Identifying Cardiotoxic Manifestations of Posttraumatic Psychopathology: A Population-based Longitudinal Investigation

识别创伤后精神病理学的心脏毒性表现：基于人群的纵向调查

• 批准号: 10344540
• 负责人: Jaimie L. Gradus
• 金额: $ 70.01万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-12-15 至 2025-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10344540
• 关键词: 18 year old; Accidents; Accounting; Address; Affect; Anxiety; Automobile Driving; Big Data; Cardiotoxicity; Cardiovascular Diseases; Cardiovascular system; Characteristics; Complex; Computerized Medical Record; Data; Data Science; Data Sources; Databases; Development; Diagnosis; Disease Outcome; Event; Exposure to; Future; Health; Heart Diseases; Heart failure; Hypertension; Incidence; Individual; Intervention; Investigation; Knowledge; Link; Literature; Machine Learning; Measures; Mental Depression; Mental disorders; Myocardial Infarction; National Heart, Lung, and Blood Institute; Outcome; Pattern; Persons; Population; Population-Based Registry; Post-Traumatic Stress Disorders; Prevalence; Prevention; Psychopathology; Public Health; Registries; Reporting; Research; Resources; Risk; Risk Factors; Role; Sampling; Sex Differences; Smoking; Stroke; Substance abuse problem; Techniques; Time; Trauma; United States; Woman; Work; assault; base; cardiovascular disorder prevention; cardiovascular disorder risk; cardiovascular health; cardiovascular risk factor; cohort; comorbidity; data registry; follow-up; improved; men; mortality; novel; novel strategies; population based; primary outcome; prospective; psychiatric comorbidity; psychologic; resilience; risk prediction model; secondary outcome; sex; substance misuse; trauma exposure; traumatic event; venous thromboembolism; virtual; working group

PROJECT SUMMARY Trauma affects the vast majority of people (50-89%) during their lifetime, and it can have lasting impacts on not only psychiatric but also cardiovascular health. Both trauma exposure and posttraumatic stress disorder (PTSD)—the quintessential trauma-related psychiatric disorder—have been linked prospectively to increased risk of developing a range of cardiovascular outcomes. However, as described in a recent NHLBI Working Group report, critical knowledge gaps must be addressed before trauma or its psychiatric sequelae might be novel targets for reducing cardiovascular disease (CVD) risk. Indeed, our current understanding is limited by a disproportionate focus on PTSD when examining subsequent CVD risk in trauma-exposed individuals. Posttraumatic psychopathology manifests in heterogeneous ways (e.g., depression, anxiety, substance abuse) that have been linked to elevated CVD risk in non-trauma-exposed samples. Further, despite differences in the prevalence and manifestations of posttraumatic psychopathology and CVD in men and women, few studies have directly examined sex differences in these associations. The field's ability to investigate these questions has been hampered by a lack of rigorous measures of trauma exposure and posttraumatic psychopathology in most existing electronic medical record databases, which have extensive data on CVD outcomes. This study will address these knowledge gaps by harnessing a unique prospective, population-based trauma cohort in order to characterize “cardiotoxic” manifestations of posttraumatic psychopathology in men and women. This trauma cohort was created using Danish electronic health registry (EHR) data as part of R01MH110453 (PI: Gradus), and it identified over 1.4 million individuals exposed to a trauma between 1994 and 2016. This established data source includes rich, highly valid, and complete registry-based data with up to 25 years of follow-up on psychiatric and cardiovascular diagnoses following trauma. We will use this existing resource, restricted to persons age 18 years and older with no prior CVD events (n = 1,068,100), to comprehensively examine posttraumatic psychopathology as a predictor of incident CVD. In Aim 1, we will harness cutting edge, novel data science techniques (machine learning) to identify particularly “cardiotoxic” manifestations of psychopathology after trauma. Given sex differences in psychiatric disorders and CVD, sex-specific psychopathology profiles associated with incident CVD risk will be examined in stratified analyses. In Aim 2, we will use traditional analyses to quantify discovered psychiatric predictors and unanticipated/novel psychiatric comorbidity profiles associated with CVD risk in the machine learning analyses, as well as a priori literature-based combinations of psychiatric disorders that increase CVD risk. This EHR-based trauma cohort provides a unique opportunity to consider comprehensively the constellation of posttraumatic psychopathology that may predict CVD, and the results of this study will be used to ultimately inform the development of targeted CVD prevention efforts in trauma-exposed populations.

项目摘要 创伤影响绝大多数人（50-89%）在他们的一生中，它可以有持久的影响， 不仅是精神方面的，还有心血管方面的。创伤暴露和创伤后应激障碍 创伤后应激障碍（PTSD）-典型的创伤相关精神障碍-已被前瞻性地与增加 发生一系列心血管结局的风险。然而，正如最近的NHLBI工作报告所述， 小组报告，关键的知识差距，必须解决之前，创伤或其精神后遗症可能是 降低心血管疾病（CVD）风险的新靶点。事实上，我们目前的理解是有限的， 在检查创伤暴露个体随后的CVD风险时，不成比例地关注PTSD。 创伤后精神病理学以不同的方式表现出来（例如，抑郁、焦虑、药物滥用） 与非创伤暴露样本中心血管疾病风险升高有关。此外，尽管存在差异， 男性和女性创伤后精神病理学和CVD的患病率和表现，很少有研究 直接研究了这些关联中的性别差异。该领域调查这些问题的能力 由于缺乏严格的创伤暴露和创伤后精神病理学指标， 大多数现有的电子病历数据库都有关于CVD结果的广泛数据。本研究 将通过利用一个独特的前瞻性，以人群为基础的创伤队列， 为了描述男性和女性创伤后精神病理学的“心脏毒性”表现。这 创伤队列是使用丹麦电子健康登记处（EHR）数据创建的，作为R 01 MH 110453的一部分（PI： Gradus），并确定了1994年至2016年间暴露于创伤的140多万人。这 已建立的数据源包括丰富、高度有效和完整的基于注册表的数据， 创伤后精神和心血管诊断的随访。我们将利用现有的资源， 仅限于年龄≥ 18岁且既往无CVD事件的患者（n = 1，068，100）， 研究创伤后精神病理学作为CVD事件的预测因子。在目标1中，我们将利用尖端技术， 新的数据科学技术（机器学习），以确定特别是“心脏毒性”的表现， 创伤后精神病理学鉴于精神疾病和心血管疾病的性别差异， 将在分层分析中检查与CVD事件风险相关的精神病理学特征。在目标2中， 我们将使用传统分析来量化已发现的精神病预测因子和未预料到的/新的 机器学习分析中与CVD风险相关的精神病合并症特征，以及先验 基于文献的精神疾病组合增加CVD风险。这个基于EHR的创伤队列 提供了一个独特的机会，全面考虑创伤后精神病理学的星座， 这可能预测CVD，这项研究的结果将被用来最终告知发展， 在创伤暴露人群中开展有针对性的CVD预防工作。