Using Social Risk to Guide Coronary Heart Disease (CHD) Preventive Treatment

描述(申请人提供)：社会经济地位、种族和民族在冠心病(CHD)死亡率方面的差异已被广泛记录，但将其转化为临床实践以减少CHD差异被证明是具有挑战性的。该项目旨在满足这一需求。目前的冠心病预防建议，如成人治疗小组(ATP)III胆固醇治疗和阿司匹林预防指南，是基于对全球冠心病风险的评估。血压治疗指南也可能在不久的将来纳入全球CHD风险评估。然而，除了年龄和性别之外，关键的社会人口学特征，如社会经济地位、种族和民族以及婚姻状况(称为社会风险因素)，不被用来估计全球风险，尽管有证据表明，它们预测冠心病风险独立于弗雷明翰风险评分(FRS)。该项目的广泛目标是证明，将社会风险纳入全球风险评估和预防性治疗指南有助于减少冠心病的差异。为此，我们提出了以下具体目标：目标1：开发和验证包含社会风险的CHD预测模型。目的2：独立于行为危险因素和C反应蛋白，评估社会风险对冠心病风险的贡献。目的3：评估社会风险对冠心病预防治疗障碍的影响。目的：根据社会风险评价ATP/FRS+社会风险指南对冠心病预防治疗的潜在影响。目的5(探索性)：评估实施ATP+社会风险指南对冠心病风险社会差异的潜在影响。目标1将通过分析社区动脉粥样硬化风险研究(ARIC)的数据来实现。该预测工具将使用第二次国家健康和营养研究(NHANES II)的数据进行验证。AIM 2将使用ARIC和NHANES II数据进行检查。AIMS 3-5将使用NHANES 1988-1994年和1999-2006年的数据。具体地说，将对这些样本进行包括社会风险的全球风险评估，以评估对冠心病预防治疗资格的影响。最终目标将模拟使用这一工具来估计对差异的影响。这一工具的使用，以及对其基础范式的认识，其影响超出了扩大社会风险人群接受药物治疗的资格范围。实施这样的全球风险工具最终可能有助于证明对社会风险最高的人实施更密集的行为干预是合理的，这些干预的重点是饮食、锻炼、戒烟和坚持用药。

DESCRIPTION (provided by applicant): Disparities in coronary heart disease (CHD) mortality by socioeconomic status, race and ethnicity, have been extensively documented, but translating them into clinical practice to reduce CHD disparities has proven challenging. This project aims to address this need. Current CHD preventive recommendations, such as Adult Treatment Panel (ATP) III cholesterol treatment and aspirin prophylaxis guidelines, are based on assessment of global risk of CHD. Guidelines for treatment of blood pressure are also likely to incorporate global CHD risk assessment in the near future. However, with the exception of age and sex, key sociodemographic characteristics such as socioeconomic status, race and ethnicity, and marital status (referred to as social risk factors) are not used to estimate global risk despite evidence that they predict CHD risk independently of Framingham Risk Scoring (FRS). The broad aim of this project is to demonstrate that incorporation of social risk into global risk assessment and preventive treatment guidelines offers potential for reducing disparities in CHD. Toward this end, we propose the following specific aims: Aim 1: To develop and validate CHD prediction models that incorporates social risk. Aim 2: To assess the contribution of social risk to CHD risk independent of behavioral risk factors and CRP. Aim 3: To assess the impact of social risk on barriers to CHD preventive therapy. Aim 4: To assess the potential impact of ATP/FRS + social risk guidelines on CHD preventive therapy according to social risk. Aim 5 (exploratory): To assess the potential impact of implementation of ATP + social risk guidelines on social disparities in CHD risk. Aim 1 will be achieve through analysis of data from the Atherosclerosis Risk in Communities Study (ARIC). The prediction tool will be validated using data from the second National Health and Nutrition Study (NHANES II). Aim 2 will be examined using both ARIC and NHANES II data. Aims 3-5 will use NHANES 1988-1994 and 1999-2006 data. Specifically, global risk assessments that include social risk will be applied to these samples to estimate the impact on CHD preventive therapy eligibility. The final aim will simulate use of this tool to estimate impact on disparities. Use of this tool, and recognition of its underpinning paradigm, has implications beyond expanded eligibility for drug therapy among those at social risk. Implementation of such a global risk tool could ultimately help justify implementation of more intensive behavioral interventions focusing on diet, exercise, smoking cessation and medication adherence for those at highest social risk.