识并促进降低这一高危人群心血管疾病风险的动力。 该研究将在莫尔豪斯医学院临床研究中心进行。 该研究是一项随机实验设计干预研究，比较了文化丰富的强化教育计划与标准护理对心血管疾病风险患者的效果。 参加焦点小组评估现有教育材料的受试者将被随机分配，接受初级保健机构的持续标准护理或强化教育计划。 增加水果、蔬菜、低脂乳制品和坚果（DASH 饮食）的计划组成部分将改善血压并降低总胆固醇和低密度脂蛋白胆固醇（目标 1 和 2）。 增加体力活动和减少或戒除习惯性吸烟将改善心血管健康（目标 3）。