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: 8735185
• 负责人: Christy Leigh Avery
• 金额: $ 10.67万
• 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 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8735185
• 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，旨在制定 2020 年及以后促进健康和减少疾病的国家目标。 CVH 强调在整个生命过程中维持低风险状况，并通过七个 CVH 指标（不吸烟、体重、体力活动、饮食、总胆固醇、血压和血糖）的测量和分类（理想、中等、差）来实施。尽管在整个生命周期中维持理想的 CVH 可能会消除美国 70% 的心血管疾病 (CVD) 流行率，但只有不到 1% 的美国人成功地维持所有七项 CVH 指标的理想水平。 CVH 状况不佳在美国少数族裔中尤其普遍，他们比非少数族裔更早达到中等或较差的 CVH 指标水平。然而，少数群体成员在 CVH 指标的理想、中等和较差水平之间过渡的年龄尚未描述。事实上，CVH 指标从理想水平到中等水平和较差水平的早期转变一直与心血管发病率和死亡率密切相关，这一事实为这一健康差异研究带来了一定的紧迫性。一个并行的需求是估计适度但可实现的增加维持理想水平的概率对整个人口的好处。 整个生命过程中的 CVH 指标，因为美国人群中中等或较差 CVH 指标水平的患病率非常高，因此完全消除这两种分类的可能性极小。然而，这两个知识差距仍未得到解决，可能反映出缺乏大规模、当代和纵向的基于人群的研究，这些研究包括美国主要种族/族裔群体，并涵盖从青春期到成年晚期的整个高危年龄阶段。在此应用程序中，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应对这些挑战，以估计约 35,000 名非裔美国人、西班牙裔/拉丁裔、美洲印第安人和白种人美国参与者中 CVH 指标的理想、中等和较差水平之间过渡的种族/族裔和性别分层年龄特定概率。然后，估计的转变概率将与已发表的干预措施和纵向队列研究的结果合并，以计算与增加维持理想 CVH 的美国人口比例的干预措施相关的种族/民族和性别特定的 CVD 减少量。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。对非裔美国人、西班牙裔/拉丁裔和美洲印第安人群体的关注进一步增加了这一创新提案的意义，因为这些群体比欧洲裔美国人更早获得中等和较差的 CVH 特征，并承担下游心血管、肾脏和脑血管疾病表现的沉重负担。