Accumulating evidence links psychosocial factors with the development of atherosclerosis. Much of this previous research has been conducted in nonhuman samples. Recent developments in the noninvasive assessment of subclinical atherosclerotic disease, along with the measurement of mental stress and stress responding, have allowed us to extend this type of investigation to human community samples, with important implications for risk stratification and prevention. During our initial funding period, we recruited a sample of 367 healthy men and women with no history of cardiovascular disease (50-70 years of age). Measures of psychosocial demands and social support were assessed during daily life, using a real-time electronic diary system. We also assessed individual differences in stress-related cardiovascular reactivity (CVR) using an automated test battery developed in our laboratory. These psychosocial factors were shown to be associated, as hypothesized, with ambulatory blood pressure (ABP), carotid artery atherosclerosis, by ultrasound, and, in some cases, with three-year carotid artery atherosclerotic progression as well. A number of gender differences in the association between psychosocial factors and atherosclerosis were observed. In this competing renewal application, we propose continuing to follow this sample for an additional 2-1/2 year funding period, with the following aims: a) to replicate and extend our initial findings on carotid atherosclerosis over a longer time course (total of 6 years), examining how psychosocial factors may be linked with the longer term trajectory of subclinical atherosclerosis in a healthy community sample; b) to determine whether changes in psychosocial factors over a 6-year time frame may be associated with commensurate alterations in the course of the disease, a question which may have implications for early intervention; c) to examine the extent to which psychosocial factors may be related to ABP changes over the 6-year follow-up period and to explore the extent to which such changes may contribute to atherosclerotic risk; and d) to determine the role of biological factors (specifically, the effects of autonomic function) and behavioral factors (specifically, the role of individual differences in verbal aggression) as possible determinants accounting for gender differences in the relationship between psychosocial factors and subclinical carotid artery disease progression. ? ?
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