This program project competitive renewal application consists of an integrated, multidisciplinary program including 3 closely related projects examining the preclinical and/or clinical markers of coronary heart disease (CHD) risk associated with type 2 diabetes, metabolic syndrome or hyperlipidemia and their involvement in the progression or amelioration of atherosclerotic CHD processes. In each project we will examine the modification of risk factors through the use of behavioral interventions such as dietary restriction, exercise, stress management and/or manipulations of social environment. Outcome variables will include measures of glycemic control/insulin resistance and/or dyslipidemia, oxidative stress, inflammation and overt manifestations of disease. The first Project will determine if compared to Standard Care (SC), a Community Approach to Lifestyle Modification for Diabetes (CALM-D) program including diet, physical activity and coping skills training, can decrease depression, weight and HbA1c and improve medication adherence in low income, minority, depressed, overweight, type 2 diabetic patients seen in a large comprehensive community health center. The second Project will determine if compared to SC, a Community Health and Risk-reduction in Metabolic Syndrome (CHARMS) program also including diet, physical activity and coping skills training, can decrease weight, increase physical activity and reduce the frequency and severity of metabolic syndrome. The third project will assess the role of behavior in the progression of atherosclerosis in the Watanabe Heritable Hyperlipidemic Rabbit by examining the influence of social environment on hyperlipidemic, oxidative, and inflammatory disease processes. The projects will interact with and rely heavily on, the Biochemical Analyses Core, the Cardiovascular Measurement Core and the Data Management and Statistical Analyses Core.
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