This competing renewal application (5 R01 HL25767-24) proposes to re-assess adolescents enrolled in Project Pressure three years after their initial assessment to address key hypotheses regarding the early emergence of behavioral risk factors for cardiovascular disease (CVD) in adolescence and their antecedents and consequences. Adolescence is an important period to study the development of CVD risk factors because CVD risk factors track in adolescents and predict clinical CVD later in life and because behavioral and biological risk factors tend to cluster together in adolescents. In the initial phase of Project Pressure, we collected data from 217 black and white, male and female high school students to test cross-sectionally a model of the development of CVD risk factors. Our model suggests that adolescents' socioeconomic status and ethnicity affect their exposure to psychological stress, including discrimination, which, in turn, is thought to lead to the development of the propensity to be vigilant for possible threat, to view ambiguous situations as potentially harmful, and to mistrust others. These cognitive propensities may become more automatic with development and lead to stable traits of hostility, anxiety, and heightened cardiovascular responsivity to stress. These traits may then affect the early development of vascular stiffness and left ventricular mass. We now propose to test the model longitudinally using the same measures as in the initial assessment, plus adding some new measures that take advantage of recent technological and conceptual advances: (a) endothelial dysfunction and carotid intima medial thickness; (b) coping with discrimination and ethnic identity; and (c) depression. We anticipate that 165 of the previous adolescents will be reassessed, which is adequate in terms of power to test our key hypotheses. The longitudinal design will be a stronger test of the model than the previously awarded grant supporting the cross-sectional study. This project will contribute to the knowledge base necessary to prevent the early development of sub clinical CVD.
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