REasons for Geographic And Racial Differences in Stroke- Myocardial Infarction-3

尽管显著下降，冠心病(CHD)仍然是#年发病率和死亡率的主要原因。 美国。为了进一步减少冠心病，更好地了解21世纪的冠心病风险和后果是 需要考虑到：1)持续的健康差距；2)ST段抬高心肌梗死(MI)的减少；3) 提高肌钙蛋白实验室分析的灵敏度，增加对非常微小和以前的 无法检测到的心肌梗死事件；4)他汀类药物的广泛使用和血运重建程序，使人群复杂化 研究和风险预测；5)更多的人在首次心肌梗死中存活；6)更加重视人口健康 管理和以病人为中心。中风的地理和种族差异的原因 (关于)队列包括2003-2007年招募的30 239名社区居住的白人和黑人参与者。 在前两个供资周期中，REGES-MI辅助研究编写了100份关于种族问题的出版物 冠心病之间的差异和已确定的新的冠心病危险因素。关于家长和其他辅助研究 收集了广泛的表型、心血管疾病(CVD)风险因素和患者报告的结果 数据，包括链接的联邦医疗保险数据。第二次家访接近完成，提供以患者为中心的 终点包括首次心肌梗死后长达10年的生活质量。这些新颖数据耦合的可用性 对所有参与者进行10年的随访为研究高危人群中的冠心病提供了一个独特的机会 亚群体，例如，社会经济地位低的人、黑人和老年人，以确定战略 优化人口健康，同时消除健康差距。我们的具体目标是：1) 确定CHD和CVD(无论是CHD还是中风)的10年发病率，并检查与 传统风险因素和新兴风险因素。 CHD事件将使用相同的严格方法进行评判 在前两个资助期内，并结合通过父母关注度判定的中风事件 学习。我们将完善已公布的冠心病和心血管疾病风险预测模型，并在 亚组(例如，年龄、种族、性别和社会经济状况)和MI类型(非常小或‘微型’MI，以及类型2 MI)。2) 制定务实的战略，以确定可以作为干预目标的高危亚群，以优化 在消除健康差距的同时，确保人口健康。 我们将计算人口归因于 通过风险因素分布的人口转移可能避免的风险和事件数量。3) 确定冠心病复发事件、心力衰竭(HF)和首次治疗后死亡率的比率和危险因素 判决的MI (包括非常小的或‘微型’心肌梗死和2型心肌梗死)或冠状动脉血运重建术， 总体和亚组(例如，冠心病事件的类型、年龄、种族、性别和社会经济状况)。4)使用2英寸中的数据- 家访，描述以患者为中心的结果(功能状态、抑郁症状、压力、认知 功能、生活质量)、心力衰竭、二级预防和风险因素管理 判决的MI 、总体和分组(例如，年龄、种族、性别和社会经济地位)。

Despite marked declines, coronary heart disease (CHD) remains a leading cause of morbidity and mortality in the US. To further decrease CHD, a better understanding of CHD risks and outcomes in the 21st century is needed in light of: 1) continued health disparities; 2) declining ST elevation myocardial infarctions (MI); 3) increasing sensitivity of troponin laboratory assays, increasing detection of very small and previously undetectable MI events; 4) wide use of statins and revascularization procedures, complicating population studies and risk prediction; 5) more people surviving their first MI; 6) increased emphasis on population health management and patient-centeredness. The REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort includes 30,239 community-dwelling white and black participants recruited in 2003-2007. In the previous 2 funding cycles, the REGARDS-MI ancillary study has produced >100 publications on racial disparities in CHD and identified novel CHD risk factors. The REGARDS parent and other ancillary studies have collected extensive phenotype, cardiovascular disease (CVD) risk factor, and patient-reported outcomes data, including linked Medicare data. A second in-home visit is nearing completion, providing patient-centered endpoints including quality of life up to 10 years following first MI. The availability of these novel data coupled with >10 years of follow-up for all participants offers a unique opportunity to study CHD among high-risk subpopulations, e.g., those with low socioeconomic status (SES), blacks, and older adults to identify strategies to optimize population health while simultaneously eliminating health disparities. Our Specific Aims are to: 1) Determine the 10-year incidence of CHD and CVD (either CHD or stroke) and examine associations with traditional and emerging risk factors. CHD events will be adjudicated using the same rigorous methods used during the first 2 funding periods and combined with stroke events adjudicated through the parent REGARDS study. We will refine published CHD and CVD risk prediction models and assess emerging risk factors in subgroups (e.g., age, race, sex, and SES) and by MI type (very small or `microsize' MI, and type 2 MI). 2) Develop pragmatic strategies to identify high-risk subgroups that could be targeted for interventions to optimize population health while simultaneously eliminating health disparities. We will calculate population attributable risks and numbers of events potentially averted through population shifts in risk factor distributions. 3) Determine the rates of, and risk factors for, recurrent CHD events, heart failure (HF), and mortality after first adjudicated MI (including very small, or `microsize' MI, and type 2 MI) or coronary revascularization procedure, overall, and in subgroups (e.g., type of CHD event, age, race, sex, and SES). 4) Using data from the 2nd in- home visit, describe patient-centered outcomes (functional status, depressive symptoms, stress, cognitive functioning, quality of life), HF, secondary prevention, and risk factor management up to 10 years after first adjudicated MI , overall and in subgroups (e.g., age, race, sex, and SES).