Cerebrovascular Disease and its Consequences in the Strong Study Cohort
强研究队列中的脑血管疾病及其后果
基本信息
- 批准号:8133352
- 负责人:
- 金额:$ 171.16万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2009
- 资助国家:美国
- 起止时间:2009-08-15 至 2014-06-30
- 项目状态:已结题
- 来源:
- 关键词:AcculturationAddressAdultAfricanAgeAge DistributionAge-YearsAgingAlcohol consumptionAmerican Indian and Alaska NativeAmerican IndiansArizonaAtherosclerosisAtrial FibrillationBenignBlood PressureBlood VesselsBrainBrain DiseasesBrain imagingBrain scanCardiacCardiovascular DiseasesCardiovascular systemCenters for Disease Control and Prevention (U.S.)Cerebrovascular DisordersCessation of lifeClinicalClinical assessmentsCognitionCohort StudiesCommunitiesDataDementiaDiabetes MellitusDiseaseDyslipidemiasEchocardiographyElderlyEmployee StrikesEpidemicEthnic groupExerciseExpenditureFutureGenderGeneral PopulationGlucoseHealthHealth care facilityHealthcareHeartHeart AtriumHemorrhageHigh PrevalenceHippocampus (Brain)HypertensionImageImage AnalysisImpaired cognitionIncidenceInfarctionInflammatoryInterventionIschemic StrokeKnowledgeLaboratoriesLeftLesionLife ExpectancyLife StyleLinkLocationMagnetic Resonance ImagingMeasurementMeasuresMedical RecordsMental DepressionMetabolicMoralityMorbidity - disease rateMotorMyocardial InfarctionMyocardial IschemiaNational Heart, Lung, and Blood InstituteNeuropsychological TestsNorth DakotaObesityOklahomaOverweightParticipantPatient Self-ReportPerformancePeripheral Vascular DiseasesPersonsPhysical ExaminationPopulationPositioning AttributePrevalencePreventionProspective StudiesPublic HealthRaceRandomized Controlled TrialsRecording of previous eventsRiskRisk FactorsSamplingScreening procedureSeveritiesSex DistributionSigns and SymptomsSmokingSocietiesSouth DakotaStrokeTestingTimeTransient Ischemic AttackTribesUltrasonographyVideotapeWeightWomanWorld Health Organizationbaseblood lipidblood pressure regulationcaucasian Americancerebral atrophycognitive functioncohortcostdepressive symptomsdisabilitydisability leavedisorder riskexperiencefollow-upindexinglife time costmembermenmortalitymotor deficitmotor impairmentnovelpopulation basedpre-clinicalracial and ethnicresearch clinical testingsexwhite matter
项目摘要
DESCRIPTION (provided by applicant): Cerebrovascular disease (CBVD), a leading cause of morbidity and mortality, is linked to cognitive and motor impairment, and depression. Magnetic resonance imaging (MRI) has redefined CBVD in large cohort studies, such as the Cardiovascular Health Study (CHS) and Atherosclerosis Risk in Communities (ARIC). In CHS and ARIC, MRI revealed high prevalences of brain abnormalities, specifically white matter hyperintensities, infarcts, and hemorrhages, in populations without known stroke or transient ischemic attack. Further, overt CBVD, such as stroke, was strikingly less common than covert MRI-defined brain disease. The covert findings were not, however, benign accompaniments of aging as they were associated with impaired motor function and cognition, depression, and a striking increase in the risk of subsequent stroke and death. These studies have convincingly demonstrated that clinically-defined CBVD dramatically underestimates the true population burden of CBVD. Much of what we know about cardiovascular disease in American Indians (AIs) comes from the Strong Heart Study (SHS), a prospective study of 4,549 older adults from 13 tribes followed over 18 years. It conducted physical exams, laboratory and cardiac studies, and chart reviews to describe risk factors, prevalence, and incidence of cardiovascular disease morbidity and mortality. Recent analyses estimated the age- and gender- adjusted stroke incidence in the SHS as 679/100,000 persons, adjusted to the age and sex distribution of the U.S. adult population. This incidence is over twice that observed in the general population indicating AIs are experiencing an epidemic of CBVD. AIs, however, were not included in CHS or ARIC or the other community- based studies of CBVD, and the SHS did not perform MRIs. We will complete a clinical and MRI evaluation to re- assess risk and protective factors and describe MRI-defined CBVD in the SHS. With these data from surviving cohort members, we will address our Specific Aims which are to: 1) estimate the prevalence and quantify the extent of CBVD defined by brain MRI findings, specifically white matter hyperintensities, infarcts, hemorrhages, and cerebral atrophy; 2) assess the relationship of risk factors with prevalent MRI-defined CBVD such as demographic, lifestyle, clinical, laboratory, echocardiographic, and ultrasound measures, and the unique influence of acculturation and degree of Indian heritage; and 3) document the strength of associations of MRI- defined CBVD with motor deficits, cognitive impairment, and depressive symptoms, and establish if they are independent of demographic, lifestyle, and laboratory measures. The elevated stroke rates suggest that AIs may be suffering from a large burden of covert CBVD. As an AI sample in which CVD has been rigorously assessed, the SHS cohort is ideal for investigating CBVD and its manifestations. Of the original cohort of 4,549 members, only ~1,950 members will be alive and able to participate; 283 have died since the last submission. Other opportunities to gain knowledge on CBVD among AIs are not forthcoming. There is an urgent need to initiate this study now since as every year passes, fewer members of the original cohort survive. PUBLIC HEALTH RELEVANCE: Cerebrovascular Disease and its Consequences in the Strong Heart Study Cohort The American Indian population is one of the fastest growing segments of our society. Recent information has shown that American Indians have strokes at least 2-3 times more often as White Americans. The damage created by strokes, and other cerebrovascular diseases, can be seen on an MRI (or brain) scan. MRIs also reveal many "silent" strokes that are never apparent to the person or their doctor. This study will examine American Indians for damage to the brain caused by both apparent and "silent" strokes. The American Indian population is experiencing an epidemic of cerebrovascular disease, which given the cost and disability caused by strokes, promises to be a staggering public health issues in the years to come.
描述(由申请人提供):脑血管疾病(CBVD)是发病率和死亡率的主要原因,与认知和运动障碍以及抑郁症有关。磁共振成像(MRI)在大型队列研究中重新定义了CBVD,例如心血管健康研究(CHS)和社区(ARIC)的动脉粥样硬化风险。在CHS和ARIC中,MRI揭示了没有已知中风或短暂性缺血性发作的人群中脑异常的高流行率,特别是白质超强度,梗塞和出血。此外,公开的CBVD(例如中风)比秘密MRI定义的脑疾病的普遍性差不多。但是,秘密发现并不是衰老的良性伴奏,因为它们与运动功能和认知,抑郁症的受损以及随后中风和死亡的风险显着增加。这些研究令人信服地表明,临床定义的CBVD极大地低估了CBVD的真正人口负担。我们对美洲印第安人(AI)中心血管疾病的大部分内容都来自强大的心脏研究(SHS),这是一项针对18年以上13个部落的4,549名老年人的前瞻性研究。它进行了体格检查,实验室和心脏研究以及图表评论,以描述心血管疾病发病率和死亡率的风险因素,流行和发生率。最近的分析估计,SHS的年龄和性别调整后的中风发生率为679/100,000人,已调整为美国成年人口的年龄和性别分布。在普通人群中观察到的这一发病率超过两倍,表明AIS患有CBVD的流行。但是,AIS不包括在CHS,ARIC或其他基于社区的CBVD研究中,而SHS没有执行MRI。我们将完成临床和MRI评估,以评估风险和保护因素,并描述SHS中MRI定义的CBVD。借助来自幸存的队列成员的数据,我们将解决我们的具体目标:1)估计脑MRI发现定义的CBVD的患病率并量化,特别是白质超强度,梗塞,出血和脑萎缩; 2)评估风险因素与普遍的MRI定义CBVD的关系,例如人口统计学,生活方式,临床,实验室,超声心动图和超声措施,以及印度遗产的适应性和程度的独特影响; 3)记录了MRI-定义的CBVD与运动缺陷,认知障碍和抑郁症状的关联的强度,并确定它们是否独立于人口统计,生活方式和实验室措施。中风率升高表明,AIS可能承担着秘密CBVD的巨大负担。作为对CVD进行了严格评估的AI样本,SHS队列非常适合研究CBVD及其表现。在最初的4,549名成员的队列中,只有〜1,950名成员将还活着并能够参加;自上次提交以来,有283人死亡。在AIS之间获得有关CBVD知识的其他机会并不是即将到来的。迫切需要立即启动这项研究,因为随着每年的流逝,原始人群中的成员越来越多。公共卫生相关性:脑血管疾病及其在强大的心脏研究队列中的后果。美洲印第安人人口是我们社会增长最快的部分之一。最近的信息表明,美国印第安人的中风至少是白人美国人的2-3倍。在MRI(或大脑)扫描中可以看到中风和其他脑血管疾病所造成的损害。 MRI还揭示了许多“沉默”中风,这些中风对人或医生从未显而易见。这项研究将检查美国印第安人是否因明显和“无声”中风造成的大脑损害。美洲印第安人人口正在经历脑血管疾病的流行病,鉴于中风造成的成本和残疾,在未来几年中有望成为一个惊人的公共卫生问题。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
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DEDRA S BUCHWALD其他文献
DEDRA S BUCHWALD的其他文献
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{{ truncateString('DEDRA S BUCHWALD', 18)}}的其他基金
Community Health and Aging in Native Groups of Elders Resource Center for Minority Aging Research (CHANGE RCMAR)
土著老年人群体的社区健康和老龄化少数民族老龄化研究资源中心 (CHANGE RCMAR)
- 批准号:
10730130 - 财政年份:2023
- 资助金额:
$ 171.16万 - 项目类别:
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