Cardiovascular Diseases Clinical Trial
To investigate how inflammation, hemostasis, and stress may contribute to neighborhood and individual-level socioeconomic differences in cardiovascular risk.
BACKGROUND:
In epidemiologic studies, associations of cardiovascular risk with individual and
neighborhood socioeconomic characteristics tend to persist after adjustment for established
cardiovascular risk factors suggesting that other mediators may be involved. However,
evidence regarding what these mediators may be is largely absent. Elucidating the reasons
for these persistent socioeconomic differences may enhance our ability to reduce these
differentials and will contribute to our understanding of the causes of cardiovascular
disease generally. Two biological processes, inflammation and hemostasis, have recently
emerged as potentially important in the development of atherosclerosis and the precipitation
of clinical cardiovascular events. Both processes have also been recently linked to
psychosocial factors and stress. However, studies investigating social gradients in
inflammation and hemostasis remain rare. In addition, the relation of psychosocial factors
and biological markers of the stress response to inflammation and hemostasis have not been
examined in large population-based studies.
DESIGN NARRATIVE:
The study is ancillary to the ongoing epidemiologic study of atherosclerosis, the
Multi-Ethnic Study of Atherosclerosis (MESA). The project will collect data on stress
hormones and follow- up measures of inflammation and hemostasis which are not part of the
existing MESA protocol on a subsample of the cohort. The study will also collect additional
data on neighborhood sources of stress for the subsample. The new data will be linked to
existing MESA data.
Using newly collected data linked to the MESA, the study will investigate (1) associations
of neighborhood and individual-level socioeconomic indicators with markers of inflammation
and hemostasis; (2) associations of individual-level psychosocial factors and sources of
chronic stress (at the individual and neighborhood level) with inflammatory markers and
hemostasis; and (3) the relationship between biological markers of the stress response (such
as cortisol and adrenaline/noradrenaline) and inflammation and hemostasis). Project aims
will be achieved by linking MESA data to newly-collected data on neighborhood
characteristics and biomarkers of inflammation, hemostasis and the stress response in MESA
participants. The project is innovative in that it will span and link three levels: the
social/environmental level (neighborhood characteristics and social position), the
behavioral/psychological level (behavioral and psychosocial factors), and the biological
level (inflammation, hemostasis, and stress hormones). The study will provide a unique
opportunity to elucidate the links between socioeconomic factors, stress, inflammation and
hemostasis in a large and diverse population-based sample.
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Observational Model: Cohort, Time Perspective: Prospective
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