An Ethnicity-Specific MetS Severity Score to Assess Risk: The Jackson Heart Study

描述（由申请人提供）：代谢综合征（MetS）是一组心血管指标，似乎与鲜为人知的潜在过程有关，这些过程增加了冠心病（CHD）、中风、2型糖尿病（T2DM）和慢性肾脏疾病（CKD）的风险，这些疾病在非裔美国人中非常普遍。代谢当量的个体组成包括腹部肥胖，高甘油三酯，低高密度脂蛋白胆固醇，高血压（BP）和高空腹血糖。传统上，一个特定个体的MetS分类是基于这些不同成分的截止点的组合。然而，使用截止值很容易错过对中度海拔低于截止值的个体进行分类。此外，MetS标准已被证明在与疾病的关联中表现出种族/民族差异。我们设计了一个性别和种族/民族特异性的连续MetS严重程度评分，该评分考虑了MetS的各个组成部分（血压升高，高密度脂蛋白低等）如何聚集并根据性别和种族/民族群体进行差异关联。因此，基于这些差异，分数按性别和种族/民族为每个组成部分分配不同的权重。一个给定个体的得分可以根据其性别和种族/民族群体的特定方程从标准临床测量中计算出来。这种新颖的评分方法在临床风险评估中具有很好的应用潜力。这个分数不仅能够考虑到非裔美国人met的独特特征，而且这个分数以一种可以在个体之间进行比较的方式表达了met的严重程度，并且可以在个体内部进行长期跟踪。我们建议使用MetS严重程度评分来评估Jackson心脏研究的参与者，以获得在临床应用中使用该工具的关键信息。我们的计划有三个方面。1)我们将评估可能影响MetS严重程度的基线、纵向流行病学和生活方式因素；2)我们将评估有和没有进展为冠心病、卒中、T2DM和CKD的个体之间的基线MetS严重程度；3)我们将评估导致上述CVD相关疾病诊断的MetS严重程度的个体内变化。我们已经聚集了一个拥有多个专业领域的团队，并将利用我们的研究结果为临床医生提供指导，将MetS严重程度作为未来疾病的不祥指标-最终目标是预防非裔美国患者的心血管疾病。

DESCRIPTION (provided by applicant): The metabolic syndrome (MetS) is a cluster of cardiovascular indices that appear to be linked by poorly- understood insidious processes that increases risk for coronary heart disease (CHD), stroke, Type 2 diabetes (T2DM) and chronic kidney disease (CKD)-diseases that are highly prevalent among African Americans. The individual components of MetS include abdominal obesity, high triglycerides, low HDL cholesterol, high blood pressure (BP), and high fasting glucose. A classification of MetS in a given individual has traditionally been based on a combination of cut-off points for these different components. However, the use of cut-offs is liable to miss classifying individuals with moderate elevations that are just below the cut-off level. Additionally, MetS criteria have been shown to exhibit racial/ethnic differences in their association with disease. We have designed a sex- and race/ethnicity-specific continuous MetS severity score that takes into account how the individual components of MetS (elevated BP, low HDL, etc.) cluster and correlate differentially by sex and racial/ethnic group. Thus, based on these differences the score assigns different weights to each component by sex and race/ethnicity. A given individual's score can be calculated from standard clinical measures using an equation specific to his/her sex and racial/ethnic group. This novel score has excellent potential for clinical application for risk assessment. Not only is the score able to take into account unique features of MetS seen in African Americans but the score expresses MetS severity in a way that can be compared between individuals and followed over time within an individual. We propose to use this MetS severity score to evaluate participants in the Jackson Heart Study to gain information critical to using this tool in clinical application. Our plan is three-fold. 1) We will assess baseline and longitudinal epidemiologic and lifestyle factors that are likely to affect MetS severity; 2) we wil assess baseline MetS severity between individuals who do and do not progress to develop CHD, stroke, T2DM and CKD; and 3) we will evaluate intra-individual changes in MetS severity leading up to diagnosis of the above CVD- associated diseases. We have gathered a team with multiple areas of expertise and will use our findings to provide guidance to clinicians regarding the use of MetS severity as an ominous indicator of future disease- with an ultimate goal of CVD prevention among African American patients.