Recurrent Hemorrhagic Stroke in Minority Populations

 描述（由申请人提供）：脑小血管疾病（CSVD）是一种常见的进行性衰老疾病，是因卒中、认知能力下降、晚期抑郁和步态恶化导致的年龄相关残疾的主要原因。在大多数情况下，潜在的血管病理学可分为两种最常见的亚型之一，小动脉硬化（AS）和脑淀粉样血管病（CAA）。虽然在MRI上CSVD通常被认为是白色改变，但当患者出现脑出血（ICH）时，CSVD经常首次引起临床关注。发现CSVD的生物学基础是制定有效预防策略的重要下一步。由于他们的CSVD都是严重的，ICH幸存者是研究CSVD的理想受试者，也是最有可能从新疗法中获益的群体。拟定研究的动机是发现ICH不成比例地影响非洲裔美国人（AA）和西班牙裔美国人（HA）人群。我们的初步分析表明，这些差异延伸到脑出血后复发性脑出血，认知能力下降和晚年抑郁症的风险，血压（BP）可能在这些差异中发挥了重要作用。我们修订后的建议，最好的标题是“ERICH中ICH幸存者的纵向随访”，将系统地确定1）AA和HA是否易患所有类型的CSVD，2）是否仅易患AS风险增加，或3）是否没有固有的易患性，但通过BP的影响，遭受更严重的CSVD。为了验证中心假设，即发现这种健康差异的机制ICH将产生CSVD的生物学见解，推进治疗的研究并在床边产生影响，我们建议利用即将结束的ICH种族/种族差异（ERICH）研究对900名ICH幸存者进行纵向随访（AA、HA和NHW各300例），在ERICH的最后两年招募，在招募时已确定神经影像学、遗传学、流行病学和社会种族变量。根据已确立和验证的方案，每6个月对受试者进行一次电话随访。

 DESCRIPTION (provided by applicant): Cerebral small vessel disease (CSVD) is a common, progressive condition of aging, and a leading contributor to age-related disability due to stroke, cognitive decline, late-life onset depression and gait deterioration. In most cases the underlying vessel pathology can be classified as one of the two most common subtypes, arteriolosclerosis (AS) and cerebral amyloid angiopathy (CAA). Although classically recognized as white matter changes on MRI, CSVD frequently comes to clinical attention for the first time when a patient presents with intracerebral hemorrhage (ICH). Discovering the biological underpinnings of CSVD is a vital next step toward development of effective preventative strategies. Because their CSVD is uniformly severe, ICH survivors are ideal subjects in which to study CSVD and also form the group most likely to benefit from novel therapies. The proposed studies are motivated by the striking observation that ICH disproportionately affects African- American (AA) and Hispanic-American (HA) populations. Our preliminary analyses demonstrate that these differences extend to post-ICH risk for recurrent ICH, cognitive decline and late-life depression and that blood pressure (BP) may play a fundamental role in these differences. Our revised proposal, best titled "Longitudinal Follow-up of ICH Survivors in ERICH," will systematically determine whether 1) AA and HA are predisposed to CSVD of all types, 2) are predisposed solely to increased risk of AS, or 3) have no inherent predisposition but, through the effects of BP suffer more severe CSVD. To test the central hypothesis that discovering the mechanisms for this health disparity ICH will yield biological insights for CSVD, advance the search for treatments and have impact at the bedside, we propose to leverage the soon- to-conclude Ethnic/Racial Variations of ICH (ERICH) study to perform longitudinal follow-up of a cohort of 900 ICH survivors (300 each of AA, HA, and NHW), recruited in the last two years of ERICH, who have had neuroimaging, genetic, epidemiologic, and socio-ethnic variables ascertained at time of enrollment. Subjects will be followed by telephone every 6 months according to established and validated protocols.