Preventing Cardiovascular Disease through Improved Risk Prediction and Communication

心血管疾病(CVD)在美国仍然是主要的死亡原因。他汀类药物治疗已经 事实证明，当他汀类药物用于高危人群时，在减少心血管事件方面非常有效，但他汀类药物仍低于... 被利用了。这些护理方面的差距代表了一个双重问题：未能适当地确定候选人 初级预防和患者在提供这些药物时未服用的情况。目前可用的型号 预测心血管疾病风险有很大的局限性，特别是对年轻人来说。此外，他们的概率 输出既不容易理解，也不会对患者产生影响。纳瓦尔博士的K01提案使用汇集的数据 从七项NHLBI队列研究中创建了一个针对年轻人的改进的心血管疾病风险预测模型。这 模型将估计“连续”终生心血管疾病风险，纳入一系列风险因素，并在 多个病人的年龄。其次，纳瓦尔博士将评估这一新的持续终身风险模型如何改进 相对于当前的风险工具，确定他汀类药物治疗的候选对象。三、提高执政能力 将这些数据传达给患者时，她会将这些风险估计转换为人群相对风险。这 将使患者了解他的心血管疾病风险特征与年龄和性别匹配的相似患者相比如何 同伴们。然后，她将使用唯一的国家注册来更好地了解如何最好地进行数字交流 以及给哪些患者提供概率数据。最后，她将开发一个基于网络的风险沟通工具 合并了新的终身风险、人群相对风险和当前的10年风险估计，并试用了此工具 在患者焦点小组中。这一基于网络的工具将链接到电子健康记录，并在 门诊临床环境，评估实时评估和患者定制的共享决策如何影响 临床护理。目前的提议还将帮助纳瓦尔博士充分加强她在公共场合的背景 健康。教学和应用统计经验，包括预测建模和因果关系方面的培训 分析，将让她变得更有准备，成为了解现实世界的国家领导者 预防性治疗的安全性和有效性。同样，正规的定性研究和培训 在这一应用中提出的行为科学，结合心血管疾病风险的实际开发 沟通工具，将使她能够建立一个独立研究计划，专注于改进吸收 通过有效的患者风险沟通，加强心血管疾病预防治疗。该培训计划建立在 已经在杜克临床研究所(DCRI)取得成功的研究。导师团队由Dr。 DCRI主任、心血管疾病后果研究专家埃里克·彼得森包括风险预测专家 (Pencina，联合导师和D‘Agostino，外部顾问)和风险沟通(Boulware，联合导师)，所有 谁将确保科学上的成功并监督候选人在其相关领域的高级培训 专业知识。到这个项目结束时，纳瓦尔博士将能够在心血管疾病方面进行高级研究 预防作为一名独立的内科医生-科学家。

Cardiovascular disease (CVD) remains a leading cause of death in the United States. Statin therapy has proven remarkably effective in reducing CVD events when used in those at risk, yet statins remain under- utilized. These gaps in care represent a twofold problem: a failure to appropriately identify candidates for primary prevention and a failure of patients to take these medications when offered. Currently available models to predict CVD risk have significant limitations, particularly for younger adults. Further, their probabilistic outputs are neither easily understood nor impactful to patients. Dr. Navar's K01 proposal uses pooled data from seven NHLBI cohort studies to create an improved CVD risk prediction model for young adults. This model will estimate “continuous“ lifetime CVD risk, incorporating a range of risk factors and evaluating risk at multiple patient ages. Second, Dr. Navar will evaluate how this novel continuous lifetime risk model improves identification of candidates for statin therapy relative to current risk tools. Third, to improve the ability to communicate these data to patients, she will transform these risk estimates into population relative risk. This will allow a patient to understand how his CVD risk profile compares with similar age- and gender-matched peers. She will then use a unique national registry to better understand how best to communicate numerical and probabilistic data to which patients. Finally, she will develop a web-based risk communication tool that incorporates the novel lifetime risk, population relative risk, and current 10-year risk estimates and pilot this tool in patient focus groups. This web-based tool will be linked to the electronic health record and tested in an outpatient clinical setting to assess how real time estimation and patient-tailored shared decision-making affect clinical care. The current proposal will also assist Dr. Navar in fully strengthening her background in public health. The didactic and applied statistical experiences, including training in predictive modeling and causal analysis, will allow her to become more prepared to be a national leader in the understanding of real world safety and effectiveness of preventive therapies. Similarly, the formal training in qualitative research and behavioral science proposed in this application, combined with the practical development of a CVD risk communication tool, will allow her to establish a program of independent research focused on improved uptake of CVD preventive therapies through effective patient risk communication. This training program builds on already successful research at the Duke Clinical Research Institute (DCRI). The mentorship team, led by Dr. Eric Peterson, Director of the DCRI and expert in CVD outcomes research, includes experts in risk prediction (Pencina, co-mentor, and D'Agostino, external advisor) and risk communication (Boulware, co-mentor), all of whom will ensure scientific success and oversee the candidate's advanced training in their relative areas of expertise. By the conclusion of this program, Dr. Navar will be able to carry out advanced research in CVD prevention as an independent physician-scientist.