A longitudinal cohort study to evaluate cardiovascular risk factors and disease in Haiti

摘要：心血管疾病（CVD）现在是海地成年人死亡的主要原因。我们 初步数据表明，高血压是海地最重要的心血管疾病危险因素， 受与贫穷有关的社会和环境决定因素驱动。然而，患病率、发生率、主要 风险因素以及社会和环境决定因素尚不清楚。纵向队列研究迫切需要 需要解决这些知识差距，以制定预防心血管疾病和改善健康的干预措施 海地人在海地和美国的结果。 我们建议通过建立第一个纵向队列来填补这一空白，以研究心血管疾病的自然史， 海地.该队列将包括太子港3 000名18岁以上的成年人，采用多级随机抽样， 根据研究入组的时间，随访2至3.5年。我们预计高血压 18-30奥尔兹的患病率将≥10%，高血压发生率将>10起事件/1000人年， 高血压的流行和发病都与贫困相关的社会和 环境决定因素我们还将研究决定因素和危险因素与CVD的关联。 我们将对全血、血清、血浆、唾液、粪便和尿液样本进行生物样本库，用于未来的研究。 我们的具体目标是： 1.在太子港建立一个3 000名成年人的人口队列， CVD危险因素和疾病及其与社会和环境决定因素的关联。 a.心血管危险因素包括高血压、糖尿病、肥胖、血脂异常、肾脏疾病、贫困、 饮食、吸烟、缺乏运动和炎症。 B.心血管疾病包括心肌梗死、心力衰竭、中风和CVD死亡率。 C.决定因素包括压力、社会孤立、抑郁、粮食不安全和铅暴露。 2.确定心血管疾病危险因素和疾病的发病率及其与社会和 环境决定因素 这项研究将为海地CVD的流行病学提供重要的见解。该研究还建立了一个 通过建立一个以人口为基础的队列，收集其他重要的 海地的慢性病（如糖尿病、肾病），建立一个生物库，并采取措施， 结果与现有的美国CVD队列直接相当。我们的最终目标是翻译新的 从这项研究的研究结果到务实的预防和治疗干预，以打击心血管疾病 在海地和美国的海地移民中流行。

ABSTRACT: Cardiovascular disease (CVD) is now the leading cause of mortality in Haitian adults. Our preliminary data suggest that hypertension is the single most important CVD risk factor in Haiti and may be driven by poverty-related social and environmental determinants. However, the prevalence, incidence, major risk factors, and social and environmental determinants are unknown. Longitudinal cohort studies are urgently needed to address these knowledge gaps in order to develop interventions to prevent CVD and improve health outcomes of Haitians in both Haiti and in the United States. We propose to fill this gap by establishing the first longitudinal cohort to study the natural history of CVD in Haiti. The cohort will include 3,000 adults >18 years in Port-au-Prince using multistage random sampling, and follow them for 2 to 3.5 years depending on the timing of study enrollment. We anticipate that hypertension prevalence will be ≥10% in 18-30 year olds, that hypertension incidence will be >10 events/1000 person years, and that both prevalent and incident hypertension will be associated with poverty-related social and environmental determinants. We will also examine the association of determinants and risk factors with CVD. We will biobank whole blood, serum, plasma, saliva, stool, and urine samples for future studies. Our Specific Aims are to: 1. Establish a population-based cohort of 3,000 adults in Port-au-Prince and assess the prevalence of CVD risk factors and diseases and their association with social and environmental determinants. a. Cardiovascular risk factors include hypertension, diabetes, obesity, dyslipidemia, kidney disease, poor diet, cigarette smoking, physical inactivity, and inflammation. b. Cardiovascular diseases include myocardial infarction, heart failure, stroke, and CVD mortality. c. Determinants include stress, social isolation, depression, food insecurity, and lead exposure. 2. Determine the incidence of CVD risk factors and diseases and their association with social and environmental determinants. This study will provide important insights into the epidemiology of CVD in Haiti. The study also builds a platform for future research by establishing a population-based cohort, collecting data on other important chronic diseases in Haiti (e.g. diabetes, renal disease), creating a biobank, and using measures and outcomes that are directly comparable to existing US CVD cohorts. Our ultimate goal is to translate new research findings from this study into pragmatic prevention and treatment interventions to fight the CVD epidemic in Haiti and in Haitian immigrants in the US.