Longitudinal Changes in Pericardial Adiposity and Subclinical Atherosclerosis

心包肥胖和亚临床动脉粥样硬化的纵向变化

• 批准号: 7889495
• 负责人: John Jeffrey Carr
• 金额: $ 142.98万
• 依托单位: WAKE FOREST UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-01 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7889495
• 关键词: Abdomen; Adipose tissue; Adult; Affect; African American; Age; Ancillary Study; Atherosclerosis; Autopsy; Behavioral; Biological Markers; Body mass index; Calcified; Calcium; Cardiac; Cardiovascular Diseases; Cardiovascular system; Cessation of life; Clinical; Cohort Studies; Communities; Contracts; Coronary; Coronary Arteriosclerosis; Coronary artery; Coronary heart disease; Coupled; Data; Development; Disease; Dual-Energy X-Ray Absorptiometry; Echocardiography; Epidemic; Etiology; Event; Exposure to; Fatty acid glycerol esters; Funding; Future; Genetic; Health; Heart; Heart Diseases; Image; Incidence; Individual; Investments; Left; Left Ventricular Mass; Lesion; Lesion by Morphology; Life; Light; Link; Literature; Measurement; Measures; Metabolic; Methods; Morbidity - disease rate; Morphology; Myocardium; Natural History; Nutritional; Obesity; Optical Coherence Tomography; Organ; Outcome Study; Participant; Patients; Pericardial body location; Phenotype; Play; Population; Prevention; Process; Relative (related person); Resolution; Risk; Risk Assessment; Risk Factors; Role; Scanning; Science; Stroke Volume; Structure; Sum; Techniques; Time; Ultrasonography; Ventricular End-Diastolic Volumes; Visceral; Weight; Work; X-Ray Computed Tomography; abdominal fat; acute coronary syndrome; aged; base; calcification; cardiovascular disorder risk; clinical practice; cohort; follow-up; heart disease risk; high risk; high standard; imaging modality; indexing; longitudinal analysis; middle age; millimeter; mortality; new therapeutic target; pericardial sac; population based; premature; programs; psychosocial; public health relevance; waist circumference; young adult

DESCRIPTION (provided by applicant): The epidemic of obesity threatens recent rogress towards reducing the health burden of coronary heart disease (CHD) in the U.S. population. While much is known regarding how obesity and cardio- metabolic risk factors affect the coronary arteries and heart, much remains uncertain. In addition to the fairly rich literature on computed tomography (CT) measures of visceral adipose tissue (VAT), there is mounting evidence that pericardial adipose tissue (PAT), and the epicardial subcompartment (PATepi), is associated with coronary atherosclerosis and cardiac structure-function. CT measures of PAT, PATepi and VAT refine the adiposity phenotype to precise organ-specific measures, compared to weight and body mass index. This project is an ancillary study to NHLBI's Coronary Artery Risk Development in Young Adults (CARDIA), a population-based study that has 25 years of longitudinal data. The long-term objectives of this proposal are to reduce death and disease through a better understanding of obesity and CHD. Our Specific Aims are: 1) To define the development and natural history of coronary artery calcified (CAC) plaque burden, spotty lesion morphology, and the interrelatedness of the two processes by cardiac CT at three time points over 10 years (2000-2010) in a bi-racial community dwelling population ages 33 to 55 years. 2) To measure PAT and PATepi in the same participants at three time points and perform longitudinal analysis, adjusted for body fatness measures (BMI and waist circumference) and other risk factors, with dependent variables the development, amount, and character of CAC score and spotty plaques by CT and adverse cardiac structure and function measured by echocardiogram. 3) To measure coronary artery remodeling index (RI) in individuals aged 43-55 years with the high-resolution year 25 CT scans and determine the association between RI and PAT, PATepi, VAT (measured by main study), CAC score and spotty lesions, adjusted for body fatness measures (BMI and waist circumference) and other risk factors. Future analysis for prediction of CHD events will be possible by 2015-2020 for aims 1-3. Cardiac CT images, without contrast, will be obtained at standard and high-resolution from a single exposure to measure PAT, PATepi, CAC score, spotty morphology and RI from a 14 second additional scan to the funded abdominal CT. The latter two "high-risk" phenotypes are associated with culprit lesions of the acute coronary syndrome identified by intracoronary ultrasound or at autopsy. This proposal leverages the investment in CARDIA by adding new science related to PAT and its role in coronary atherosclerosis and cardiac structure-function. This project will link 25 years of CARDIA longitudinal data (anthropometric, biomarker, behavioral, psychosocial, nutritional, genetic, CT VAT and cardiac echocardiography) to new phenotypes. Prospectively measuring these phenotypes in 2010-11 will enable future analysis for prediction of clinical CHD events by 2015-20, further strengthening the impact. PUBLIC HEALTH RELEVANCE: Obesity in early life in African American and white dults is a factor in premature heart disease and cardiovascular death. We will leverage an existing study of 5,115 individuals with 25 years of follow-up to make new measurements with CT and echocardiography. We will determine how changes in the fat located around the heart over ten years in adults 33-55 years influences subsequent heart disease.

描述（由申请人提供）：肥胖症的流行威胁着最近在减少美国人群冠心病（CHD）健康负担方面取得的进展。虽然关于肥胖和心血管代谢危险因素如何影响冠状动脉和心脏已经知道了很多，但还有很多不确定的。除了关于内脏脂肪组织（VAT）的计算机断层扫描（CT）测量的相当丰富的文献外，还有越来越多的证据表明心包脂肪组织（PAT）和心外膜亚室（PATepi）与冠状动脉粥样硬化和心脏结构-功能相关。与体重和身体质量指数相比，PAT、PATepi和VAT的CT测量将肥胖表型细化为精确的器官特异性测量。该项目是NHLBI的年轻人冠状动脉风险发展（CARDIA）的辅助研究，该研究是一项基于人群的研究，具有25年的纵向数据。该提案的长期目标是通过更好地了解肥胖和冠心病来减少死亡和疾病。我们的具体目标是：1）通过心脏CT在10年（2000-2010年）的3个时间点，在年龄33 - 55岁的两种族社区居住人群中确定冠状动脉钙化（CAC）斑块负荷、斑点状病变形态的发展和自然史，以及两个过程的相互关系。2)在三个时间点测量相同参与者的PAT和PATepi，并进行纵向分析，调整体脂测量（BMI和腰围）和其他风险因素，因变量为CAC评分和斑点状斑块的发展、数量和特征，以及超声心动图测量的不良心脏结构和功能。3)采用高分辨率25年CT扫描测量43-55岁个体的冠状动脉重塑指数（RI），并确定RI与PAT、PATEpi、VAT（通过主研究测量）、CAC评分和斑点病变之间的相关性，并根据体脂测量（BMI和腰围）和其他风险因素进行校正。到2015-2020年，将有可能对目标1-3进行冠心病事件预测分析。将通过单次曝光以标准和高分辨率获得心脏CT图像（无造影剂），以测量PAT、PATEpi、CAC评分、斑点形态和RI（从14秒的额外扫描到资助的腹部CT）。后两种“高危”表型与冠状动脉内超声或尸检发现的急性冠状动脉综合征罪犯病变相关。该提案通过增加与PAT及其在冠状动脉粥样硬化和心脏结构-功能中的作用相关的新科学来利用对CARDIA的投资。该项目将把25年的CARDIA纵向数据（人体测量、生物标志物、行为、心理社会、营养、遗传、CT VAT和心脏超声心动图）与新的表型联系起来。在2010-11年对这些表型进行的测量将使未来的分析能够预测2015-20年的临床CHD事件，进一步加强其影响。 公共卫生相关性：非裔美国人和白色成年人的早期肥胖是过早心脏病和心血管死亡的一个因素。我们将利用现有的5，115例患者的研究，随访25年，通过CT和超声心动图进行新的测量。我们将确定33-55岁成年人心脏周围脂肪的变化如何影响随后的心脏病。