Identifying Epidemiological Risk Factors for Abdominal Aortic Aneurysm

确定腹主动脉瘤的流行病学危险因素

• 批准号: 8249066
• 负责人: Weihong Tang
• 金额: $ 61.49万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-04-01 至 2015-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8249066
• 关键词: Abdomen; Abdominal Aortic Aneurysm; Address; Adult; Affect; African American; Atherosclerosis; Biological; Biological Markers; Blood specimen; Cardiac; Categories; Cause of Death; Cessation of life; Clinical; Cohort Studies; Communities; Complex; Cross-Sectional Studies; Data; Disease; Elderly; Epidemiologic Studies; Epidemiology; Etiology; Extracellular Matrix; Extracellular Matrix Degradation; General Population; Hospital Records; Individual; Inflammation; Life; Measures; Medicare; Operative Surgical Procedures; Participant; Plasma; Prevalence; Prevention; Prospective Studies; Protocols documentation; Public Health; Risk; Risk Factors; Role; Rupture; Ruptured Abdominal Aortic Aneurysm; Sampling; Testing; Thrombosis; Time; Ultrasonography; Woman; abdominal aorta; base; cardiovascular risk factor; clinical Diagnosis; cohort; cost; cost effective; effective intervention; follow-up; human old age (65+); improved; insight; men; middle age; mortality; novel; population based; prevent; prospective; public health relevance; repaired

DESCRIPTION (provided by applicant): Abdominal aortic aneurysm (AAA) is a common disease in the elderly and an important public health problem. Ruptured AAA is associated with a 65% to 85% mortality rate and ranked one of the leading causes of death in the elderly. Elective surgery or endovascular repair for identified large AAA are the only effective interventions for AAA and there are no specific pharmacological agents that have been shown to be effective in preventing or reducing AAA progression in the general population. The etiology of AAA is complex and not well understood. Although traditional cardiovascular risk factors have been associated with the risk of AAA, their importance in the etiology of AAA is not well established. Furthermore, the novel etiopathogenic mechanisms such as extracellular matrix remodeling and degradation, inflammation, and thrombosis have been hypothesized but their roles are not appropriately determined. We propose to take advantage of the planned cardiac ultrasound exams in the Atherosclerosis Risk in Communities (ARIC) Study to perform an ultrasound examination of the abdominal aorta to identify undiagnosed AAA cases in this large population-based cohort. In addition, these will be pooled with 265 existing cases already identified through hospital records and those to be identified through Medicare linkage. Utilizing the risk factor and plasma samples already collected in ARIC at baseline, we will conduct epidemiological studies of AAA in this large prospective cohort that has been followed for more than 20 years. The specific aims of this application are: 1) to perform an ultrasound examination of the abdominal aorta in approximately 6,886 ARIC participants, 25% African-Americans, who will be 67-89 years and expected to attend the next ARIC exam in 2011-13. Based on a prevalence estimate of 6.1% asymptomatic AAA in men and 1.7% in women older than 65 years, we anticipate to identify 235 undiagnosed AAA cases in the ARIC cohort. With the previously diagnosed clinical cases during 1987-2011, we expect a total of 475 AAAs. 2) To investigate the associations of AAA with potential novel risk factors previously measured in ARIC or to be measured in stored blood samples collected at ARIC baseline in 1987- 89. Specifically, we will evaluate novel biomarkers in the following categories: (a) extracellular matrix remodeling; (b) extracellular matrix degradation; (c) inflammation; and (d) thrombosis. This study will be the first to comprehensively evaluate the role of novel risk factors in the etiology of AAA in a large, population- based cohort of middle-aged adults followed for more than 20 years. Conducting this study within ARIC takes advantage of ARIC's extensively characterized cohort, existing biological samples available at no cost to the current project, and provides a particularly rapid and cost-effective way to establish an AAA cohort as the abdominal ultrasound protocol is readily added to the cardiac ultrasound to be performed in the 2011-13 ARIC exam. PUBLIC HEALTH RELEVANCE: Data from this study will provide new insights in the biological determinants of AAA, and potentially improve prevention and early management of AAA to prevent ruptures.

描述（申请人提供）：腹主动脉瘤（AAA）是老年人的常见病和重要的公共卫生问题。 AAA 破裂与 65% 至 85% 的死亡率相关，是老年人死亡的主要原因之一。针对已确定的大 AAA 的选择性手术或血管内修复是 AAA 的唯一有效干预措施，并且没有特定的药物已被证明可以有效预防或减少一般人群中 AAA 的进展。 AAA 的病因很复杂，目前尚不清楚。尽管传统的心血管危险因素与 AAA 风险相关，但它们在 AAA 病因学中的重要性尚未明确。此外，人们已经假设了新的致病机制，例如细胞外基质重塑和降解、炎症和血栓形成，但它们的作用尚未得到适当确定。我们建议利用社区动脉粥样硬化风险 (ARIC) 研究中计划的心脏超声检查对腹主动脉进行超声检查，以识别这一基于人群的大型队列中未确诊的 AAA 病例。此外，这些病例将与已通过医院记录确定的 265 例现有病例以及将通过 Medicare 联系确定的病例合并在一起。利用 ARIC 基线时已收集的危险因素和血浆样本，我们将在这个已跟踪 20 多年的大型前瞻性队列中进行 AAA 流行病学研究。该应用程序的具体目标是： 1) 对大约 6,886 名 ARIC 参与者进行腹主动脉超声检查，其中 25% 是非裔美国人，年龄为 67-89 岁，预计将参加 2011-13 年的下一次 ARIC 检查。根据 65 岁以上男性无症状 AAA 患病率估计为 6.1%，女性无症状 AAA 患病率为 1.7%，我们预计在 ARIC 队列中识别出 235 例未确诊的 AAA 病例。根据 1987 年至 2011 年期间先前诊断的临床病例，我们预计 AAA 总数为 475 例。 2) 研究 AAA 与先前在 ARIC 中测量的或将在 1987-89 年 ARIC 基线收集的储存血液样本中测量的潜在新危险因素的关联。具体来说，我们将评估以下类别的新生物标志物： (a) 细胞外基质重塑； (b) 细胞外基质降解； (c) 炎症； (d) 血栓形成。这项研究将首次全面评估新型危险因素在 AAA 病因学中的作用，该研究对一个大型中年成年人队列进行了 20 多年的跟踪研究。在 ARIC 内进行这项研究利用了 ARIC 广泛表征的队列、当前项目免费提供的现有生物样本，并提供了一种特别快速且经济有效的方法来建立 AAA 队列，因为腹部超声方案很容易添加到 2011-13 ARIC 检查中执行的心脏超声中。 公共健康相关性：这项研究的数据将为 AAA 的生物学决定因素提供新的见解，并有可能改善 AAA 的预防和早期管理，以防止破裂。