REasons for Geographic And Racial Differences in Stroke-Myocardial Infarction-2

描述(申请人提供)：随着2010年接近尾声，很明显，尽管我们朝着消除健康方面的种族差异的2010年健康人目标迈进了很大一步，但我们还没有实现我们的冠心病(CHD)目标。在一定程度上，由于需要依赖社区动脉粥样硬化风险研究(ARIC)的发病率，这项研究在20年前招募了参与者，这在一定程度上阻碍了进展。这些数据可能无助于回答为什么冠心病(CHD)死亡率的黑白差异可能会扩大。此外，参加ARIC的黑人主要是从冠心病高死亡率地区的单一社区招募的。与更广为人知的卒中带相似，美国县级的冠心病死亡率差异高达10倍；ARIC的研究不能检查地区差异。因此，我们仍然不知道为什么黑人的心肌梗死(MI)发病率低于白人，但冠心病死亡率高于白人。中风研究中的地理和种族差异的原因是产生了研究急性冠心病种族和地区差异所需的数据。这一预期队列从2003年至2007年招募，包括30,239名社区居民，基线年龄为45岁，居住在美国48个毗邻的州，其中42%是黑人(n=12,490)，55%是女性(n=16,612)。丰富的基线数据包括病史、功能状态、健康行为、心理社会测量、生理测量(血压、身高和体重)、血和尿生物标记物(例如胆固醇、蛋白尿、C反应蛋白)和心电图。我们来自Agents-MI-1的初步数据显示，与65岁的参与者相比，65岁的参与者的黑白冠心病发病率差异较小。此外，在迄今进行的随访中，白人的非致命性急性心肌梗死发病率在冠心病死亡率高的地区最高，而黑人则不是。总而言之，这些发现表明ARIC研究中发病率的种族差异可能不能一概而论。现有的冠心病事件数量(352例确诊/可能的心肌梗死，187例冠心病死亡)不足以检查这些具有挑衅性的早期发现背后的原因。我们现在寻求资金以延长随访时间，目标是：1.估计地区和种族特定的明确或可能的MI、急性CHD死亡率，包括院内和院外死亡和猝死的比率。H1。黑人和白人的急性非致命性心肌梗死的发病率在65岁的人群中相似，但黑人的发病率低于白人。H2。急性非致命性心肌梗死的发病率因地区而异，在冠心病死亡率高的地区白人发病率最高，但黑人不是。H3.黑人的急性冠心病死亡率总体上高于白人，在所有冠心病死亡率地区都是如此。2.找出非致命性和致命性冠心病的种族差异的可能解释因素。H1。传统的弗雷明翰心脏研究(FHS)的CHD风险因素、非FHS的CHD风险因素、CHD预防实践(AHA的《生活的简单7》)和CHD预防服务在白人和黑人之间有所不同，这在一定程度上解释了黑人CHD死亡率较高的原因。探索性H2。黑人和白人对某些冠心病危险因素的易感性不同，这在一定程度上解释了白人冠心病发病率和黑人冠心病死亡率较高的原因。

DESCRIPTION (provided by applicant): As 2010 draws to a close, it is evident that despite great strides toward the Healthy People 2010 objective to eliminate racial disparities in health, we have fallen short of achieving our goal for coronary heart disease (CHD). In part, progress has been hampered by the need to rely on the Atherosclerosis Risk in Communities (ARIC) study for incidence rates, a study which recruited participants >20 years ago. These data may not be helpful in answering why Black-White disparities for coronary heart disease (CHD) mortality may be widening. Furthermore, Blacks enrolled in ARIC were recruited primarily from a single community in a high CHD mortality region. Similar to the more widely recognized Stroke Belt, US county level CHD mortality varies as much as 10 fold; the ARIC study cannot examine regional differences. As a result, we still do not know why Blacks have lower myocardial infarction (MI) incidence yet higher CHD mortality than Whites. The REasons for Geographic And Racial Differences in Stroke Study is generating data needed to study racial and regional differences in acute CHD. This prospective cohort, recruited from 2003-7, includes 30,239 community dwellers age >45 years at baseline residing in the 48 contiguous US states, with 42% Blacks (n=12,490) and 55% women (n=16,612). Rich baseline data include medical history, functional status, health behaviors, psychosocial measures, physiologic measures (BP, height and weight), blood and urine biomarkers (e.g., cholesterol, albuminuria, CRP) and ECGs. Our preliminary data from REGARDS-MI-1 reveal smaller Black-White CHD incidence differences for participants age <65 years compared with those age >65 years. Furthermore, in follow-up conducted to date, nonfatal acute MI incidence rates are highest in high CHD mortality regions for Whites, but not for Blacks. Together, these findings suggest that racial differences in incidence in the ARIC study may not be generalizable. The number of CHD events currently available (352 definite/probable MI, 187 CHD deaths) is insufficient to examine the reasons underlying these provocative early findings. We now seek funding to extend follow-up, aiming to: 1. To estimate region and race-specific rates of definite or probable MI, acute CHD mortality, including in- and out-of-hospital deaths, and sudden death. H1. Acute nonfatal MI incidence for Blacks and Whites is similar for those age <65 years, but lower for Blacks versus Whites age >65 years. H2. Acute nonfatal MI incidence varies by region and is highest in high CHD mortality regions for Whites, but not Blacks. H3. Acute CHD mortality is higher for Blacks than Whites overall, and across all CHD mortality regions. 2. To identify potential explanatory factors for racial difference in nonfatal and fatal CHD. H1. Traditional Framingham Heart Study (FHS) CHD risk factors, non-FHS CHD risk factors, CHD preventive practices (AHA's "Life's Simple 7") and CHD preventive services differ between Whites and Blacks, in part explaining higher CHD mortality in Blacks. Exploratory H2. Susceptibility to some CHD risk factors differs for Blacks and Whites in part explaining higher White CHD incidence and higher Black CHD mortality.