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

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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).