Integrating Risk Trajectories and Social Determinants to Enhance Cardiovascular Risk Assessment in Older Adults

整合风险轨迹和社会决定因素以加强老年人的心血管风险评估

• 批准号: 10627247
• 负责人: Matthew E. Dupre
• 金额: $ 2.98万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-15 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10627247
• 关键词: Accounting; Address; Adopted; Adult; Age; Aging; American; American Heart Association; Atherosclerosis; Atherosclerosis Risk in Communities; Behavioral; Blood Pressure; Blood Vessels; Cardiology; Cardiovascular Diseases; Caring; Cessation of life; Cholesterol; Classification; Clinical; Communities; Data; Development; Disease; Disease Outcome; Education; Elderly; Event; Exercise; Foundations; Goals; Guidelines; Hazard Models; Health and Retirement Study; Individual; Intervention; Knowledge; Measures; Medical; Mental Depression; Methods; Mission; Modeling; Onset of illness; Patients; Performance; Persons; Physiological; Population; Population Group; Population Heterogeneity; Preventive therapy; Primary Prevention; Public Health; Risk; Risk Assessment; Risk Factors; Risk Reduction; Sampling; Series; Social support; Time; Translating; Translations; United States; United States National Institutes of Health; Validation; Visualization software; age related; base; behavioral health; cardiovascular disorder prevention; cardiovascular disorder risk; cardiovascular health; cardiovascular risk factor; cohort; college; design; disability; disadvantaged population; disorder prevention; disorder risk; evidence base; follow-up; implementation study; improved; innovation; multi-ethnic; multiple datasets; offspring; predictive modeling; prevent; prospective; psychosocial; risk prediction; routine care; shared decision making; social determinants; social health determinants; socioeconomics; support tools; tool; treatment strategy

PROJECT SUMMARY: Cardiovascular disease (CVD) is a leading cause of disability and death in the United States; and the risks for disease are greatest among older adults. For more than half a century, CVD risk calculators have been used to estimate a person’s risk of developing CVD and to guide treatment strategies to prevent disease. Unfortunately, the tool recommended by current guidelines performs poorly in older adults and among dis/advantaged population groups. The proposed reasons for these shortcomings are twofold. First, the existing model does not account for changes in risk factors—e.g., cholesterol, blood pressure (BP), etc.—that occur with age-related declines in vascular function and/or the use of preventive therapies. Second, the existing model does not account for social determinants of health (SDOH) and other non-clinical factors that have been shown to improve risk prediction across diverse population groups. Without addressing these issues, a vital tool for CVD prevention will remain suboptimal and opportunities to reduce the development of CVD in adults who are at greatest risk of disease will remain urgent and unmet. Our central hypothesis is that CVD risk prediction and its translation to disease prevention can be greatly improved in older adults by synchronizing age-related changes among multiple established risk factors while accounting for SDOH and other factors that contribute to CVD risks. Using nationally-representative data (Health and Retirement Study [HRS]) and pooled community-based cohorts (Atherosclerosis Risk in Communities [ARIC], Cardiovascular Health Study [CHS], Multiethnic Study of Atherosclerosis [MESA], Framingham [FHS] Original, and FHS Offspring), our aims are threefold: First, we will use group-based trajectory models to classify age-related changes within and among the major risk factors for CVD in a nationally-representative sample of older adults (65+). Results will then be validated with external (pooled cohort) data to identify the most efficient and robust classifications of age-related changes among the multiple established risk factors. Second, we will predict the onset of CVD based on the multi-trajectory profiles of risk factors. By accounting for changes in risk factors and trajectory group-membership with advancing age, this approach will mirror a real-world clinical setting where follow-up measures become available during routine care and a patient’s changes in risk factors translate into greater (or lesser) risks for a CVD event. Third, we will examine a wide array of socioeconomic, psychosocial, and behavioral factors to identify SDOH and other key factors related to individual risk profiles and CVD outcomes. The major aims of this proposal are highly aligned with the National Institutes of Health’s (NIH) mission to better understand the interdisciplinary dynamics of aging to prevent disease in older adults. Our study responds to this call by using multiple datasets and innovative methods to optimize CVD risk assessment in older adults. With this integrated new knowledge, our study will have significant potential to better inform the design, targeting, and timing of clinical interventions to improve the primary prevention of CVD in a diverse and aging U.S. population.

心血管疾病（CVD）是美国残疾和死亡的主要原因。 疾病的风险在老年人中最大。半个多世纪以来， 计算器已被用来估计一个人的发展心血管疾病的风险，并指导治疗策略， 预防疾病。不幸的是，目前指南推荐的工具在老年人中表现不佳， 在流离失所者/流离失所者群体中。造成这些缺点的原因有两个方面。一是 现有模型没有考虑风险因素的变化-例如，胆固醇，血压（BP）等-的 与年龄相关的血管功能下降和/或使用预防性治疗有关。二是现有 模型没有考虑健康的社会决定因素（SDOH）和其他非临床因素， 这表明可以提高对不同人群的风险预测。如果不解决这些问题， 预防CVD的工具仍将是次优的，并有机会减少成年人CVD的发展 那些最容易患病的人仍然是迫切需要解决的问题。我们的中心假设是， 预测及其转化为疾病预防可以大大提高老年人， 多个既定风险因素中与年龄相关的变化，同时考虑SDOH和其他因素， 增加CVD风险。使用全国代表性数据（健康和退休研究[HRS]）和汇总 基于社区的队列（社区动脉粥样硬化风险[ARIC]，心血管健康研究[CHS]， 多种族研究动脉粥样硬化[梅萨]，Fragrance [FHS]原始，和FHS后代），我们的目标是 三方面：首先，我们将使用基于组的轨迹模型对年龄相关的变化进行分类， CVD的主要危险因素在一个全国性的代表性样本的老年人（65+）。结果将是 使用外部（合并队列）数据进行验证，以确定年龄相关的最有效和最稳健的分类 多个既定风险因素之间的变化。第二，我们将预测心血管疾病的发病的基础上， 风险因素的多轨迹特征。通过考虑风险因素和轨迹组成员的变化， 随着年龄的增长，这种方法将反映真实世界的临床环境，其中随访措施变得 在常规护理期间可用，并且患者风险因素的变化转化为患者的更大（或更小）风险。 CVD事件。第三，我们将研究一系列广泛的社会经济、社会心理和行为因素， 确定SDOH和其他与个体风险状况和CVD结果相关的关键因素。的主要内容 这项建议与美国国立卫生研究院（NIH）的使命高度一致，以更好地了解 老龄化的跨学科动态，以预防老年人的疾病。我们的研究通过使用 多个数据集和创新方法，以优化老年人的CVD风险评估。与此集成 新的知识，我们的研究将有很大的潜力，更好地为设计，目标和时间， 临床干预措施，以改善美国多样化和老龄化人群中CVD的一级预防。