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

描述（由申请人提供）：随着2010年接近尾声，很明显，尽管在消除健康方面的种族差异的2010年健康人目标方面取得了很大进展，但我们还没有实现我们在冠心病（CHD）方面的目标。在某种程度上，由于需要依赖社区动脉粥样硬化风险（ARIC）研究的发病率，这一进展受到了阻碍，该研究在20年前招募了20名参与者。这些数据可能无助于回答为什么冠心病（CHD）死亡率的黑人-白人差异可能会扩大。此外，参加ARIC的黑人主要来自冠心病高死亡率地区的单一社区。与更广泛认可的卒中带类似，美国县级冠心病死亡率相差高达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）发生率比白人低，而冠心病死亡率却比白人高。卒中中地理和种族差异的原因研究正在生成研究急性冠心病的种族和地区差异所需的数据。该前瞻性队列于2003- 2007年招募，包括居住在美国48个相邻州的30,239名基线年龄为bb0 - 45岁的社区居民，其中42%为黑人（n=12,490）， 55%为女性（n=16,612）。丰富的基线数据包括病史、功能状态、健康行为、社会心理测量、生理测量（血压、身高和体重）、血液和尿液生物标志物（如胆固醇、蛋白尿、CRP）和心电图。我们来自REGARDS-MI-1的初步数据显示，年龄<65岁的参与者与年龄≥65岁的参与者相比，黑人和白人冠心病发病率的差异较小。此外，在迄今为止进行的随访中，非致死性急性心肌梗死发病率在白人冠心病高死亡率地区最高，而黑人则不是。总之，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。目前可获得的冠心病事件数量（352例明确/可能的心肌梗死，187例冠心病死亡）不足以检验这些具有争议性的早期发现背后的原因。我们现在寻求资金以扩大后续行动，目标是：估计地区和种族特定的确定或可能的心肌梗死、急性冠心病死亡率（包括院内和院外死亡）和猝死率。H1。黑人和白人65岁以下人群的急性非致死性心肌梗死发生率相似，但黑人65岁以下人群的发生率低于白人。H2。急性非致死性心肌梗死的发病率因地区而异，白人在冠心病高死亡率地区最高，黑人则不然。H3。总体而言，黑人的急性冠心病死亡率高于白人，在所有冠心病死亡率地区都是如此。2. 确定非致死性和致死性冠心病种族差异的潜在解释因素。H1。传统弗雷明汉心脏研究（FHS）的冠心病风险因素、非FHS的冠心病风险因素、冠心病预防措施（美国心脏协会的“简单生活7”）和冠心病预防服务在白人和黑人之间存在差异，这在一定程度上解释了黑人冠心病死亡率较高的原因。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，部分解释了白人冠心病发病率较高和黑人冠心病死亡率较高。

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.