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低强度，不太积极的治疗，在这个高， 风险人群基于有限的临床试验数据和更多副作用的可能性。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）， CVD事件在老年人中的发生率高于心肌梗死或卒中。最近的试验表明， 老年高风险参与者的绝对CVD风险降低，强调需要改善风险 评估，以告知治疗决策和患者-医生关于治疗的讨论。心脏 生物标志物已被证明可以识别高风险个体，并改善HF风险预测， 在社区动脉粥样硬化风险（ARIC）研究中，中年人的传统风险因素。在 建议的工作，我们将开发动脉粥样硬化CVD和HF的风险预测工具，为非常老年人量身定制， 包括心脏生物标志物测量，以提供更全面的心血管疾病风险评估并允许 对治疗的潜在获益和风险以及中年生活方式、人口统计学、 和临床因素，导致健康的心血管老化。除了关于传统风险因素的数据外， 从ARIC的CVD事件，我们建议测量心脏损伤，应激，纤维化和炎症的生物标志物 参加最近一次访视（访视5：2011-2013;大多数年龄≥70岁）的所有ARIC受试者和 即将进行的访视（访视6：n= 4，214，2016-2017，大多数年龄≥75岁;访视7：n= 3，827，2018-2019），以解决 我们的目的：1：评估合并队列方程风险计算器在动脉粥样硬化CVD中的性能 并使用最佳循环生物标志物和风险来开发一种改进的风险计算器 因素面板; 2：量化和比较HF与动脉粥样硬化CVD的风险，开发风险预测工具 用于极老年人的HF事件和原发性HF、心肌梗死和卒中的综合工具， 预防; 3：确定导致“健康心血管衰老”的主要中年因素， 无临床CVD事件和心脏生物标志物升高。