Predicting CHD Events in Black and White Women

描述（由申请人提供）：冠心病（CHD）是目前女性死亡的头号原因。年轻女性冠心病死亡人数的增加，加上老年女性冠心病发病率和患病率的预计增加，描绘了一幅黯淡的未来冠心病发病率图景。为了扭转这一趋势，早期发现女性冠心病至关重要，但诊断女性冠心病具有挑战性，因为她们经常经历与男性不同的缺血。我们之前的研究结果显示，97%的急性冠脉综合征（ACS）女性回顾性报告在ACS前一个多月出现与冠心病不相关的前体症状（PS），表明是时候进行干预了。我们还发现了PS的显著种族差异。然而，没有临床测试的工具描述了种族多样化女性报告的PS的全部范围。我们开发并测试了McSweeney急性和前期心肌梗死症状调查（MAPMISS），对大约1000名不同种族的女性进行回顾性评估，以评估她们的PS和与ACS相关的急性症状。然而，我们不知道回顾性鉴定的PS是否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研究，以确定MAPMISS是否能够前瞻性地区分2年内将发生和不会发生冠心病事件的女性。通过生存和纵向分析确认这一假设，同时确定最敏感和最具体的症状，将提供必要的证据基础，帮助临床医生决定是否将妇女转诊进行心血管诊断测试。我们将使用标准的心理测量技术来开发MAPMISS筛选仪器。我们将比较接收器操作曲线下的面积，以确定最准确、最有效和最节省的筛选措施。我们还将探讨MAPMISS屏幕分数与冠心病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.