Cardiovascular disease (CVD) remains the leading cause of death among women. Risk of CVD increases substantially during perimenopause, the critical window of 6-8 years before a woman?s final menstrual period. Increasing evidence suggests that Latinas have a significantly worse CVD risk factor profile than non-Hispanic women, which can be attributed to multiple sociocultural and environmental factors (e.g., lower socioeconomic position, discrimination, stress). These factors are related to CVD through their influence on health behaviors, as well as potential mechanisms involving inflammatory and neuroendocrine pathways. Although behavioral intervention research targeting CVD risk during perimenopause emerged over the past decade, no studies were designed to intervene on behavioral influences to decrease biological CVD risk among perimenopausal Latinas. Using the National Institute of Minority Health and Health Disparities (NIMHD) Framework, we will address the sociocultural and built environments and intervene on behavioral influences to decrease biologic CVD risk among perimenopausal Latinas.
The aim of this investigation is to examine feasibility and initial efficacy of a behavioral intervention led by community health workers to a) decrease the primary outcomes of biologic CVD risk factors (blood pressure [BP], arterial stiffness, lipids, blood glucose); b) improve secondary outcomes (health behaviors: nutrition, physical activity, sleep, coping strategies) and other biological factors (adiposity, inflammatory and stress biomarkers, vasomotor symptoms) from baseline to 6- and 12-month follow-up. We will recruit participants from two community groups: one group will be randomly assigned to complete the intervention; the other will be a wait-list control. This intervention has 3 phases: 12 weekly sessions (Phase I: education, physical activity, stress management, coping skills training) followed by 3 monthly sessions of continued support (Phase II); and finally 6 months of skill maintenance on their own (Phase III). The long-term goal of this award is to develop Dr. Corts? independence as an investigator, leading a program of research dedicated to improving women?s cardiovascular health, and to implement interventions for prevention and self-management of CVD in perimenopausal women, particularly Latinas. The proposed K23 will support her development through mentorship and training in: 1) community-engaged research; 2) clinical trial design, implementation, and evaluation; 3) the effect of behavioral interventions on biologic outcomes; and 4) professional development skills in leadership, publication, and grantsmanship. To accomplish her research aims and training goals, Dr. Corts has assembled an interdisciplinary team of scientists with expertise in community engagement, intervention design, clinical trial analysis, sociocultural and biological measures, and career development mentorship. This research holds potential to accelerate greatly the acquisition of knowledge related to CVD risk among perimenopausal Latinas, and the impact of behavioral interventions to reduce CVD risk in this underserved population.
The proposed research is relevant to public health because perimenopausal Latinas remain considerably less likely than non-Hispanic White women to meet physical activity and dietary guidelines, or be aware that CVD is the leading cause of death among women. Because Hispanic/Latinos are the largest ethnic minority in the United States (US), progress regarding CVD risk among perimenopausal Latinas may lead to significant improvement in the overall CVD burden in the US. Furthermore, the proposed research may provide insight on the interplay among sociocultural and built environments, behavioral influences and biological influences contributing to women?s overall cardiovascular health.