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 创伤会影响一生中绝大多数人（50-89％），这可能会对不持续影响 只有精神病，但也是心血管健康。创伤暴露和创伤后应激障碍 （PTSD） - 典型的与创伤有关的精神疾病 - 已与增加有关 发展一系列心血管结局的风险。但是，如最近的NHLBI工作中所述 小组报告，必须在创伤或其精神病后遗症之前解决关键的知识差距 减少心血管疾病（CVD）风险的新目标。确实，我们目前的理解受到 在检查暴露创伤的个体中随后的CVD风险时，不成比例的关注PTSD。 创伤后的心理病理学以异质方式表现出来（例如抑郁，动画，滥用药物） 与非创伤暴露样本中CVD风险升高有关的。此外，拼命的差异 男性和女人的创伤后心理病理学和CVD的患病率和表现，很少研究 在这些关联中直接检查了性别差异。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心理病理学的措施而受到阻碍 大多数现有的电子病历数据库，这些数据库具有有关CVD结果的大量数据。这项研究 将通过利用独特的前瞻性，基于人群的创伤队列来解决这些知识差距 为了表征男性和女人创伤后心理病理学的“心脏毒性”表现。这 创伤队列是使用丹麦电子健康注册中心（EHR）数据创建的，作为R01MH110453的一部分（PI：： Gradus），它确定了140万人在1994年至2016年之间遭受创伤的人。 已建立的数据源包括丰富，高效和完整的基于注册表的数据，最多25年 创伤后的精神病和心血管诊断的后续。我们将使用此现有资源 仅限于18岁及以上的人，没有事先的CVD事件（n = 1,068,100） 检查创伤后的心理病理学作为事件CVD的预测指标。在AIM 1中，我们将利用最前沿， 新颖的数据科学技术（机器学习），以识别特别的“心脏毒性”表现 创伤后的心理病理学。鉴于精神疾病和CVD的性别差异，特定于性别 与事件CVD风险相关的心理病理学概况将在分层分析中检查。在AIM 2中， 我们将使用传统分析来量化发现的精神病预测因子和意外/新颖 机器学习分析中与CVD风险相关的精神病合并症概况以及先验 基于文献的精神疾病组合，这些疾病会增加CVD风险。这个基于EHR的创伤队列 提供了一个独特的机会来全面考虑创伤后心理病理学的星座 这可能会预测CVD，这项研究的结果将用于最终告知 在暴露创伤的人群中有针对性的CVD预防工作。