This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. African American men and women suffer from excessive rates of cardiovascular disease (CVD) compared to white Americans. High levels of psychosocial and socioenvironmental stress contribute to the disproportionate CVD and death rates in this population. The present collaborative team has previously demonstrated in NHLBI-supported randomized controlled trials that intervention with a selected stress reduction approach, the Transcendental Meditation program, was associated with significant reductions in CVD risk factors and surrogate markers for clinical CVD. These include decreases in hypertension, myocardial ischemia, and carotid atherosclerosis, as well as improvements in quality of life. While these short-term results are encouraging, the proposed single site study will allow long-term follow-up of this sample to evaluate effects on hard CVD outcomes with an additional five funded years. This will bring the total study and intervention time to nine years which will have sufficient power to detect significant differences in more rigorous 'hard' CVD endpoints and at the same time assess the sustainability of the effects of behavioral intervention in this high risk population. Therefore, the specific aims are: A.
SPECIFIC AIMS 1. To evaluate the long-term effects of stress reduction compared to health education control on the primary outcome of 'hard' events of mortality, myocardial infarction, and stroke. 2. To evaluate the long-term effects of stress reduction compared to health education control on combined 'hard' and 'soft' clinical CVD events as a secondary outcome. 3. To evaluate the long-term effects of stress reduction compared to health education control on traditional cardiovascular risk factors, psychosocial stress factors and quality of life. 4. To assess the associations of baseline demographics, traditional CVD risk factors, and psychosocial factors with the primary outcome of CVD morbidity and mortality; and the potential role of changes in these risk-related factors in mediating effects of intervention on the primary clinical outcome. 5. To evaluate the long-term cost effectiveness of stress reduction compared to health education in the secondary prevention of CVD in high-risk African Americans.
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