Coronary artery calcium synthetic cohort and lifetime percentile project (CACSC-LPP)

冠状动脉钙合成队列和终生百分位项目 (CACSC-LPP)

• 批准号: 10731429
• 负责人: MICHAEL J BLAHA
• 金额: $ 12.28万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10731429
• 关键词: Adult; Agatston Score; Age; American; Asian population; Aspirin; Biological; Calcium; Cardiovascular Diseases; Cholesterol; Clinical; Collaborations; Companions; Consumption; Coronary Arteriosclerosis; Data; Data Pooling; Data Set; Decision Making; Elderly; Ensure; Ethnic Origin; Ethnic Population; Foundations; Future; Gender; Guidelines; Individual; Infrastructure; Institution; International; Investments; Lipids; Literature; Location; Longevity; Measures; Modernization; National Heart, Lung, and Blood Institute; Participant; Patient risk; Patients; Persons; Pharmaceutical Preparations; Pharmacotherapy; Phenotype; Population; Positioning Attribute; Prevention Guidelines; Prevention therapy; Preventive; Primary Prevention; Race; Recommendation; Research; Research Personnel; Resources; Risk; Risk Factors; Rural; Source; South Asian; Techniques; Testing; Time; Translating; United States National Institutes of Health; cardiovascular disorder prevention; cardiovascular disorder risk; cohort; coronary artery calcium; data harmonization; data standards; emerging adult; ethnic diversity; ethnic minority; human very old age (85+); improved; innovation; lifetime risk; middle age; mobile application; multidisciplinary; point of care; premature atherosclerosis; prototype; racial diversity; racial minority; risk prediction; sex; tool; treatment strategy; web site

Coronary artery calcium (CAC) testing provides a direct measure of an individual’s atherosclerotic burden that is robustly associated with cardiovascular disease (CVD) risk. Accordingly, CAC scoring has a IIa recommendation in the 2018 AHA/ACC Cholesterol Treatment and 2019 ACC/AHA Primary Prevention Guidelines and is also recommended by many other national and international guidelines for the allocation of primary prevention medications. The clinical implications of the Agatston score can vary significantly based on the age, sex, and race/ethnicity population percentile score, which is particularly crucial for estimating long- term or lifetime CVD risk, especially for younger persons in whom a low Agatston score may commonly be reflective of premature atherosclerosis and significantly increased lifetime risk. However, current guideline- recommended CAC percentile scores were developed from only one NHLBI cohort comprised of predominantly middle-aged participants and there is no centralized website or resource with all the available tools to facilitate interpretation of the CAC score. Consequently, there is an unmet need to 1) develop CAC percentile data across the lifespan that is more representative of the US population and more diverse across racial/ethnic minorities, particularly South Asians, who have a significantly increased CVD risk yet are not included in current percentile score calculators and 2) create a centralized website and mobile app to aid in the interpretation of CAC at the point of care. Therefore, using standardized data harmonization techniques, we propose to pool data from 7 NHBLI cohorts and 3 real-world clinically-derived cohorts to create the gender- balanced, racially/ethnically diverse CAC Synthetic Cohort Lifetime Pooling Project (CACSC-LPP) of approximately 20,000 NHBLI participants with CAC data across the lifespan (age 30-95 years old) and an additional ~90,000 participants from clinical CAC cohorts. Harmonizing the individual participant level data will pragmatically leverage the enormous NIH investment (monetary and time) in these cohorts to create a new pooled dataset that expands the clinical impact beyond what was originally envisioned. It will also create an ideal foundation to iteratively expand the CACSC-LPP to ensure better representation for all persons living in the US, with an initial focus on South Asians. Additionally, we will build upon our prototype CAC-tools website and companion app so that clinicians and patients can enter a CAC score (plus any other available risk factor data) and retrieve their CAC percentile. This website/app will serve as the definitive source for all CAC related tools and would be well positioned to be endorsed by future national CVD guidelines (see LOS, Drs. Lloyd- Jones & Arnett). Through the creation of the 1) CACSC-LPP, 2) CAC percentile calculator across the lifespan, and 3) centralized CAC website/app this project will improve personalized CVD risk prediction, implementation of ACC/AHA primary prevention recommendations, while also creating the infrastructure for multidisciplinary and cross-institutional collaborations to further improve our understanding of CAC for CVD risk prediction.

冠状动脉钙（CAC）测试提供了一个人的动脉粥样硬化负担的直接措施， 与心血管疾病（CVD）风险密切相关。因此，CAC评分为IIa 2018年AHA/ACC胆固醇治疗和2019年ACC/AHA一级预防的建议 许多其他国家和国际准则也建议， 初级预防药物。Agatston评分的临床意义可能因 年龄、性别和种族/民族人口百分位数，这对估计长期 长期或终生CVD风险，特别是对于年轻人，低Agatston评分通常 反映了过早的动脉粥样硬化和显著增加的终生风险。但是，目前的指导方针- 推荐的CAC百分位数评分仅来自一个NHLBI队列， 主要是中年参与者，没有集中的网站或资源，所有可用的 有助于解释CAC评分的工具。因此，存在以下未满足的需求：1）开发CAC 整个生命周期的百分位数数据更能代表美国人口， 少数种族/民族，特别是南亚人，他们的心血管疾病风险显著增加，但没有 包括在当前百分位数分数计算器中，以及2）创建集中式网站和移动的应用程序，以帮助 在护理点对CAC的解释。因此，使用标准化的数据协调技术，我们 建议汇总7个NHBLI队列和3个真实世界临床衍生队列的数据，以创建性别- 平衡的，种族/民族多样化的CAC合成队列终身汇总项目（CACSC-LPP）， 大约20，000名NHBLI参与者在整个生命周期（30-95岁）内具有CAC数据， 来自临床CAC队列的另外约90，000名参与者。统一单个参与者一级的数据将 务实地利用NIH在这些队列中的巨大投资（金钱和时间）， 合并数据集，扩大了临床影响，超出了最初的设想。它还将创建一个 理想的基础，反复扩大CACSC-LPP，以确保更好地代表所有生活在 美国，最初的重点是南亚人。此外，我们将建立在我们的原型CAC工具网站 和配套应用程序，以便临床医生和患者可以输入CAC评分（加上任何其他可用的风险因素 数据）并检索其CAC百分位数。此网站/应用程序将作为所有CAC相关的最终来源 工具，并将被未来的国家CVD指南所认可（见LOS，Lloyd博士- Jones & Arnett）。通过创建1）CACSC-LPP，2）整个生命周期的CAC百分位计算器， 和3）集中的CAC网站/应用程序该项目将改善个性化的CVD风险预测， 行政协调会/AHA初级预防建议，同时也创造基础设施， 和跨机构的合作，以进一步提高我们对CAC的心血管疾病风险预测的理解。