Favorable Cardiovascular Health and the Compression of Morbidity in Older Age

说明(申请人提供)：中年期间心血管(CV)健康状况良好的人(即所有主要心血管风险因素，包括血压、胆固醇、体重指数、不吸烟和没有诊断为糖尿病)的理想水平，已被证明一生中患心血管疾病的风险较低，寿命较长。之前关于拥有良好简历的好处的研究已经分别检查了发病率和死亡率等结果。到目前为止，尚不清楚其他病态情况是否只是取代了心血管疾病，或者心血管健康状况良好的人是否真的经历了健康寿命的延长(即没有重大发病率)。虽然我们知道良好的心血管健康会延缓心血管疾病的发生并延长寿命，但它对累积终生发病率的影响仍不清楚。这项建议的总体目标是了解中青年心血管健康如何实现延长健康生命期和减少老年发病率(所有主要慢性病)的终生负担的目标。为了实现这一目标，我们将利用芝加哥心脏检测项目工业研究(CHA；1967-1973年筛查39,522名男性和女性)与2010年之前的联邦医疗保险索赔数据之间的当前联系，这将为我们提供超过25年的跟踪调查。然后，我们将使用复杂的统计方法来解决以下具体目标。具体目标：1.确定中青年心血管健康良好是否与将心血管疾病发病率压缩到死亡前的较短时间内和/或较低的老年心血管疾病平均发病率水平有关2.确定中青年心血管健康良好是否与死亡前较短时间内的发病率和/或老年人较低的平均发病率(所有主要慢性病的发病率)有关3.确定中年心血管健康良好是否与较低的累积、年度和终生医疗费用有关。

DESCRIPTION (provided by applicant): Individuals with favorable cardiovascular (CV) health, (i.e. having ideal levels of all major cardiovascular risk factors, including blood pressure, cholesterol, body mass index, not smoking and no diagnosis of diabetes), during middle-age have been shown to have a lower lifetime risk for cardiovascular disease and a longer lifespan. Previous studies on the benefits of a having a favorable CV profile have examined outcomes such as morbidity and mortality separately. As yet, it remains unclear whether other morbid conditions simply replace CVD or whether individuals in favorable CV health actually experience an extension of healthy life (i.e. without major morbidity). While we know that favorable CV health delays the onset of cardiovascular disease and increases longevity, its impact on cumulative lifetime morbidity remains unknown. The over-arching goal of this proposal it to understand how favorable cardiovascular health at younger and middle ages may achieve the goal of prolonging the period of healthy life and reducing the lifetime burden of morbidity (from all major chronic diseases) at older age. To accomplish this aim we will take advantage of the current linkage of the Chicago Heart Detection Project in Industry Study (CHA; 39,522 men and women screened in 1967-1973) with Medicare claims data through 2010, which will provide us with over 25 years of follow-up. We will then use sophisticated statistical methods to address the following specific aims. Specific Aims: 1. To determine whether favorable cardiovascular health at younger and middle ages is associated with the compression of CVD morbidity into a shorter period of time before death and/or lower average level of CVD morbidity in older age 2. To determine whether favorable cardiovascular health at younger and middle ages is associated with the compression of morbidity into a shorter period of time before death and/or lower average level of morbidity (from all major chronic diseases) in older age 3. To determine whether favorable cardiovascular health during middle-age is associated with lower cumulative, annual, and end of life Medicare expenditures.