VCID and Stroke in a Bi-racial National Cohort

项目摘要/摘要： -- 轻度认知障碍(MCI)、痴呆症和中风在黑人中显著更高 45岁以上，在美国东南部地区的居民中。原因是 中风的地理和种族差异研究是全国性的纵向队列研究 对大约30,000名黑人和白人的研究旨在促进对 认知功能减退和中风的流行病学以及种族和地理因素 在这些结果中存在差异。目前的应用程序有三个目标： 1.确定种族和地域的社会、心血管和环境机制 认知损害和痴呆(VCID)事件中血管因素的差异。 有了中年评估和十多年的纵向认知数据，我认为 独特的定位，可识别潜在的血管、社会和行为机制 VCID的差异，以及干预措施可能缩小差异的可修改路径 在VCID中。在完成嵌套校准/确认研究以开发算法之后 对于MCI和痴呆症的分类，我们将区分种族和地理特征 VCID的差异，并确定对调解人的干预是否会减少或消除 差距。 2.回答中风和脑血管疾病流行病学中尚未回答的问题。 在17000名积极队列中继续采用成功的卒中监测方法 成员们，这项研究将评估风险因素变化与新生物标记物的联系 随着第二次面对面检查的完成而量化，具有中风风险和差异 中风风险。此外，随着队列的老龄化，这一目标将提供非常需要的 关于老年人中风流行病学的信息。 3.利用事故风险因素数据和生物量确定发展的途径 事件高血压和糖尿病，目的是了解事件对事件的影响 VCID和中风。我们已经证明，中风风险的种族差异中，≈30%是 归因于高血压和糖尿病患病率的种族差异，这项研究 将调查导致高血压发病率较高的生物标志物途径 以及黑人的糖尿病。 每个拟议的目标都涉及一个对公共卫生有深远影响的主题，并涉及 到目前为止的进展使这项研究具有独特的地位，可以使用经过验证的方法来解决这些目标 以高效的方式。

PROJECT SUMMARY/ABSTRACT    Mild cognitive impairment (MCI), dementia and stroke are substantially higher among blacks aged 45+, and among residents of the southeastern region of the US. The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study is national, longitudinal cohort study of ~ 30,000 blacks and whites designed to advance the understanding of the epidemiology of cognitive decline and stroke, and the contributors to racial and geographic disparities in these outcomes. The current application has three aims: 1. Identify social, cardiovascular, and environmental mechanisms of racial and geographic disparities in incident vascular contributions to cognitive impairment and dementia (VCID). With assessment in mid-life and over a decade of longitudinal cognitive data, REGARDS is uniquely positioned to identify vascular, social, and behavioral mechanisms underlying disparities in VCID, and modifiable pathways on which interventions may narrow disparities in VCID. After completion of a nested calibration/confirmation study to develop an algorithm for the classification of MCI and dementia, we will characterize racial and geographic disparities in VCID and determine if interventions on mediators would diminish or eliminate disparities. 2. Answer as-yet-unanswered questions in stroke and cerebrovascular disease epidemiology. By continuing the successful approaches for stroke surveillance among 17000 active cohort members, the study will assess the association of risk factor changes and novel biomarkers quantified with the completion of the second in-person exam with stroke risk and disparities in stroke risk. In addition, with the aging of the cohort, this aim will provide greatly needed information on stroke epidemiology in the elderly. 3. Utilize incident risk factor data and biospecimens to identify pathways for development of incident hypertension and diabetes, with the goal of understanding the impact on incident VCID and stroke. We have documented that ≈30% of the racial disparity in stroke risk is attributable to racial disparities in prevalence of hypertension and diabetes, and the study will investigate the biomarker pathways contributing to the higher incidence of hypertension and diabetes in blacks. Each proposed aim addresses a topic of profound public health impact, and REGARDS progress to date uniquely positions the study to address these aims using proven approaches in an efficient manner.