Predicting CHD Events in Black and White Women

描述(申请人提供)：冠心病(CHD)是目前女性的头号死因。年轻女性CHD死亡人数的增加，加上老年女性CHD发病率和流行率的预计增加，为她们未来的CHD发病率描绘了一幅黯淡的图景。要扭转这一趋势，在女性中及早发现CHD是必不可少的，但在女性中诊断CHD是具有挑战性的，因为她们的缺血经历往往与男性不同。我们之前的研究结果显示，97%的急性冠脉综合征(ACS)女性患者在发病前一个月以上出现过与冠心病不常见的前驱症状(PS)，这表明有时间进行干预。我们还发现PS存在显著的种族差异。然而，没有经过临床测试的工具描述了不同种族女性报告的全部PS。我们开发并测试了McSweeney急性和前驱心肌梗死症状调查(MAPMISS)，对大约1000名不同种族的女性进行了调查，以回顾评估她们的PS和与ACS相关的急性症状。然而，我们不知道回顾发现的PS是否会被证明对预测女性冠心病事件有用。因此，我们建议进行一项纵向观察性研究，以确定MAPMISS是否会在两年内对将经历和不会经历冠心病事件的女性进行前瞻性区分。通过生存和纵向分析证实这一假设，结合确定最敏感和最具体的症状，将提供必要的证据基础，以帮助临床医生决定是否将女性转诊为心血管诊断测试。我们将使用标准的心理测量技术来开发MAPMISS筛查仪器。我们将比较接收器操作员曲线下的面积，以确定最准确、最有效和最节俭的筛查措施。我们还将探索MAPMISS筛查分数和CHD诊断测试结果之间的对应关系。

DESCRIPTION (provided by applicant): Coronary Heart Disease (CHD) is currently the number one cause of death in women. The increasing number of CHD deaths in younger women plus the projected increase in the incidence and prevalence of CHD in older women paints a bleak picture of their future CHD rates. To reverse this trend, early detection of CHD in women is essential, but diagnosing CHD in women is challenging since they often experience ischemia differently than men do. Our previous findings revealed that 97% of women with acute coronary syndrome (ACS) retrospectively reported experiencing prodromal symptoms (PS) not commonly associated with CHD for more than a month prior to ACS, indicating time to intervene. We also found significant racial differences in PS. However, no clinically tested instrument describes the full range of PS that racially diverse women report. We developed and tested the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS) with approximately 1000 racially diverse women to retrospectively assess their PS and acute symptoms associated with ACS. However, we do not know if PS identified retrospectively will prove useful in predicting CHD events in women. Therefore, we propose to conduct a longitudinal observational study to determine if the MAPMISS will differentiate prospectively between women who will and will not experience a CHD event in a 2-year period. Confirmation of this hypothesis through survival and longitudinal analysis, in conjunction with identifying the most sensitive and specific symptoms, would provide the evidence-base needed to assist clinicians in deciding whether to refer a woman for cardiovascular diagnostic testing. We will use standard psychometric techniques to develop a MAPMISS screening instrument. We will compare the area under receiver operator curves to identify the most accurate, efficient, and parsimonious measure for screening. We also will explore the correspondence between the MAPMISS screen scores and CHD diagnostic test results.