Chicago Healthy Aging Low Risk MRI Angiography (CHARISMA) Study

描述(由申请人提供)：近年来，注意力转向那些心血管疾病(CVD)风险因素(低风险；LR)有利的个人，其定义是不吸烟、没有糖尿病、低总胆固醇水平、低血压和瘦体重指数。与非LR身份的人相比，那些在青壮年/中年(50岁)具有LR身份的人在余生中患心血管疾病的风险大大降低，大大延长了寿命，并显著提高了与健康相关的生活质量，并在老年人(65岁)时降低了医疗费用。目前尚不清楚青壮年/中年LR状态的个体是否也有同样低水平的亚临床冠状动脉粥样硬化(SubCAD)和较低的左心室(LV)质量。目前，技术的进步使非侵入性血管成像成为可能，它可以与使用磁共振成像(MRI)对心肌结构和功能进行敏感的非侵入性评估相结合。这项应用的总体目标是更好地确定预防与青壮年LR状态相关的临床心血管事件的潜在机制。芝加哥健康老龄化研究(CHAS)是一项由NHLBI支持的研究，它将重新检查1967-1973年首次检查的1500名年龄在65-79岁之间的人；这些CHAS参与者中，600人是LR，900人不是25-44岁的LR。因此，CHAS提供了一个独特的机会，利用冠状动脉MR血管成像和心脏MRI来研究青年时期LR/NOT-LR状态对亚CAD和心脏结构和功能的影响。本申请旨在作为CHAS的一项辅助研究，并将解决以下具体目标：1)确定25-44岁的左心室状态与65-79岁的冠状动脉粥样硬化的MRI测量的相关性；2)确定25-44岁的左心室状态与65-79岁的左室包块的MRI测量的相关性；以及3)在25-44岁的LR和NOT-LR状态的背景下，确定65-79岁时测量的亚CAD和LV质量的MRI测量与同时测量的炎症标志物、身体功能和其他亚临床CVD测量的相关性。综上所述，我们将使用MRI技术来检查那些年轻/中年时风险较低的人，现在他们的年龄在65-79岁之间，以确定他们的亚冠心病和左心室重量增加的负担。这项研究将填补我们对LR状态长期后果知识的重大空白，这可能最终导致公共卫生和预防战略的改善。与公共健康相关：近年来，人们的注意力转向了那些具有冠状动脉疾病(CAD)有利危险因素(低风险；LR)的个人，其定义是不吸烟、没有糖尿病、低总胆固醇水平、低血压和瘦体重指数。这些人在他们的余生中极大地降低了患冠心病的风险，大大延长了寿命，显著提高了与健康相关的生活质量，并在老年人(65岁)时降低了医疗费用。然而，目前尚不清楚这些人是否永远不会患上动脉粥样硬化，这是冠心病的前兆，还是他们会患上动脉粥样硬化但不会转化为临床事件，如心脏病发作。目前，技术的进步允许使用磁共振成像(MRI)对冠状动脉进行成像，而不必进行有创性的心脏插管。这项应用的总体目标是更好地确定预防与青年时期低风险状态相关的临床CAD事件的长期保护的潜在机制。我们将对芝加哥健康老龄化研究的一组参与者(约250人)进行核磁共振成像，以评估冠状动脉粥样硬化量和心肌大小。综上所述，我们将使用核磁共振技术来检查那些年轻/中年时风险较低的人，以及现在65-79岁的人，以确定他们的冠心病负担和心泵功能问题。这项研究将填补我们对低风险状态的长期后果知识的重大空白，这可能最终导致公共卫生和预防战略的改善。

DESCRIPTION (provided by applicant): In recent years, attention has turned to individuals who have a favorable risk factor profile (low risk; LR) for cardiovascular disease (CVD), defined by no smoking, lack of diabetes, low total cholesterol levels, low blood pressure, and lean body mass index. Compared with individuals with not-LR status, those with LR status in young adulthood/middle age (<50 years) have dramatically reduced risk for development of CVD during their remaining lifespan, substantially greater longevity, and significantly greater health-related quality of life and lower medical costs at older ages (>65 years). It is not known whether individuals with LR status in young adulthood/middle age have similarly low levels of subclinical coronary atherosclerosis (subCAD) and lower left ventricular (LV) mass. Advances in technology currently allow for non-invasive angiographic imaging, which can be combined with sensitive non-invasive assessment of myocardial structure and function using magnetic resonance imaging (MRI). The overall goal of this application is to better define the mechanisms underlying the protection against clinical CVD events associated with LR status in young adulthood. The Chicago Healthy Aging Study (CHAS) is a NHLBI-supported study that will re-examine 1500 individuals aged 65-79 years who were initially examined in 1967-1973; 600 of these CHAS participants were LR and 900 were not-LR at ages 25-44 years. Thus, the CHAS provides a unique opportunity to study the consequences of LR/not-LR status in young adulthood on subCAD and cardiac structure and function, using coronary MR angiography and cardiac MRI. The present application is designed as an ancillary study to the CHAS, and will address the following Specific Aims: 1) To determine the association of LR status at ages 25-44 years with MRI measures of coronary atherosclerosis at ages 65-79 years; 2) To determine the association of LR status at ages 25-44 years with MRI measures of LV mass at ages 65-79 years; and 3) To determine the association of MRI measures of subCAD and LV mass measured at ages 65-79 years with concurrent measures of inflammatory markers, physical functioning, and other measures of subclinical CVD, in the context of LR versus not-LR status at ages 25-44 years. In summary, we will use MRI technology to examine people who were at low risk in young adulthood/middle age and are now 65-79, to determine their burden of subCAD and of elevated LV mass. This research will fill critical gaps in our knowledge of the long-term consequences of LR status, which may ultimately lead to improvements in public health and preventive strategies. PUBLIC HEALTH RELEVANCE: In recent years, attention has turned to individuals who have a favorable risk factor profile (low risk; LR) for coronary artery disease (CAD), defined by no smoking, lack of diabetes, low total cholesterol levels, low blood pressure, and lean body mass index. These individuals have dramatically reduced risk for development of CAD during their remaining lifespan, substantially greater longevity, and significantly greater health-related quality of life and lower medical costs at older ages (>65 years). However, it is not known whether these individuals never develop atherosclerosis, the precursor of CAD, or whether they develop it but it does not convert into clinical events, such as heart attacks. Advances in technology currently allow for imaging of coronary arteries using magnetic resonance imaging (MRI) without having to perform invasive heart catheterization. The overall goal of this application is to better define the mechanisms underlying the long-term protection against clinical CAD events associated with low risk status in young adulthood. We will perform MRI to assess the amount of atherosclerosis in coronary arteries and the size of the heart muscle in a subset (approximately 250) of participants of the Chicago Healthy Aging Study. In summary, we will use MRI technology to examine people who were at low risk in young adulthood/middle age and are now 65-79 years old, to determine their burden of CAD and of problems with heart pumping function. This research will fill critical gaps in our knowledge of the long-term consequences of low risk status, which may ultimately lead to improvements in public health and preventive strategies.