Profiling Cardiovascular Events and Biomarkers in the Very Old to Improve Personalized Approaches for the Prevention of Cardiac and Vascular Disease

分析老年人的心血管事件和生物标志物，以改进预防心脏和血管疾病的个性化方法

• 批准号: 9277554
• 负责人: CHRISTIE Mitchell BALLANTYNE
• 金额: $ 79.42万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-01 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9277554
• 关键词: Address; Adult; Adverse effects; Age; Aging; Algorithms; American; Atherosclerosis; Atherosclerosis Risk in Communities; Benefits and Risks; Biological Markers; Blood Pressure; Brain natriuretic peptide; Cardiac; Cardiology; Cardiovascular Diseases; Cardiovascular system; Cholesterol; Clinical; Clinical Management; Clinical Trials; Cognitive aging; Coronary heart disease; Data; Decision Making; Dementia; Development; Disease; EFRAC; Elderly; Equation; Event; Fibrosis; Galectin 3; Guidelines; Heart failure; High Prevalence; Hospitalization; Impaired cognition; Incidence; Individual; Inflammation; Injury; Intervention Trial; Knowledge; Lead; Left Ventricular Ejection Fraction; Life Style; Lipids; Measurement; Measures; Medical; Medicare; Myocardial Infarction; N-terminal; Older Population; Organ; Participant; Patients; Performance; Physicians; Population; Prevention; Prevention trial; Preventive; Primary Prevention; Process; Provider; Public Health; Recommendation; Risk; Risk Assessment; Risk Factors; Risk Reduction; Stress; Stroke; Troponin I; Troponin T; Tumorigenicity; Vascular Diseases; Visit; Work; aged; base; cardiovascular disorder prevention; cardiovascular disorder risk; circulating biomarkers; cohort; high risk; high risk population; improved; inflammatory marker; middle age; mortality; novel marker; outcome forecast; patient population; personalized approach; population based; tool

Although older individuals have the highest absolute risk for cardiovascular disease (CVD) events, U.S. cholesterol and blood pressure guidelines recommend lower-intensity, less-aggressive treatment in this high- risk population based on limited clinical trial data and potential for more side effects. The current risk prediction equation does not include individuals aged >79 years, nor does it include heart failure (HF), a more common CVD event in older individuals than myocardial infarction or stroke. Recent trials have demonstrated greater absolute CVD risk reduction in older high-risk participants, underscoring the need for improved risk assessment to inform treatment decisions and patient–physician discussions regarding therapy. Cardiac biomarkers have been shown to identify higher-risk individuals and to improve HF risk prediction beyond traditional risk factors in middle-aged adults in the Atherosclerosis Risk in Communities (ARIC) Study. In the proposed work, we will develop risk prediction tools for atherosclerotic CVD and HF tailored for very old adults, including cardiac biomarker measurements, to provide more comprehensive CVD risk assessment and to allow more precise assessment of potential benefits and risks of therapy as well as midlife lifestyle, demographic, and clinical factors that lead to healthy cardiovascular aging. In addition to data on traditional risk factors and CVD events from ARIC, we propose to measure biomarkers of cardiac injury, stress, fibrosis, and inflammation in all ARIC participants who attended the most recent visit (visit 5: 2011–2013; most aged ≥70 years) and the upcoming visits (visit 6: n=4,214, 2016–2017, most aged ≥75 years; visit 7: n=3,827, 2018–2019) to address our aims: 1: To assess the performance of the Pooled Cohort Equation risk calculator for atherosclerotic CVD in very old adults and to develop an improved risk calculator using the best circulating biomarkers and risk factor panel; 2: To quantify and compare risk of HF versus atherosclerotic CVD, develop risk prediction tools for incident HF in very old adults and a comprehensive tool for HF, myocardial infarction, and stroke for primary prevention; 3: To identify major midlife factors leading to “healthy cardiovascular aging,” defined as the absence of clinical CVD events and elevated cardiac biomarkers.

尽管老年人发生心血管疾病 (CVD) 事件的绝对风险最高，但美国 胆固醇和血压指南建议在这种高胆固醇血症中采用较低强度、较不积极的治疗方法。 基于有限的临床试验数据和潜在更多副作用的风险人群。当前风险预测 方程不包括年龄>79岁的个体，也不包括心力衰竭（HF），这是一种更常见的疾病 老年人中的CVD事件比心肌梗塞或中风更严重。最近的试验表明更 老年高危参与者的绝对 CVD 风险降低，强调了改善风险的必要性 评估为治疗决策和患者与医生关于治疗的讨论提供信息。心脏 生物标志物已被证明可以识别高风险个体并改善心力衰竭风险预测 社区动脉粥样硬化风险 (ARIC) 研究中中年人的传统危险因素。在 拟议的工作，我们将开发专为老年人量身定制的动脉粥样硬化 CVD 和 HF 风险预测工具， 包括心脏生物标志物测量，以提供更全面的 CVD 风险评估并允许 更准确地评估治疗的潜在益处和风险以及中年生活方式、人口统计、 以及导致健康心血管衰老的临床因素。除了传统风险因素和 ARIC 的 CVD 事件，我们建议测量心脏损伤、压力、纤维化和炎症的生物标志物 在参加最近一次访问的所有 ARIC 参与者中（访问 5：2011-2013 年；大多数年龄≥70 岁）以及 即将进行的访问（访问 6：n=4,214，2016-2017 年，大多数年龄≥75 岁；访问 7：n=3,827，2018-2019）以解决 我们的目标： 1：评估动脉粥样硬化 CVD 汇集队列方程风险计算器的性能 并使用最佳循环生物标志物和风险开发改进的风险计算器 因素面板； 2：量化和比较心衰与动脉粥样硬化 CVD 的风险，开发风险预测工具 用于治疗高龄成人的心力衰竭，也是针对原发性心力衰竭、心肌梗塞和中风的综合工具 预防; 3：确定导致“健康心血管衰老”的主要中年因素，定义为 没有临床心血管事件和心脏生物标志物升高。