Behavioral Factors in Coronary Heart Disease
Condition: Cardiovascular Diseases; Heart Diseases; Coronary Disease; Metabolic Syndrome X
MeSH terms: Cardiovascular Diseases; Heart Diseases; Coronary Disease; Metabolic Syndrome
Study type: Observational

Summary: 
      To elucidate the role of biobehavioral factors in the etiology, pathogenesis and course of
      coronary heart disease (CHD) and to use this knowledge to devise more effective prevention,
      treatment and rehabilitation approaches.
    

Detailed description: 
      BACKGROUND:

      The integrating theme of the study is that hostility affects both behaviors and biologic
      functions in ways that increase the risks of developing coronary atherosclerosis or suffering
      an acute CHD event. Disciplines involved include psychology, internal medicine, cardiology,
      psychiatry, pharmacology, biostatistics, epidemiology, and molecular biology.

      DESIGN NARRATIVE:

      There were five subprojects in the original program project grant. Subproject 1 examined the
      social, behavioral and biologic concommitants of both natural and experimental interpersonal
      conflicts as a function of multimodal hostility assessments. Subproject 2 examined the role
      of hostility and social support in survival among CHD patients and attempted to identify the
      behavioral mediators of survival effects. Subproject 4 evaluated the effects of hostility,
      both alone and jointly with risk factors and social factors, on CHD incidence in over 5,000
      participants in the University of North Carolina Alumni Heart Study. Subproject 5 evaluated
      the effects of age, smoking, lipids, and adrenergic receptors on physiologic reactivity of
      hostile and nonhostile men to anger induced by interpersonal challenges in the lab as well as
      the events of daily life. Subproject 7 extended the evaluation of anger-associated biologic
      reactivity in hostile and nonhostile persons by studying biobehavioral responses of 200 women
      employed in a real world high stress work situation; it also evaluated the impact of a stress
      management intervention designed to reduce anger on biobehavioral reactivity in these same
      employees.

      The study was renewed in fiscal year (FY) 1997 to expand the primary focus on hostility to
      include a set of psychosocial, behavioral, and biological characteristics that increased
      coronary heart disease risk and appeared to cluster in certain individuals and groups,
      especially those low in socioeconomic status (SES). Subproject 1 examined in approximately
      360 subjects the synergistic effects of SES and psychosocial risk factors such as depression,
      hostility, and social isolation on biological and behavioral factors suspected or known to
      contribute to atherogenesis. Subproject 2 evaluated the role of the central nervous system
      serotonin function as a potential mediator of the clustering of health-damaging psychosocial
      and biobehavioral characteristics in the same individuals and low SES groups. Subproject 3,
      the Psychosocial Risk for Cardiovascular Disease in Youth Project (PRCVDYP), used three
      ongoing general population studies of youth as a basis for examining the development of
      psychosocial risk for cardiovascular disease. The investigators hypothesized that low SES
      youth would exhibit, in addition to increased levels of the psychosocial and behavioral risk
      factors under study, increased sympathetic nervous system tone and reactivity to mental
      challenge, as well as decreased peripheral nervous system tone. They also hypothesized that
      depression, social isolation, and harsh parenting will interact with low SES to increase
      cardiovascular disease risk. Subproject 4 used a rat model to investigate early experience,
      serotonin and adult function.

      The study was renewed in FY 2004 and includes three subprojects. Subproject 1 will determine
      the role of gene-environment interactions in the expression of psychosocial and biobehavioral
      risk factors for cardiovascular disease. Variants will be identified in candidate genes and
      chromosomal loci that are associated with the endophenotypes of hostility, personality, other
      psychosocial risk factors, health behaviors, and the following responses to rest and stress
      -- cardiovascular and neuroendocrine function, platelet activation and serotonin transporter
      function, circulatory inflammatory markers and the tendency of all of these characteristics
      to cluster in the same individuals and low socioeconomic groups. A total of 400 probands
      (half African American, half Caucasian, half women) and at least one sibling for each proband
      will be recruited for a total of 800 to 1200 subjects. Subproject 2 will explore in 400
      subjects the genetics of glucose metabolism, hostility, and cardiovascular disease risk
      factors. Subproject 3 will examine the genetics, hostility and biology of stress in daily
      life in 400 probands and one sibling for every proband.
    

Observational model: Family-Based
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Healthy normal volunteers
      
Biospecimen description: 
      Urine and plasma samples and extracted DNA are retained