Relative to whites, older black and Hispanic adults experience higher rates of many major risk factors for cardiovascular disease: physical inactivity, obesity, fasting hyperglycemia, and dyslipidemia. Blacks also have elevated rates of hypertension, while Hispanlcs have elevated rates of the metabolic syndrome. Beyond cardiovascular disease, these populations also face high exposures to major and traumatic life stressors, contributing to high rates of depression and anxiety symptoms. Linkages between depression and cardiovascular disease are well documented. Despite this, interventions targeting depression have not shown improvements in cardiovascular mortality, and strategies targeting single risk factors have also failed to reduce health disparities, investigators from the Rush Center for Urban Health Equity propose to test a multi-level approach that targets 1) individual psychological and behavioral risk by providing preferential attention to the treatment of depression and 2) the health care system by building a multi-disciplinary team in a primary care setting, in which treatment of depression and behavioral risk factors of diet, activity, and medication adherence are integrated in the service of reducing the metabolic syndrome. The primary aim of the BRIGHTEN Heart (Bridging Resources of a Geriatric Health Team via Electronic Networking ~ Heart) trial is to determine whether BRIGHTEN Heart can reduce depression symptoms in older minority adults with comorbid depression and metabolic syndrome. Secondary aims are to determine whether the BRIGHTEN Heart intervention can result in reduced prevalence of metabolic syndrome as compared to an attention control and to test the mediating hypothesis that the BRIGHTEN Heart intervention results in improvements in adherence with medications. An exploratory aim is to explore the impact of trauma and major life stressors on the results of the intervention. Methods: 250 black and Hispanic adults will be recruited from three large community health centers in Chicago. Subjects must be over age 65, have a BMI S25.0, and have symptoms of depression documented via the PHQ-g instrument. Subjects will then be randomized to either receive the multi-level BRIGHTEN Heart team intervention or be invited to participate in a membership program providing regular health education to older adults. All subjects will be followed for six months. Outcome measures will include the PHQ-9 depression instrument, and cardiometabolic risk factors including fasting blood glucose, hemoglobin Ale, HDL cholesterol, blood pressure, and cardiac CRP. The trial will also provide disparities research training for minority students and early career health professionals.
Cardiovascular health disparities have persisted or worsened in the past two decades, despite efforts to narrow the gap. If the BRIGHTEN Heart multi-level intervention is found effective in reducing depression and metabolic syndrome among older minority adults, it could be readily implemented in clinics and community health centers to reverse the excess toll taken by cardiovascular disease.
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