AIANP:Healing Hearts

PROJECT TITLE:	HEALING HEARTS
FUNDING SOURCE:	NHLB/NIH
DATES OF FUNDING:	2003-2008
PRINCIPAL INVESTIGATOR(S):	Spero M. Manson, PhD.
CENTER STAFF INVOLVED:	Doug Bremmer, Viola Vaccarino, Jack Goldberg, Dedra Buchwald, John Carroll, Lisa Bighorn

SPECIFIC AIMS/RESEARCH GOALS:

This study has 3 Specific Aims:

to determine whether individuals with PTSD, compared to those without PTSD, show greater evidence of subclinical CVD, including a lower coronary flow reserve, and an increased carotid intima-media thickness;
to ascertain whether HRV is lower in individuals with PTSD compared to those without PTSD, a reduction in HRV is a risk factor for coronary arrhythmias and sudden death; and
to investigate the role of lifestyle (e.g., smoking, alcohol use, exercise, obesity, oral health), cultural (e.g., acculturation, religiosity), and biological (e.g., blood pressure, blood lipid and glucose concentrations) mediators in the relationship of PTSD with coronary flow reserve and HRV.

RESEARCH DESIGN: N/A

PARTICIPANTS:
The proposed study will examine the association between PTSD and subclinical CVD in AIs. The SUPERPFP database will be used to identify a group of Northern Plains AIs who were free from CVD and had a DSM-IV diagnosis of lifetime PTSD in the initial study conducted from (1997-1999). A comparison group of Northern Plains AIs matched on age, sex and tribe, without CVD or PTSD will be randomly selected from the same database. Each selected individual will be invited to undergo a comprehensive clinical and laboratory evaluation to assess the nature and extent of current CVD risk factors, current CVD, and determine if markers of subclinical disease are present more frequently among individuals with PTSD than among those free from PTSD after controlling for various demographic, clinical, and cultural factors.

MEASURES:

Sociodemographic Information
Age	Interview	Confounder
Blood Quantum	Interview	Mediator / Confounder
Education	Interview	Confounder
Marital Status	Interview	Mediator / Confounder
Social Support	Interview
Psychological/functional constructs
General psychological distress	Interview	Risk factor
CES-D (depressive symptoms)	Interview	Risk factor
Trauma Inventory	Interview	Risk factor
Hostility / Aggression	Interview	Risk factor
SCID (psychiatric diagnoses including PTSD)	Interview	Risk factor
SF-36 (health status)	Interview	Mediator / Confounder
History of CVD	Interview	Secondary outcome
Behavioral risk factors
Smoking	Interview	Control factor (mediator)
Physical activity	Interview	Control factor (mediator)
Alcohol consumption	Interview	Control factor (mediator)
Dietary intake	Interview	Control factor (confounder/ antecendent)
Family history	Interview	Control factor (condounder/ antecendent)
Cultural factors
Acculturation	Interview	Control factor (condounder/ antecendent)
Ceremonial tobacco use	Interview	Control factor (condounder/ antecendent)
Traditional health practices	Interview	Control factor (mediator)
CVD risk factors
Blood pressure	Clinical measurement	Control factor (mediator)
Anthropometric measures	Clinical measurement	Control factor (mediator)
Blood lipids	Laboratory measurement	Control factor (mediator)
Blood glucose, insulin, HbA1c	Laboratory measurement	Control factor (mediator)
Fibrinogen, C-reactive protein, P-selectin	Laboratory measurement	Control factor (mediator)
Homocysteine	Laboratory measurement	Control factor (mediator)
Current diabetes, hypertension	Interview	Secondary analyses
Current use of medications	Interview	Control factors/ secondary analyses
Neurohormonal factors
Plasma ACTH, cortisol, DHEA-S	Laboratory measurement	Control factor (mediator)
Plasma norepinephrine, epinephrine	Laboratory measurement	Control factor (mediator)
Coronary flow reserve	PET myocardial perfusion imaging	Primary outcome
HVR	24-hour ECG monitoring	Primary outcome
Carotid intima-media thickness	B-mode ultrasound	Secondary outcome

PUBLICATIONS:
None at this time.