Predicting CHD Events in Black and White Women

描述（由申请人提供）：冠心病（CHD）目前是女性死亡的头号原因。年轻妇女冠心病死亡人数的增加，加上老年妇女冠心病发病率和患病率的预计增加，为她们未来的冠心病发病率描绘了一幅暗淡的画面。为了扭转这一趋势，早期发现女性冠心病是必不可少的，但诊断女性冠心病是具有挑战性的，因为她们经常经历与男性不同的缺血。我们以前的研究结果显示，97%的急性冠状动脉综合征（ACS）女性回顾性报告经历前驱症状（PS）通常不与冠心病超过一个月前ACS，提示时间干预。我们还发现PS中存在显著的种族差异。然而，没有临床测试的工具描述了全方位的PS，种族多样化的妇女报告。我们开发并测试了McSweeney急性和前驱心肌梗死症状调查（MAPMISS），其中约1000名不同种族的女性回顾性评估了其PS和ACS相关的急性症状。然而，我们不知道回顾性地确定PS是否将被证明对预测女性CHD事件有用。因此，我们建议进行一项纵向观察性研究，以确定MAPMISS是否能前瞻性地区分2年内将发生和未发生CHD事件的女性。通过生存和纵向分析确认这一假设，结合确定最敏感和具体的症状，将提供所需的证据基础，以帮助临床医生决定是否将妇女转介进行心血管诊断检测。我们将使用标准的心理测量技术来开发一个MAPMISS筛选工具。我们将比较受试者工作曲线下的面积，以确定最准确，有效和简约的筛选措施。我们还将探讨MAPMISS筛查评分与CHD诊断测试结果之间的对应关系。

DESCRIPTION (provided by applicant): Coronary Heart Disease (CHD) is currently the number one cause of death in women. The increasing number of CHD deaths in younger women plus the projected increase in the incidence and prevalence of CHD in older women paints a bleak picture of their future CHD rates. To reverse this trend, early detection of CHD in women is essential, but diagnosing CHD in women is challenging since they often experience ischemia differently than men do. Our previous findings revealed that 97% of women with acute coronary syndrome (ACS) retrospectively reported experiencing prodromal symptoms (PS) not commonly associated with CHD for more than a month prior to ACS, indicating time to intervene. We also found significant racial differences in PS. However, no clinically tested instrument describes the full range of PS that racially diverse women report. We developed and tested the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS) with approximately 1000 racially diverse women to retrospectively assess their PS and acute symptoms associated with ACS. However, we do not know if PS identified retrospectively will prove useful in predicting CHD events in women. Therefore, we propose to conduct a longitudinal observational study to determine if the MAPMISS will differentiate prospectively between women who will and will not experience a CHD event in a 2-year period. Confirmation of this hypothesis through survival and longitudinal analysis, in conjunction with identifying the most sensitive and specific symptoms, would provide the evidence-base needed to assist clinicians in deciding whether to refer a woman for cardiovascular diagnostic testing. We will use standard psychometric techniques to develop a MAPMISS screening instrument. We will compare the area under receiver operator curves to identify the most accurate, efficient, and parsimonious measure for screening. We also will explore the correspondence between the MAPMISS screen scores and CHD diagnostic test results.