Regional & Racial Differences in Hemostasis & Risk of Stroke & Heart Disease

描述(由申请人提供)：我们建议为Neil A.Zakai博士(佛蒙特州大学初级教员)提供一个为期5年的研究和培训计划，通过调查止血生物标记物水平对30,228名黑人和白人中风和冠心病(CHD)的地区和种族差异的影响，在血管流行病学方面发展独立的职业生涯。国际公认的心血管流行病学研究员玛丽·库什曼博士将担任该项目的主要导师。在这项研究期间，库什曼博士将支持该项目的教育和研究方面。咨询委员会是从流行病学、神经学和血液学专家中挑选出来的，以提供建立网络和未来合作的最佳机会。扎凯博士将亲自与咨询委员会会面，并每月通过电话会议与其会面。为了实现扎凯博士未来的独立研究生涯，我们建议在佛蒙特州大学和约翰霍普金斯大学彭博公共卫生学院开设流行病学和生物统计学方面的具体课程。该项目将是一项病例队列研究，重点是多种止血生物标记物(单独和成组)对美国中风和冠心病发病率的地区和种族差异的影响。具体目标是：1)创建RECES内的嵌套病例队列研究；2)使用多变量建模和因子分析来阐明中风和冠心病的发病机制；3)将止血生物标志物和传统的心血管疾病危险因素整合到一个中风和冠心病风险模型中，该模型可以解释心血管疾病的种族和/或地区差异。佛蒙特大学的临床和生化研究实验室是进行这项研究的理想场所，它将实验室方面和流行病学专业知识结合在一起，以确保丰富的翻译研究经验。 公共卫生相关性：冠心病和中风存在地区和种族差异，不能用传统的心血管危险因素解释。我们假设，止血方面的地区和种族差异是其中一些差异的基础。

DESCRIPTION (provided by applicant): We propose a 5-year research and training program for Dr. Neil A. Zakai (a junior faculty member at the University of Vermont) to develop an independent career in vascular epidemiology by investigating the impact hemostatic biomarker levels have on regional and racial differences in stroke and coronary heart disease (CHD) in the 30,228 black and white individuals in the REasons for Geographic and Racial Differences in Stroke study (REGARDS). Dr. Mary Cushman, an internationally recognized investigator in cardiovascular epidemiology, will serve as the principle mentor for this project. Though the period of this study, Dr. Cushman will support the educational and research aspects of this project. The advisory committee was selected from experts in epidemiology, neurology, and hematology to provide the best opportunities for networking and future collaborations. Dr. Zakai will meet with the advisory committee both in person and through teleconferences on a monthly basis. To achieve a future independent research career for Dr. Zakai, we propose specific coursework in epidemiology and biostatistics at the University of Vermont and the Johns Hopkins Bloomberg School of Public Health. The project will be a case-cohort study focusing on the impact of multiple hemostatic biomarkers (both individually and in groups) on the regional and racial differences in stroke and CHD incidence in the United States. The specific aims will 1) create the nested case-cohort study within REGARDS, 2) use multivariable modeling and factor analysis to elucidate mechanisms for stroke and CHD and 3) integrate hemostatic biomarkers and traditional CVD risk factors into a model for stroke and CHD risk that can account for racial and/or regional differences in CVD. The Laboratory for Clinical and Biochemical Research at the University of Vermont serves as an ideal setting to conduct this research by bringing together the laboratory aspects and the epidemiological expertise to ensure a rich translational research experience. PUBLIC HEALTH RELEVANCE: There are regional and racial differences in coronary heart disease and stroke not explained by conventional cardiovascular risk factors. We hypothesize that regional and racial differences in hemostasis underlie some of these disparities.