Accelerated CV Aging in Youth Related to CV Risk Factor Clusters

与心血管危险因素群相关的青少年心血管加速老化

• 批准号: 8420470
• 负责人: Elaine Mott Urbina
• 金额: $ 54.51万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-01-01 至 2015-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8420470
• 关键词: Acceleration; Accounting; Address; Adolescent; Adult; Affect; African American; Age; Aging; Arterial Fatty Streak; Arteries; Atherosclerosis; Autopsy; Behavior Therapy; Benchmarking; Blood Glucose; Blood Vessels; Cardiac; Cardiovascular Diseases; Cardiovascular system; Carotid Arteries; Caucasians; Caucasoid Race; Child; Childhood; Cholesterol; Clinical; Coronary artery; Cross-Sectional Studies; Data; Deterioration; Development; Diabetes Mellitus; Ethics; Evaluation; Event; Funding; Future; Guidelines; Heart; Hypertension; Image; Individual; Insulin Resistance; Intervention; Knowledge; Lead; Left Ventricular Mass; Lipids; Measurement; Measures; Monitor; Myocardial Infarction; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome; Outcome Measure; Patients; Pharmacotherapy; Population; Prevention; Prevention Guidelines; Relative (related person); Research; Risk; Risk Factors; Risk Reduction; Stroke; Structure; Testing; Thick; Time; Treatment Effectiveness; Ultrasonography; United States National Institutes of Health; Withholding Treatment; Youth; abstracting; arterial stiffness; base; cardiovascular disorder risk; cardiovascular risk factor; cohort; design; diabetic; evidence base; experience; follow-up; high risk; illness length; improved; innovation; intima media; lifetime risk; prevent; prospective; sound; successful intervention; young adult

Project Summary Abstract Long term follow-up of adults has shown that obesity, and high blood pressure, cholesterol and blood sugar increase the risk for future heart attack and stroke. When these cardiovascular (CV) risk factors occur in clusters, the risk for CV disease is greater than if the risk based on individual factors were added. Similarly, autopsy studies in children and adolescents show that clusters of CV risk factors damage the heart and blood vessels well before clinical events occur. Whether ultrasound and other types of non-invasive studies can demonstrate cardiac damage and hardening of the arteries (accelerated CV aging) in adolescents and young adults related to CV risk factor clusters is not known. Furthermore, the normal rate of CV aging in youth must be documented before the effect of individual or clustered risk factors for CV aging can be established. The central hypothesis for this proposal is that more rapid CV aging (thicker heart and carotid arteries, decreased cardiac function, increased arterial stiffness, reduced arterial wall function) will occur over time in youth with CV risk factors, especially those that cluster with obesity such as type 2 diabetes mellitus, as compared to lean, low-risk subjects. This hypothesis will be tested by re-examination 5 to 7 years later, of a group of adolescents and young adults in whom baseline CV measurements (using ultrasound and other non- invasive tests) were already collected. The aims are to 1) measure the rate of CV aging in adolescents and young adults and 2) determine which clusters of CV risk factors best predict accelerated CV aging (deterioration in CV structure and function). This study will address a knowledge gap by providing data describing the rate of normal CV aging in youth using non-invasive tests. This approach is valuable because it is impractical to measure CV risk factors in children and then follow them for decades until they experience heart attack or stroke. Using these non- invasive tests as the outcome, evidence-based cut-points can be developed to determine when aggressive treatment (like drug therapy) for pediatric CV risk factors should be initiated. This will improve upon the current guidelines which 1) set arbitrary levels defining an abnormal risk factor level that are not based on hard CV data and 2) only address a single risk factor at high level and do not account for the contribution of clusters of CV risk factors at borderline levels to risk for future CV disease. Furthermore, if proven effective in identifying accelerated CV aging, these non-invasive tests can be used to monitor effectiveness of treatment. Successful completion of this project will change the current paradigm in pediatric CV prevention from one of arbitrary cut- points for treatment to one of guidelines based on sound scientific study where primary CV prevention in children focuses aggressive intervention on youth with documented accelerated CV aging.

项目摘要摘要 成人的长期随访表明肥胖，高血压，胆固醇和血糖 增加未来心脏病发作和中风的风险。当这些心血管（CV）风险因素发生时 集群，CV疾病的风险比增加基于个体因素的风险更大。相似地， 对儿童和青少年的尸检研究表明，简历风险因素的簇损害了心脏和血液 临床事件发生之前的船只。超声和其他类型的非侵入性研究是否可以 表现出青少年和年轻人的动脉损伤和动脉硬化（加速CV衰老） 与CV风险因素群集有关的成年人尚不清楚。此外，青年时期的简历衰老的正常率必须 在可以建立个人或聚类危险因素的效果之前，请记录在CV衰老的效果之前。 该提议的中心假设是更快的CV衰老（心脏和颈动脉较厚， 心脏功能降低，动脉僵硬增加，动脉壁功能降低）将随着时间的流逝而发生 患有简历危险因素的青年，尤其是那些与肥胖症（例如2型糖尿病）聚集的年轻人， 与瘦的，低风险的受试者相比。该假设将在5到7年后通过重新检查，以 基线CV测量的青少年和年轻人（使用超声和其他非 - 已经收集了侵入性测试）。目的是1）衡量青少年和 年轻人和2）确定哪些简历风险因素的簇可以最好地预测CV衰老的加速 （CV结构和功能恶化）。 这项研究将通过提供描述青年正常简历衰老率的数据来解决知识差距 使用非侵入性测试。这种方法是有价值的，因为测量简历风险因素是不切实际的 孩子们，然后跟随他们数十年，直到他们经历心脏病或中风。使用这些非 - 作为结果，可以开发基于证据的切点来确定何时侵略性 应启动针对小儿简历危险因素的治疗（例如药物疗法）。这将改善当前 指南哪个1）设置定义异常风险因素水平的任意级别，而不是基于硬质量CV 数据和2）仅在高级别上解决一个单一的风险因素，并且不考虑群集的贡献 CV风险因素在边界水平上遇到未来简历疾病的风险。此外，如果被证明有效识别 加速的简历衰老，这些非侵入性测试可用于监测治疗的有效性。成功的 该项目的完成将改变当前的小儿简历预防范例 基于合理的科学研究的指南之一的治疗点，其中预防初级简历 儿童将积极的干预重点放在有记录的加速简历衰老的青年上。