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

University Of Alabama At Birmingham, Birmingham AL

Investigators

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Abstract

? 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.