Epidemiologic Study of Ethnicity and Lifetime Risks for Cardiovascular Disease

描述(由申请人提供)：目前的临床实践预防指南依赖于对10年内发生心血管疾病(CVD)或冠心病(CHD)的绝对风险的估计，以使治疗的强度与风险的大小相匹配。然而，许多人患心血管疾病的10年风险较低，但终身风险较高。因此，国家胆固醇教育计划的成人治疗小组III(NCEP ATP-III)建议在有关药物治疗的决定中考虑长期和终生风险。到目前为止，仅在白人队列中进行的有限数量的研究检查了心血管事件的终生风险。目前还没有关于其他族裔人群心血管疾病终生风险的数据。终生风险法通过考虑发生相关疾病的风险和相互竞争的死亡原因的风险，在死亡前估计发生疾病的绝对风险。由于心血管疾病的发病率和相互竞争的死亡原因都被考虑在终身风险评估中，因此心血管疾病的终身风险在具有不同风险因素负担和非心血管疾病原因死亡率不同的民族之间可能有很大差异。我们建议从多个大型流行病学队列研究中产生和汇集估计，以比较不同种族之间患心血管疾病的终生风险。拟纳入这项研究的队列包括社区的动脉粥样硬化风险、Framingham心脏、火奴鲁鲁心脏、波多黎各心脏健康、CARDIA、心血管健康、People‘s Gas、Western Electric、芝加哥心脏协会工业检测项目、妇女健康倡议观察性研究、MRFIT筛查和其他，包括50多万人。由此得到的关于心血管疾病终身风险的数据将有助于估计现在和未来心血管疾病的人口负担，比较种族/民族内部和群体之间心血管疾病和其他常见疾病的终身风险，并加强风险沟通，它们有可能帮助识别新的心血管疾病风险人群。这一应用代表了一种分析现有数据的新方法，可能会对非白人族裔群体中的心血管疾病流行病学产生实质性的新见解。

DESCRIPTION (provided by applicant): Current clinical practice prevention guidelines rely on estimates of the absolute risk for development of cardiovascular disease (CVD) or coronary heart disease (CHD) within 10 years, in order to match the intensity of therapy to the magnitude of risk. However, many individuals have low 10-year risks but elevated lifetime risks for CVD. The National Cholesterol Education Program's Adult Treatment Panel III (NCEP ATP-III) therefore recommends consideration of long-term and lifetime risks in decisions regarding drug therapy. To date, a limited number of studies performed in exclusively white cohorts have examined lifetime risks for CVD events. No data are available regarding lifetime risks for CVD among other ethnic groups. Lifetime risk methods estimate the absolute risk for development of a disease prior to dying, by accounting for the risk of developing the disease of interest as well as the risk for competing causes of death. Since both CVD incidence and competing cause of death are considered in lifetime risk estimation, lifetime risks for CVD may vary considerably between ethnic groups with differing risk factor burdens and diverse rates of death from non-CVD causes. We propose to generate and pool estimates from multiple large epidemiologic cohort studies to compare lifetime risks for CVD between different ethnicities. Among the cohorts to be included in the proposed study are the Atherosclerosis Risk in Communities, Framingham Heart, Honolulu Heart, Puerto Rico Heart Health, CARDIA, Cardiovascular Health, People's Gas, Western Electric, Chicago Heart Association Detection Project in Industry, and Women's Health Initiative Observational Studies, MRFIT screenees, and others, comprising over 500,000 individuals. The resulting data on lifetime risks for CVD will be useful in estimating the population burden of CVD now and in the future, in comparing lifetime risks for CVD and other common diseases within and between race/ethnic groups, and in enhancing risk communication, and they have the potential to help identify new populations of patients at risk for CVD. This application represents a novel approach to analyzing existing data that is likely to yield substantial new insights into the epidemiology of CVD among non-white ethnic groups.