Risk Reduction for Premenopausal African-Americans

This two-phase, multi-site, 1-year study aimed to specify CHD risk factors in premenopausal African American women (AAW) aged 18-45 years; determine if particular phenotypes or genotypes predict CHD, hypertension, or diabetes; and pilot test an intervention to reduce risk factors.

Phase I compared 177 at-risk AAW (aged 18 to 45 years) to 113 low-risk AAW (88 active duty military and 201 civilians). A subsample of 14 at-risk and 14 low-risk active duty women was randomly selected for full-body MRI to study the waist-to-hip ratio in premenopausal AAW and to delineate areas of adipose and subcutaneous tissue and their link to known CHD risk.

Phase II pilot-tested a 12-week intervention on 25 active duty women aimed at changes in weight, percentage body fat, cigarette smoking, physical activity, coping strategies, nutritional intake, cholesterol levels, blood pressure, glycemic control, and fasting insulin levels.

Genetic typing found D6S89 185, D6S89 191, and TNFɑ 103 significantly more often in high-risk AAW and D6S89 195 and DQB1 302 more frequently in low-risk AAW. The APOE4 allele was found in 105 subjects. CHD risk factors each correlated to different gene subsets.

CHD risk factor variance was assessed by MRI. Trunk fat independently and positively related to VLDL, VLDL3, serum insulin, and diastolic blood pressure; leg fat correlated negatively to the same, consistent with results from Caucasian men and women. Visceral fat related independently to triglycerides.

The pilot concentrated on reduced saturated fats; increased fiber and fruit; increased physical activity, self-esteem, and self-efficacy; and reduced reaction to stress. SAS Proc Univariate analysis was used to detect changes in data taken 1 week before the intervention and within 2 weeks after its completion; the subjects were all insulin resistant initially, but only two remained so.