Potential future benefits of cardiovascular risk factor control in today’s young adults

 描述（由申请人提供）：大约1300万年轻人（年龄20-39岁）患有高胆固醇，大约600万患有高血压。最近的治疗指南不鼓励年轻人治疗高血压或高胆固醇。胆固醇治疗指南尤其如此，该指南基于心血管疾病的短期（十年）风险。然而，越来越多的证据表明，年轻人的高血压或高胆固醇是晚年心血管疾病的强有力预测因素，即使在考虑了晚年风险因素水平之后。对于这个项目，我们建议建立在这个证据的基础上，将生命过程，年龄相关的风险因素的风险和影响的年轻成人的风险因素暴露到一个微观模拟模型的心血管疾病的风险在年轻人。我们组建了一支由心血管疾病流行病学、生物统计学、卫生经济学评估和计算机模拟建模专家组成的团队，以评估治疗和控制美国年轻人高血压或胆固醇的增量价值。我们的目标是利用这些专业知识和方法，以便：·评估潜在的健康益处（生命年增加）的早期高血压和胆固醇治疗和控制在年轻的成年期，占避免累积动脉粥样硬化损害从早期生活暴露于这些危险因素，·预测2015年至2050年糖尿病前期年轻人早期血压和胆固醇治疗和控制的潜在健康益处。我们假设，与40岁后根据10年风险控制血压和胆固醇相比，40岁前治疗和控制高血压和胆固醇将在质量调整生命年中产生上级终身收益。然而，我们预计这些益处将对不良事件发生率和与多年坚持健康生活方式选择或每天服用预防性药物相关的任何潜在生活质量下降非常敏感。相关性：结果 这项研究可能会改变患者、医疗保健提供者、支付者和临床指南制定者对年轻人CVD风险和早期一级预防潜力的看法，并可能最终有助于改善生命周期。 美国成年人的心血管健康这些结果有可能影响临床实践指南的修改，并鼓励以工作场所为基础的预防计划和其他针对年轻成人心血管健康促进的预防计划。

 DESCRIPTION (provided by applicant): About 13 million young adults (ages 20-39 years) have high cholesterol and about six million have high blood pressure. Recent treatment guidelines have discouraged treatment of high blood pressure or high cholesterol in young adults. This is particularly true of cholesterol treatment guidelines, which are based on short-term (ten year) risk for cardiovascular disease. However, evidence is accumulating that high blood pressure or cholesterol in the young adult years is a strong predictor of later life cardiovascular disease, even after accounting for later life risk factors levels. For this project,we propose to build on this evidence by incorporating life course, age-related risk factor trajectorie and impact of young adult risk factor exposures into a microsimulation model of cardiovascular disease risk in young adults. We have assembled a team of experts in cardiovascular disease epidemiology, biostatistics, health economic evaluation, and computer simulation modeling in order to evaluate the incremental value of treating and controlling high blood pressure or cholesterol in U.S. young adults. We aim to use this expertise and these methods in order to: • Estimate the potential health benefits (life years gained) of early high blood pressure and cholesterol treatment and control during young adulthood, accounting for avoided cumulative atherosclerotic damage from early life exposures to these risk factors, and • Project the potentil health benefits of early blood pressure and cholesterol treatment and control in young adults with pre-diabetes from 2015 to 2050. We hypothesize that treatment and control of high blood pressure and cholesterol before age 40 years would yield superior lifetime gains in quality-adjusted life years compared with controlling BP and cholesterol according to 10-year risk after age 40 years. However, we anticipate that these benefits will be very sensitive to adverse event rates and any potential quality of life decrement associated with years of adhering to healthful lifestyle choices or taking preventive medications on a daily basis. Relevance: The results of this study may change the way patients, health care providers, payers, and clinical guideline makers perceive CVD risk and the potential for early primary prevention in young adults, and may eventually contribute towards improved lifetime cardiovascular health in U.S. adults. The results have the potential to influence modifications to clinical practice guidelines and encourage worksite-based and other prevention programs targeted at young adult cardiovascular health promotion.