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: 8588974
• 负责人: Elaine Mott Urbina
• 金额: $ 54.26万
• 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/8588974
• 关键词: Acceleration; Accounting; Address; Adolescent; Adolescent and Young Adult; 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; non-invasive imaging; 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 对成年人的长期随访表明，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， 聚类，CV疾病的风险大于如果添加基于个体因素的风险。同样地， 儿童和青少年的尸检研究表明，CV风险因素簇损害心脏和血液 在临床事件发生之前，超声波和其他类型的非侵入性研究是否可以 证明青少年和年轻人的心脏损伤和动脉硬化（加速CV老化） 与CV风险因素簇相关的成人尚不清楚。此外，年轻人CV老化的正常速度必须 在确定CV老化的单个或聚集风险因素的影响之前，应记录这些风险因素。 该提议的中心假设是，更快的CV老化（心脏和颈动脉增厚， 心脏功能降低、动脉僵硬度增加、动脉壁功能降低）将随着时间的推移发生， 有CV风险因素的年轻人，尤其是那些与肥胖相关的年轻人，例如2型糖尿病， 与瘦的、低风险的受试者相比。这一假设将在5至7年后通过重新审查来检验， 基线CV测量（使用超声和其他非超声检查）的青少年和年轻成人组 侵入性测试）已经收集。目的是1）测量青少年的CV老化率， 2）确定哪些CV风险因素簇最能预测加速CV老化 （CV结构和功能恶化）。 本研究将通过提供描述青年正常CV老化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，因为它是不切实际的测量心血管风险因素， 孩子们，然后跟踪他们几十年，直到他们经历心脏病发作或中风。使用这些非- 侵入性测试的结果，循证为基础的临界点，可以制定，以确定何时侵略性 应开始针对儿童CV风险因素的治疗（如药物治疗）。这将改善目前的 指导原则，1）设定任意水平，定义不基于硬CV的异常风险因素水平 数据和2）只解决一个高水平的单一风险因素，不考虑集群的贡献， CV风险因素处于未来CV疾病风险的临界水平。此外，如果证明有效， 加速CV老化，这些非侵入性测试可用于监测治疗的有效性。成功 该项目的完成将改变目前儿科CV预防的模式， 根据基于可靠科学研究的指南之一进行治疗的要点， 儿童将积极干预集中在有记录的CV加速老化的年轻人身上。