Preventing Cardiovascular Disease through Improved Risk Prediction and Communication

心血管疾病（CVD）仍然是美国的主要死亡原因。他汀类药物治疗 已证明他汀类药物用于高危人群时，在减少CVD事件方面显着有效，但他汀类药物仍处于- 利用。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， 一级预防和患者未能采取这些药物时，提供。现有型号 预测CVD风险有很大的局限性，特别是对于年轻人。此外，其概率 输出既不容易理解，对患者也没有影响。Navar博士的K 01提案使用汇总数据 从七个NHLBI队列研究，以创建一个改进的年轻人CVD风险预测模型。这 模型将估计“连续的”终身CVD风险，纳入一系列风险因素，并评估风险， 多个患者年龄。其次，Navar博士将评估这种新颖的连续终身风险模型如何改进 相对于当前风险工具，他汀类药物治疗候选者的识别。第三，提高能力， 将这些数据传达给患者，她将把这些风险估计转化为人群相对风险。这 将使患者了解其CVD风险状况与年龄和性别匹配的类似患者相比如何 同龄人然后，她将使用一个独特的国家登记册，以更好地了解如何最好地沟通数字 和概率数据。最后，她将开发一个基于网络的风险沟通工具， 结合新的终身风险、人群相对风险和当前的10年风险估计，并试用该工具 病人焦点小组这一基于网络的工具将与电子健康记录相连接，并在 门诊临床设置，以评估真实的时间估计和患者定制的共享决策如何影响 临床护理目前的提案还将协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的培训 分析说，这将使她在了解真实的世界方面做好更多准备，成为一名国家领导人 预防性治疗的安全性和有效性。同样，在定性研究和 行为科学在此应用中提出，结合CVD风险的实际发展， 交流工具，将使她能够建立一个独立的研究计划，重点是提高吸收 通过有效的患者风险沟通来预防CVD治疗。该培训计划建立在 杜克临床研究所（DCRI）已经成功的研究。导师团队由Dr. DCRI主任、CVD结局研究专家Eric Peterson，包括风险预测专家 （共同导师Pencina和外部顾问D 'Agostino）和风险沟通（共同导师Boulware），所有 他们将确保科学的成功，并监督候选人在其相关领域的高级培训， 专业知识通过这项计划的结论，纳瓦尔博士将能够进行先进的研究，在CVD 作为一名独立的医学科学家。

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.