The natural history of cardiovascular health in U.S. populations

美国人群心血管健康的自然史

• 批准号: 8623574
• 负责人: Christy Leigh Avery
• 金额: $ 10.38万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-15 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8623574
• 关键词: Adolescence; Adopted; Adult; African American; Age; American; American Heart Association; American Indians; Blood Glucose; Blood Pressure; Body Weight; Cardiovascular Diseases; Cardiovascular system; Caucasians; Caucasoid Race; Cerebrovascular Disorders; Cholesterol; Classification; Cohort Studies; Coronary artery; Coronary heart disease; Data; Development; Diet; Disease; Disease-Free Survival; Epidemic; Ethnic group; European; Event; Family Study; Glucose; Goals; Health; Health Care Costs; Health Promotion; Healthcare; Heart; High Prevalence; Hispanics; International; Intervention; Intervention Studies; Kidney; Knowledge; Latino; Life; Life Cycle Stages; Longevity; Maintenance; Measurement; Measures; Metric; Minority; Minority Groups; Modeling; Morbidity - disease rate; National Health and Nutrition Examination Survey; Natural History; Participant; Pattern; Physical activity; Population; Probability; Public Health; Publishing; Quality of life; Race; Research; Risk; Shoulder; Smoking; Stroke; age group; base; cardiovascular disorder prevention; community health study; ethnic minority population; experience; health disparity; innovation; insight; intervention program; markov model; member; mortality; novel; population based; public health relevance; sex; young adult

DESCRIPTION (provided by applicant): Ideal cardiovascular health (CVH) is a novel concept recently defined and adopted by the American Heart Association to set national goals for health promotion and disease reduction through 2020 and beyond. CVH emphasizes the maintenance of a low-risk profile throughout the life course and is operationalized through measurement and classification (ideal; intermediate; poor) of seven CVH metrics (nonsmoking, body weight, physical activity, diet, total cholesterol, blood pressure, and blood glucose). Although maintenance of ideal CVH across the lifespan may eliminate ¿ 70% of the U.S. cardiovascular disease (CVD) epidemic, fewer than 1% of Americans successfully maintain ideal levels of all seven CVH metrics. Suboptimal CVH profiles are especially prevalent among U.S. minority groups, who attain intermediate and poor levels of CVH metrics earlier in life than their non-minority counterparts. However, the ages at which members of minority populations transition between ideal, intermediate and poor levels of CVH metrics have not been described. The fact that early transitions from ideal to intermediate and poor levels of CVH metrics have been strongly and consistently associated with cardiovascular morbidity and mortality lends some urgency to this line of health disparities research. A parallel need is estimation of the populatio-wide benefits of modest, but achievable increases in the probability of maintaining ideal levels of CVH metrics across the life course, as the very high prevalence of intermediate or poor CVH metric levels in U.S. populations makes complete elimination of these two classifications highly unlikely. However, these two knowledge gaps remain unaddressed, likely reflecting a lack of large, contemporary, and longitudinal population-based studies that include the major U.S. race/ethnic groups and cover the entire at-risk age epochs that span adolescence to late adulthood. In this application we respond to these challenges by leveraging extant cross-sectional data and state of the art Markov models to estimate the race/ethnic- and sex-stratified age-specific probabilities of transitioning between ideal, intermediate and poor levels of CVH metrics among approximately 35,000 African American, Hispanic/Latino, American Indian, and Caucasian U.S. participants. The estimated transition probabilities will then be merged with results from published intervention and longitudinal cohort studies to calculate race/ethnic- and sex- specific reductions in CVD associated with interventions that increase the proportion of the U.S. population maintaining ideal CVH. Together, results from this study will inform public health and intervention programs aimed at promoting ideal CVH in the age groups most at risk for its loss. A focus on African American, Hispanic/Latinos, and American Indian populations adds further significance to this innovative proposal, as these populations attain intermediate and poor CVH profiles earlier than European Americans and shoulder elevated burdens of the downstream cardio-, renal- and cerebrovascular disease manifestations.

描述（由申请人提供）：理想心血管健康（CVH）是美国心脏协会最近定义和采用的一个新概念，旨在为2020年及以后的健康促进和疾病减少设定国家目标。CVH强调在整个生命过程中保持低风险特征，并通过测量和分类（理想;中等;差）7个CVH指标（不吸烟，体重，体力活动，饮食，总胆固醇，血压和血糖）来操作。尽管在整个生命周期内保持理想的CVH可以消除美国70%的心血管疾病（CVD）流行，但只有不到1%的美国人成功地保持了所有七个CVH指标的理想水平。次优的CVH特征在美国少数民族群体中尤其普遍，他们比非少数民族群体更早达到中等和较差的CVH指标水平。然而，少数群体成员在理想、中等和较差CVH指标水平之间过渡的年龄尚未描述。CVH指标从理想到中等和较差水平的早期过渡与心血管发病率和死亡率密切相关，这一事实使这一系列健康差异研究变得紧迫。一个平行的需要是估计维持理想水平的可能性的适度但可实现的增加对整个人口的好处。 整个生命过程中的CVH指标，因为美国人群中中等或较差CVH指标水平的非常高的患病率使得完全消除这两种分类非常不可能。然而，这两个知识差距仍然没有得到解决，这可能反映了缺乏大规模的，当代的，纵向的基于人群的研究，包括美国主要的种族/族裔群体，并涵盖了整个处于危险中的年龄段，从青春期到成年后期。在本申请中，我们通过利用现有的横截面数据和最先进的马尔可夫模型来估计在大约35，000名非洲裔美国人、西班牙裔/拉丁裔、美洲印第安人和高加索美国参与者中在理想、中等和较差水平的CVH指标之间过渡的种族/种族和性别分层年龄特异性概率，从而应对这些挑战。然后将估计的转移概率与已发表的干预和纵向队列研究的结果合并，以计算与增加维持理想CVH的美国人群比例的干预相关的CVD种族/种族和性别特异性降低。总之，这项研究的结果将为公共卫生和干预计划提供信息，这些计划旨在促进最有可能丧失CVH的年龄组的理想CVH。对非洲裔美国人、西班牙裔/拉丁美洲人和美洲印第安人人群的关注为这一创新提案增加了进一步的意义，因为这些人群比欧洲裔美国人更早达到中度和较差的CVH特征，并承担了下游心血管、肾脏和脑血管疾病表现的负担。