Cardiovascular Risk among Transgender Persons in a Regional Electronic Health Record Registry

区域电子健康记录登记中跨性别者的心血管风险

• 批准号: 10092599
• 负责人: JARROD DALTON
• 金额: $ 9.89万
• 依托单位: CLEVELAND CLINIC LERNER COM-CWRU
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-15 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10092599
• 关键词: Accounting; Administrative Supplement; Adult; Affect; Age; American; American Heart Association; Antihypertensive Agents; Assessment tool; Atherosclerosis; Cardiology; Cardiovascular Diseases; Cardiovascular Models; Cardiovascular system; Caring; Cessation of life; Clinic; Clinical; Communities; Community Developments; Data; Decision Making; Dimensions; Discipline of Nursing; Economics; Effectiveness; Electronic Health Record; Endocrinology; Environment; Equation; Event; Foundations; Gonadal Steroid Hormones; Guidelines; Health Sciences; Health system; Healthcare Systems; Heterogeneity; Hormone use; Immunology; Internal Medicine; Lead; Measures; Methods; Modeling; Morbidity - disease rate; Myocardial Infarction; Nature; Neighborhoods; Ohio; Outcome; Patients; Performance; Persons; Pharmaceutical Preparations; Population; Prevention; Preventive therapy; Primary Health Care; Primary Prevention; Psychiatry; Quality of life; Registries; Research; Research Personnel; Risk; Risk Assessment; Risk Factors; Sampling; Science; Sexual and Gender Minorities; Social Work; Socioeconomic Status; Stroke; Subgroup; System; Time; United States; Variant; Work; atherosclerosis risk; base; cardiovascular disorder prevention; cardiovascular disorder risk; cardiovascular risk factor; clinical decision support; clinical decision-making; cohort; college; contextual factors; cost; ethnic minority population; gender minority; health data; heart disease risk; hormone therapy; human very old age (85+); improved; insight; interest; low socioeconomic status; mortality; population health; predictive modeling; prevention service; racial minority; response; spatial epidemiology; tool; transgender; transgender women; translational scientist; urban poverty

PROJECT SUMMARY/ABSTRACT Cardiovascular disease limits the activity and quality of life of millions of adults every year, costing the United States billions of dollars, and accounting for more than 40% of all deaths among those 65-74 and 60% of all deaths for those aged 85 and older.1 Accurate assessment of atherosclerotic cardiovascular disease (ASCVD) risk is needed for effective primary prevention. More research on how SEP affects atherosclerotic risk is needed, particularly among gender minorities. Guidelines from the American College of Cardiology and American Heart Association (ACC/AHA) for prevention of ASCVD now uniformly include the assessment of risk of heart attack and stroke using risk calculators (the AHA/ACC Pooled Cohort Equations (PCE)) to determine the appropriateness of statin and anti-hypertensive medications, preventive therapies which are known to substantially reduce the burden of serious cardiovascular events and cardiovascular death. However, too little is known about the performance of standard cardiovascular risk factors in transgender persons. For several decades, researchers have been interested in better understanding cardiovascular risk among transgender persons, and among those receiving cross-sex hormone therapy in particular. Review studies have found some indication of increased ASCVD morbidity and mortality among transgender persons, particular transgender women, but these reviews also concluded that prior studies were of low quality, had small samples, a constrained number of measured ASCVD risk factors and too few cardiovascular events to enable robust conclusions about cardiovascular risk. This supplemental study, “Cardiovascular Risk among Transgender Persons in a Regional Electronic Health Record Registry” is proposed in response to “NOT-OD-20-032: Notice of Special Interest: Administrative Supplements for Research on Sexual and Gender Minority (SGM) Populations”. Our prior work indicates a significant degree of neighborhood-level variability in major ASCVD events (myocardial infarction, stroke or cardiovascular death), with low-SEP neighborhoods associated with event rates over three times that of high-SEP neighborhoods. Moreover, neighborhood SEP explained four times the amount of neighborhood-level variation in ASCVD event rates than that explained by the ACCF/AHA Pooled Cohort Equations Risk Model. The focus of this study is on examining and decomposing cardiovascular risk and underlying cardiovascular risk factors among transgender adults in a 20-year regional electronic health record registry. This work will provide (i) an understanding of ASCVD risk in transgender persons and (ii) support for clinical decision making for primary prevention of adverse cardiovascular events. This supplemental applications proposes to conduct our analysis in a transdisciplinary team-based environment, in a newly-established, cutting-edge regional research registry, based on electronic health data from Northeast Ohio’s two largest health systems, Cleveland Clinic and MetroHealth.

项目总结/摘要 心血管疾病每年限制了数百万成年人的活动和生活质量， 美国数十亿美元，占65-74岁死亡人数的40%以上，占所有死亡人数的60%。 85岁及以上人群的死亡人数。1动脉粥样硬化性心血管疾病（ASCVD）的准确评估 有效的初级预防需要有风险。 需要更多关于SEP如何影响动脉粥样硬化风险的研究，特别是在少数性别人群中。 美国心脏病学会和美国心脏协会（ACC/AHA）的指南 ASCVD的预防现在统一包括使用风险评估心脏病发作和中风的风险。 计算器（AHA/ACC合并队列方程（PCE）），以确定他汀类药物的适当性， 抗高血压药物，预防性治疗，这是众所周知的，大大减少负担， 严重心血管事件和心血管死亡。然而，对它的性能知之甚少。 变性人的标准心血管风险因素。几十年来，研究人员 有兴趣更好地了解跨性别者的心血管风险， 尤其是跨性别激素疗法回顾性研究发现ASCVD增加的一些迹象 变性人，特别是变性妇女的发病率和死亡率，但这些审查也 得出的结论是，以前的研究质量低，样本量小，测量数量有限， ASCVD风险因素和心血管事件太少，无法得出关于心血管风险的可靠结论。 这项补充研究，“在区域电子健康中跨性别者的心血管风险” 记录登记处”是为了响应“NOT-OD-20-032：特别关注通知：行政 性和性别少数群体研究补编”。 我们先前的工作表明，在主要ASCVD事件中， （心肌梗死、卒中或心血管死亡），低SEP社区与事件相关 房价是高房价社区的三倍多。此外，邻里SEP解释了四倍， ASCVD事件发生率的社区水平变异量大于ACCF/AHA汇总解释的变异量 队列方程风险模型。这项研究的重点是检查和分解心血管风险 和潜在的心血管危险因素在跨性别成年人在20年的区域电子健康 记录登记处。这项工作将提供（i）对变性人ASCVD风险的理解和（ii） 为不良心血管事件一级预防的临床决策提供支持。 本补充申请建议在基于跨学科团队的基础上进行分析 环境，在一个新成立的，尖端的区域研究登记处，基于电子健康数据 来自东北部俄亥俄州最大的两个医疗系统，克利夫兰诊所和大都会健康中心。