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

描述（由申请人提供）： 随着2010年即将结束，很明显，尽管在实现2010年健康人目标方面取得了很大进展，以消除健康方面的种族差异，但我们还没有实现我们的冠心病（CHD）目标。在某种程度上，进展受到了需要依赖社区动脉粥样硬化风险（ARIC）研究发病率的阻碍，该研究招募了>20年前的参与者。这些数据可能无助于回答为什么黑人和白人的冠心病（CHD）死亡率差异可能正在扩大。此外，ARIC招募的黑人主要来自CHD高死亡率地区的单一社区。与更广泛认可的中风带相似，美国县级CHD死亡率差异高达10倍; ARIC研究无法检查地区差异。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。卒中中地理和种族差异的原因研究正在生成研究急性CHD中种族和地区差异所需的数据。该前瞻性队列研究于2003年至2007年招募，包括30，239名基线年龄>45岁的社区居民，居住在美国48个相邻州，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、心理社会指标、生理指标（BP、身高和体重）、血液和尿液生物标志物（例如，胆固醇、白蛋白尿、CRP）和ECG。我们来自REGARDS-MI-1的初步数据显示，年龄65岁的参与者的黑白CHD发病率差异较小<65 years compared with those age >。此外，在迄今为止进行的随访中，白人的非致死性急性心肌梗死发病率在CHD死亡率高的地区最高，但黑人并非如此。总之，这些发现表明，在ARIC研究中，种族差异的发病率可能是不可推广的。目前可用的CHD事件数量（352例明确/可能的MI，187例CHD死亡）不足以检查这些早期发现的潜在原因。我们现在寻求资金，以扩大后续行动，旨在：1。估计明确或可能的MI、急性CHD死亡率（包括院内和院外死亡）和猝死的地区和种族特异性发生率。H1。年龄&lt;65岁的黑人和白人的急性非致死性MI发病率相似，但年龄&gt;65岁的黑人比白人低。H2。急性非致死性心肌梗死的发病率因地区而异，在CHD死亡率高的地区，白人发病率最高，而黑人则不是。H3.总体而言，黑人的急性CHD死亡率高于白人，并且在所有CHD死亡率地区。2.确定非致死性和致死性CHD种族差异的潜在解释因素。 H1。传统心脏病研究（FHS）CHD危险因素，非FHS CHD危险因素，CHD预防实践（AHA的“生活简单7”）和CHD预防服务在白人和黑人之间存在差异，部分解释了黑人的CHD死亡率较高。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较高的白色冠心病发病率和较高的黑人冠心病死亡率。

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.