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Open Access Study protocol

The St. Louis African American health-heart study: methodology for the study of cardiovascular disease and depression in young-old African Americans

Robin R Bruchas13, Lisa de las Fuentes14, Robert M Carney2, Joann L Reagan1, Carlos Bernal-Mizrachi3, Amy E Riek3, Chi Charles Gu4, Andrew Bierhals5, Mario Schootman6, Theodore K Malmstrom7, Thomas E Burroughs8, Phyllis K Stein1, Douglas K Miller9 and Victor G Dávila-Román1*

Author Affiliations

1 Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8086, St. Louis, MO 63110, USA

2 Department of Psychiatry, Washington University School of Medicine, 4320 Forest Park Avenue Suite 301, St. Louis, MO 63108, USA

3 Endocrinology, Metabolism and Lipid Research Division, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA

4 Division of Biostatistics, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8067, St. Louis, MO 63110, USA

5 Mallinckrodt Institute of Radiology, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA

6 Division of Health Behavior Research, Washington University School of Medicine, 660 south Euclid Avenue, St. Louis, MO 63110, USA

7 Department of Neurology & Psychiatry, School of Medicine, Saint Louis University, St. Louis, MO, USA

8 Center for Outcomes Research, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104, USA

9 Regenstrief Institute, Inc., and Indiana University Center for Aging Research, School of Medicine, Indiana University, 410 West 10th Street, Indianapolis, IN 46202, USA

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BMC Cardiovascular Disorders 2013, 13:66  doi:10.1186/1471-2261-13-66

Published: 8 September 2013

Abstract

Background

Coronary artery disease (CAD) is a major cause of death and disability worldwide. Depression has complex bidirectional adverse associations with CAD, although the mechanisms mediating these relationships remain unclear. Compared to European Americans, African Americans (AAs) have higher rates of morbidity and mortality from CAD. Although depression is common in AAs, its role in the development and features of CAD in this group has not been well examined. This project hypothesizes that the relationships between depression and CAD can be explained by common physiological pathways and gene-environment interactions. Thus, the primary aims of this ongoing project are to: a) determine the prevalence of CAD and depression phenotypes in a population-based sample of community-dwelling older AAs; b) examine the relationships between CAD and depression phenotypes in this population; and c) evaluate genetic variants from serotoninP and inflammatory pathways to discover potential gene-depression interactions that contribute significantly to the presence of CAD in AAs.

Methods/design

The St. Louis African American Health (AAH) cohort is a population-based panel study of community-dwelling AAs born in 1936–1950 (inclusive) who have been followed from 2000/2001 through 2010. The AAH-Heart study group is a subset of AAH participants recruited in 2009–11 to examine the inter-relationships between depression and CAD in this population. State-of-the-art CAD phenotyping is based on cardiovascular characterizations (coronary artery calcium, carotid intima-media thickness, cardiac structure and function, and autonomic function). Depression phenotyping is based on standardized questionnaires and detailed interviews. Single nucleotide polymorphisms of selected genes in inflammatory and serotonin-signaling pathways are being examined to provide information for investigating potential gene-depression interactions as modifiers of CAD traits. Information from the parent AAH study is being used to provide population-based prevalence estimates. Inflammatory and other biomarkers provide information about potential pathways.

Discussion

This population-based investigation will provide valuable information on the prevalence of both depression and CAD phenotypes in this population. The study will examine interactions between depression and genetic variants as modulators of CAD, with the intent of detecting mechanistic pathways linking these diseases to identify potential therapeutic targets. Analytic results will be reported as they become available.

Keywords:
Coronary artery disease; Depression; Genetic analyses; African Americans; Inflammatory biomarkers; Inflammatory pathway; Serotonin-signaling pathway; Heart rate variability; Built environment; Bayesian analysis