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April 11, 2005
META-Health project teams up Emory, Morehouse

BY holly korschun

The National Institutes of Health (NIH) has awarded a research team at Emory and Morehouse School of Medicine $6 million for a five-year partnership to address health disparities between African Americans and Caucasians at high risk for developing cardiovascular disease.

NIH’s National Heart, Lung and Blood Institute funded such partnerships, each consisting of a collaborative interchange among research-intensive institutions, minority-serving systems, academicians, clinicians, public health practitioners, students and laypersons, all working within high-risk ethnic communities.

Atlanta’s program—dubbed META-Health (“Morehouse and Emory are Teaming up to eliminAte Health disparities”)—will be distinctive in its focus on the “metabolic syndrome,” a cluster of health risk factors including hypertension, abnormal cholesterol, high triglycerides, abdominal obesity and elevated blood glucose. Individuals with at least three of these factors are identified as having metabolic syndrome, putting them at very high risk for developing diabetes and cardiovascular disease.

Several epidemiologic studies have shown African Americans are more likely to suffer from cardiovascular disease than Caucasians. The goal of the partnership is first to identify specific differences in risk factors in those two populations, including differences in biomarkers, clinical signs and psychosocial factors, as well as disparities in recognition and treatment of metabolic syndrome. Armed with this greater understanding, the research team then will develop and test targeted interventions aimed at improving overall cardiovascular health.

At Emory, the META-Health partnership team will be led by the School of Medicine’s Arshed Quyyumi, professor of medicine (cardiology), along with Sandra Dunbar, Charles Howard Candler Professor of Cardiovascular Nursing in the Nell Hodgson Woodruff School of Nursing; Patricia Clark,
assistant professor of adult and elder health; Viola Vaccarino, associate professor of medicine; and Bobby Khan, assistant professor of medicine. The Morehouse team is led by Gary Gibbons, director and founder of the school’s Cardiovascular Research Institute, along with medical professors Rebecca Din and Priscilla Pemu.

“Often there is poor recognition of metabolic syndrome by physicians,” Quyyumi said. “Even when patients are being treated for hypertension, physicians many times are not focusing on the other cardiovascular risk factors, or on lifestyle and psychosocial factors.”

Earlier studies indicate that African Americans and Caucasians probably experience metabolic syndrome in different ways, Quyyumi continued. Blacks appear to have lower incidence of cholesterol and triglyceride abnormalities with a similar frequency of insulin resistance. This potentially leads to underdiagnosis of metabolic syndrome, he said, despite the fact that African Americans have a higher incidence of diabetes and cardiovascular disease.

“Ethnic differences in the clinical features of the metabolic syndrome may cause diagnoses to be missed,” Quyyumi said. “Our study will test these hypotheses further and try to find the connections between clinical and psychosocial factors on the one hand, and blood tests for biomarkers and vascular assessments to more specifically identify those at added risk.

“In addition, there is evidence that children of patients with the syndrome are at increased risk of developing obesity and insulin resistance. Eventually, we hope to address why these complications of obesity run in families by establishing a genomic database to identify the genetic differences that would account for some of these disparities.”

As for interventions, the META-Health project will develop and seek opinions in three focus groups: individuals who have successfully managed their weight and other risk factors; people with difficulty managing risk factors; and individuals newly diagnosed with hypertension and metabolic syndrome.

“By understanding and intervening with people who have existing risk factors but who do not yet have overt coronary artery disease, we believe we may be able to modify risk and reduce heart disease,” Dunbar said.

Several hundred patients with metabolic syndrome will participate in a randomized clinical trial testing a lifestyle management program aimed at improving physical activity, diet, weight control and medication compliance. Participants will receive pedometers to promote walking and self-monitoring, with the goal of walking 10,000 steps each day. Telephone follow-up and counseling will provide motivation and support. After one year, researchers will measure changes in biomarkers of risk, physical activity and vascular function.

Vaccarino will lead a clinical trial that will incorporate transcendental meditation and address psychosocial factors that may contribute to risk for metabolic syndrome. Earlier research by investigators at Morehouse and elsewhere have shown that meditation can help reduce blood pressure and may reduce other features of the syndrome.

 

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