WTC-Heart: A Cohort Study of Heart Diseases in Word Trade Center Responders

WTC-Heart：世界贸易中心响应者心脏病队列研究

• 批准号: 8777789
• 负责人: Alfredo Morabia
• 金额: $ 48.97万
• 依托单位: QUEENS COLLEGE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8777789
• 关键词: WTC; Heart; Cohort; Study; Diseases

DESCRIPTION (provided by applicant): From preliminary evidence, exposure to the 9/11 World Trade Center (WTC) disaster increases risk of cardiovascular diseases (CVD). The WTC-Heart cohort study, established in 2011, rigorously assesses this potential CVD effect in surviving rescue workers and volunteers (responders). Cohort median age is 45. We propose to complete a two-year follow-up and install a sustainable strategy for its long-term follow-up. Using the recruited and currently followed-up WTC-Heart cohort, objectives are: 1) assess the two-year coronary heart disease (CHD) and general CVD risks; 2) compare the Framingham Heart Study (FHS) scores for CHD and CVD with the observed WTC-Heart risks; extra risk factors assessed by WTC-Heart but not included in the FHS score are a) exposure to the 9/11 dust cloud and b) PTSD and depression; 3) compare the CHD risk of WTC responders aged over 55 to that of the INVEST cohort, comprised of Washington Heights, NYC residents who were not directly exposed to the air pollution and mental stress at Ground Zero; 4) install a passive follow-up procedure based on hospitalization and death registries, and determine the potential bias related from switching from an active to a passive follow-up. WTC-Heart (N=6,492) comprises responders actively recruited at annual monitoring visits at the World Trade Center Health Program (WTCHP) Mt. Sinai and North Shore sites. Determinants of cardiovascular disease, including blood lipids, 9/11 exposure, depression, and probable PTSD were measured on the date of enrollment. Measures of blood pressure, BMI, and waist circumference assessments were standardized. An on-going follow-up for incident and recurrent CVD consists of annual screenings, interviews, and medical record review. The 2-year predicted risk of CHD and the observed risk will be calculated using baseline characteristics and the results of the follow-up. Comparisons with the INVEST cohort will be done at the end of the 2-year follow-up. As of November 2013, follow-up is complete for 3,300 participants (50% of the cohort). Response rates are above 50% for the first months. Thirty-seven incident CVD events were identified through questionnaire and personal interviews. The proposed study will: 1) continue the active follow-up for another 2 years to obtain a two-year CHD and CVD risk estimates and compare them with FHS scores; and 2) install procedures for a long-term passive follow-up based on linkage with hospitalization and mortality data. In the event that the long-term cardiovascular health of 9/11 responders is impacted above and beyond the usual determinants of cardiovascular disease risk, we may propose a revised WTC-score to identify high-risk responders and guide treatment more effectively. This assessment tool will not only guide care for WTC responders, but also guide medical surveillance of civilians affected by future disasters.

描述（由申请人提供）：从初步证据来看，暴露于9/11世界贸易中心（WTC）灾难会增加心血管疾病（CVD）的风险。2011年建立的WTC心脏队列研究严格评估了幸存救援人员和志愿者（响应者）的这种潜在CVD影响。队列中位年龄为45岁。我们建议完成为期两年的后续行动，并为其长期后续行动制定一项可持续战略。 使用招募的和目前随访的WTC-心脏队列，目的是：1）评估两年的冠心病（CHD）和一般CVD风险; 2）将FHS的CHD和CVD评分与观察到的WTC-心脏风险进行比较;由WTC-心脏评估但不包括在FHS评分中的额外风险因素是a）暴露于9/11尘云和B）PTSD和抑郁症; 3）将55岁以上的WTC应答者的CHD风险与INVEST队列的CHD风险进行比较，INVEST队列由纽约市华盛顿高地的居民组成，他们没有直接暴露于归零地的空气污染和精神压力; 4）根据住院和死亡登记建立被动随访程序，并确定从主动随访转换为被动随访的潜在偏倚。 WTC-Heart（N= 6，492）包括在世界贸易中心健康计划（WTCHP）Mt.西奈和北岸站点。心血管疾病的决定因素，包括血脂，9/11暴露，抑郁症和可能的创伤后应激障碍在入组当天进行了测量。血压、BMI和腰围评估的测量标准化。对事件和复发性CVD的持续随访包括年度筛查、访谈和病历审查。将使用基线特征和随访结果计算CHD的2年预测风险和观察到的风险。将在2年随访结束时与INVEST队列进行比较。 截至2013年11月，完成了3，300名参与者（队列的50%）的随访。最初几个月的答复率超过50%。通过问卷调查和个人访谈确定了37例CVD事件。拟议的研究将：1）继续主动随访2年，以获得两年CHD和CVD风险估计值，并将其与FHS评分进行比较; 2）根据与住院和死亡率数据的联系，安装长期被动随访程序。 如果9/11反应者的长期心血管健康受到的影响超出了心血管疾病风险的通常决定因素，我们可能会提出修订后的WTC评分，以识别高风险反应者并更有效地指导治疗。这一评估工具不仅将指导对世贸中心应急人员的护理，还将指导对未来受灾害影响的平民的医疗监测。