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

描述（由申请人提供）：代谢综合征（MetS）是一组心血管指标，似乎与不甚了解的潜在过程有关，这些过程增加了冠心病（CHD）、中风、2型糖尿病（T2 DM）和慢性肾病（CKD）的风险，这些疾病在非裔美国人中高度流行。代谢综合征的各个组成部分包括腹部肥胖、高甘油三酯、低HDL胆固醇、高血压（BP）和高空腹血糖。传统上，给定个体中MetS的分类是基于这些不同组分的截止点的组合。然而，使用分界线容易对刚好低于分界线的中等海拔的个体漏分类。此外，MetS标准已被证明在与疾病的相关性方面表现出种族/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，HDL降低等）按性别和种族/民族群体聚类和差异相关。因此，根据这些差异，评分按性别和种族/族裔为每个组成部分分配不同的权重。给定个体的评分可以使用特定于他/她的性别和种族/民族的方程从标准临床测量计算。这种新的评分具有很好的临床应用风险评估的潜力。该评分不仅能够考虑在非裔美国人中观察到的MetS的独特特征，而且该评分以可以在个体之间进行比较并在个体内随时间推移进行随访的方式表达MetS严重程度。我们建议使用此MetS严重程度评分来评估杰克逊心脏研究中的参与者，以获得在临床应用中使用此工具的关键信息。我们的计划有三个方面。1)我们将评估可能影响MetS严重程度的基线和纵向流行病学和生活方式因素; 2）我们将评估患有和未发展为CHD、中风、T2 DM和CKD的个体之间的基线MetS严重程度;和3）我们将评估MetS严重程度的个体内变化，从而诊断出上述CVD相关疾病。我们已经组建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-最终目标是在非洲裔美国人患者中预防CVD。

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.