Young Adult and Midlife Transitions in Physical Activity and Sedentary Behavior with Heart Failure Risk and Progression: Coronary Artery Risk Development in Young Adults (CARDIA)

年轻人和中年体力活动和久坐行为的转变与心力衰竭风险和进展：年轻人冠状动脉风险发展（CARDIA）

• 批准号: 10224323
• 负责人: Kelley Pettee Gabriel
• 金额: $ 142.73万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10224323
• 关键词: Accelerometer; Address; Adult; Aerobic; Age; Aging; Ancillary Study; Attenuated; Behavioral; Biological; Biological Markers; Blood specimen; Brain natriuretic peptide; Cardiac; Caring; Classification; Clinical; Clinical Trials Design; Complement; Coronary Artery Risk Development in Young Adults Study; Coronary heart disease; Data; Disease; Dose; EFRAC; Early Intervention; Elderly; Eligibility Determination; Equation; Event; Exercise Test; Financial Hardship; Functional disorder; Future; Goals; Guidelines; Health; Health Benefit; Healthcare Systems; Heart; Heart failure; High Prevalence; Hour; Hypertension; Individual; Intervention; Leisures; Literature; Maintenance; Measures; N-terminal; Nature; Non-Insulin-Dependent Diabetes Mellitus; Older Population; Outcome; Oxygen; Participant; Pharmacotherapy; Phenotype; Physical activity; Population; Prevalence; Prevention; Prevention approach; Prevention strategy; Progressive Disease; Public Health; Race; Race Relations; Reporting; Research; Risk; Testing; Time; Troponin T; Walking; Woman; Work; base; behavior change; black men; cardiorespiratory fitness; chronotropic; clinical practice; clinical risk; cohort; emerging adult; improved; innovation; lifetime risk; light intensity; meter; middle age; novel; outcome prediction; pre-clinical; preservation; prevent; programs; public health relevance; racial disparity; response; sedentary; sedentary lifestyle; sex; uptake; vigorous intensity; young adult

ABSTRACT Heart failure prevalence is increasing in the U.S., particularly among blacks and older adults. Heart failure is a progressive disease defined by stages, and onset of asymptomatic, preclinical heart failure is often evident decades before symptomatic, clinical disease. This provides an opportunity to discover novel targets for intervention during preclinical stages to prevent or attenuate progression to clinical heart failure stages. This early prevention approach is critical since, once an individual advances to the next stage, regression is unlikely. Reported moderate to vigorous intensity physical activity (MVPA) and cardiorespiratory fitness (CRF) are independently related to a reduced risk of lifetime, clinical heart failure; a relation that has been primarily studied in midlife or older adults. Nothing is known about the relations of light intensity physical activity (LPA) or sedentary behaviors (SED) with heart failure. This focus on event-driven endpoints discounts the progressive nature of heart failure and biases the field against discovery of novel targets for improving more proximal outcomes that are predictive of future clinical disease, including N-terminal pro-brain natriuretic peptide (NT-proBNP), high sensitivity cardiac Troponin T (hscTnT), peak oxygen uptake (peak VO2), and heart failure stage classification. Evidence from CARDIA demonstrates an increased prevalence of preclinical heart failure, and progression to more severe heart failure stages over 25-years defining young adulthood to midlife. This has occurred in parallel with declines in reported MVPA and CRF over these 25-years, and replacement of active time for sedentary time (based on accelerometry) during the first 10-years of midlife. Given that these biomarkers are not currently available in CARDIA, the impacts of these exposures have not been tested in this cohort, or in other studies. To address this need, we propose the CARDIA Activity and Heart Failure (ACT-HF) Study, a four-year ancillary study to the Year 35 core exam (2020-21; cohort ages 53-65 years). Participants will be all those who attend the core exam, who meet eligibility criteria, and agree to participate (estimated n≥2,431). To complement 35-years of extant data, CARDIA ACT-HF measures include: (1) third accelerometry measures to fully characterize midlife, (2) first measures of NT-proBNP and hscTnT in CARDIA (at Years 20, 30 & 35 via stored blood samples), and (3) a final maximal graded exercise test (GXT) test for measured or estimated peak VO2. The validity of the 400-meter walk test, as a possible replacement for the maximal GXT in future exams, will be tested. We aim to examine the: (1) independent and simultaneous longitudinal relations of 20-year changes in a) reported MVPA and b) CRF from early adulthood to midlife with 15-year changes in heart failure biomarkers collected across midlife; (2) independent and simultaneous longitudinal relations of accelerometer-based a) MVPA, b) LPA, and c) SED changes with heart failure biomarkers across midlife; and (3) bidirectional relations of a) accelerometer-based MVPA, LPA, and SED and b) CRF with heart failure stages across midlife. Interactions of these relations by race and sex will be tested in all study aims.

抽象的 在美国，心力衰竭的患病率正在增加，特别是在黑人和老年人中。心力衰竭是一种 按阶段定义的进行性疾病，无症状、临床前心力衰竭的发作通常很明显 早于有症状的临床疾病数十年。这提供了发现新靶标的机会 在临床前阶段进行干预，以预防或减轻进展为临床心力衰竭阶段。这 早期预防方法至关重要，因为一旦个体进入下一阶段，就会出现倒退。 不太可能。报告中度至高强度体力活动 (MVPA) 和心肺健康 (CRF) 与降低终生临床心力衰竭风险独立相关；主要是一种关系 研究对象为中年或老年人。关于光强度体力活动 (LPA) 的关系一无所知 或久坐行为（SED）导致心力衰竭。这种对事件驱动端点的关注削弱了 心力衰竭的渐进性，使该领域对发现改善更多症状的新目标产生偏见 可预测未来临床疾病的近期结果，包括 N 端脑钠尿前体 肽 (NT-proBNP)、高灵敏度心肌肌钙蛋白 T (hscTnT)、峰值摄氧量 (峰值 VO2) 和心脏 故障阶段分类。来自 CARDIA 的证据表明临床前心脏病的患病率有所增加 心力衰竭，以及在 25 年内进展为更严重的心力衰竭阶段，定义为青年期到中年。 这与这 25 年来报告的 MVPA 和 CRF 的下降同时发生，并且替代 中年头 10 年的活动时间与久坐时间（基于加速度测量）的比例。鉴于这些 CARDIA 目前尚无生物标志物，这些暴露的影响尚未在本报告中进行测试 队列或其他研究。为了满足这一需求，我们提出了 CARDIA 活动和心力衰竭 (ACT-HF) 研究是 35 年级核心考试的一项为期四年的辅助研究（2020-21 年；队列年龄 53-65 岁）。参加者 是指所有参加核心考试、符合资格标准并同意参加的人员（预计 n≥2,431)。为了补充 35 年的现有数据，CARDIA ACT-HF 措施包括：(1) 第三加速度测量 全面表征中年特征的措施，(2) CARDIA 中 NT-proBNP 和 hscTnT 的首次测量（20 岁时， 30 和 35 通过储存的血液样本），以及（3）最终最大分级运动测试（GXT）测试测量或 估计峰值摄氧量。 400 米步行测试作为最大 GXT 的可能替代方案的有效性 以后的考试，都会被考验。我们的目的是研究：（1）独立且同时的纵向关系 从成年早期到中年，a) 报告的 MVPA 和 b) CRF 的 20 年变化以及 15 年的变化 中年时期收集的心力衰竭生物标志物； (2) 独立且同时的纵向关系 基于加速度计的 a) MVPA、b) LPA 和 c) SED 在中年期间随心力衰竭生物标志物的变化；和 (3) a) 基于加速度计的 MVPA、LPA 和 SED 和 b) CRF 与心力衰竭的双向关系 跨越中年的阶段。所有研究目标都将测试这些种族和性别关系的相互作用。