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

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的救援人员和志愿者（响应者）的潜在心血管疾病影响。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可持续战略。使用招募和目前随访的WTC-Heart队列，目的是：1)评估2年冠心病（CHD）和一般心血管疾病的风险；2)比较弗雷明汉心脏研究（FHS）对CHD和CVD的评分与观察到的WTC-Heart风险；WTC-Heart评估但未包括在FHS评分中的其他危险因素有：a)暴露于9/11尘埃云中；b)创伤后应激障碍和抑郁症；3)比较55岁以上的世贸中心响者与INVEST队列的冠心病风险，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世贸中心遗址的空气污染和精神压力；4)建立一个基于住院和死亡登记的被动随访程序，并确定从主动随访转向被动随访的潜在偏差。WTC-Heart （N=6,492）包括在世界贸易中心健康计划（WTCHP）西奈山和北岸站点的年度监测访问中积极招募的应答者。在入组之日测量心血管疾病的决定因素，包括血脂、9/11暴露、抑郁和可能的创伤后应激障碍。对血压、BMI和腰围进行标准化评估。对突发和复发性心血管疾病的持续随访包括年度筛查、访谈和医疗记录审查。根据基线特征和随访结果计算2年预测的冠心病风险和观察到的风险。与INVEST队列的比较将在2年随访结束时进行。截至2013年11月，完成了3300名参与者（占队列的50%）的随访。头几个月的应答率在50%以上。通过问卷调查和个人访谈确定了37例CVD事件。该研究将：1)继续积极随访2年，获得2年CHD和CVD风险评估，并与FHS评分进行比较；2)建立基于住院和死亡率数据联系的长期被动随访程序。如果9/11响应者的长期心血管健康受到的影响超过心血管疾病风险的通常决定因素，我们可能会提出修订的wtc评分来识别高风险响应者并更有效地指导治疗。这一评估工具不仅将指导世贸中心救援人员的护理工作，还将指导对受未来灾害影响的平民进行医疗监测。

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.