Young Women With Acute Myocardial Infarction

描述(由申请人提供)：患有急性心肌梗死(AMI)的年轻女性代表了缺血性心脏病风险的极端表型，同时，与类似年龄的男性相比，她们构成了一个庞大的未被研究群体，死亡风险高于男性。这种不良风险和不充分的调查相结合，为解决年轻女性急性心肌梗死患者的护理和预后提供了一个至关重要的机会，以揭示影响其预后的关键生物和环境决定因素。因此，我们提出了第一项针对年轻女性急性心肌梗死的大型、全面的观察性研究(YWAMI)。YWAMI将包括2000名患有急性心肌梗死的女性，年龄在18-55岁之间，以及一个由1000名男性组成的比较队列，他们来自美国和加拿大的88家医院，为期3年。为了实现这些目标，我们组建了一支由心血管疾病性别差异、结果研究、流行病学、统计学、遗传学、生物标记物研究、健康状况测量、心理社会研究、心脏病学和急诊医学等领域的领先研究人员组成的团队。我们的具体目标是：1)表征急性心肌梗死后预后的性别差异(包括死亡率、住院和健康状况)；2)确定人口统计学、临床和心理社会危险因素患病率的性别差异；3)确定护理质量的性别差异；4)确定选定生物因素(包括性激素、生物标记物和基因变异)患病率的性别差异。我们将非常详细地描述这些差异，并阐明造成结果差异的生物和环境因素。来自所有四个目标的分析将被用于为年轻的急性心肌梗死患者开发临床上有用的风险分层模型，解释结果的性别差异，并确定干预目标。我们还将存储每个受试者的血清和DMA，为预期的未来年轻女性和男性急性心肌梗死的分子生物学研究创造一个资源。我们将与美国心脏病学会、美国心脏协会和VHA，Inc.合作，传播这项研究的结果，这些结果可用于改善年轻女性和男性急性心肌梗死的预防、护理和预后。公共卫生影响：总体而言，尽管心脏病在年轻女性中造成的死亡人数与乳腺癌一样多，但很少有研究涉及影响其结局的生物、环境和社会因素。患有心脏病的年轻女性比同龄男性有更高的死亡风险。我们建议对心脏病发作的年轻女性进行最大规模、最全面的研究，以确定她们康复的关键决定因素，并发现有助于我们改善她们护理的知识。

DESCRIPTION (provided by applicant): Young women with an acute myocardial infarction (AMI) represent an extreme phenotype in ischemic heart disease risk and, at the same time, constitute a large understudied group with excess mortality risk compared with similarly aged men. This combination of adverse risk and inadequate investigation provides a critically important opportunity to address the care and outcomes of young women with AMI to uncover key biological and environmental determinants of their prognosis. Accordingly, we propose the first large, comprehensive, observational study of young women with AMI (YWAMI). YWAMI will include 2,000 women, 18-55 years of age, with AMI and a comparison cohort of 1,000 men enrolled over 3 years from 88 hospitals across the United States and in Canada. To accomplish these aims we have assembled a team of leading researchers in sex disparities in cardiovascular disease, outcomes research, epidemiology, statistics, genetics, biomarker research, health status measurement, psychosocial research, cardiology, and emergency medicine. Our Specific Aims are to: 1) characterize sex differences in outcomes following AMI (including mortality, hospitalization and health status); 2) determine sex differences in the prevalence of demographic, clinical, and psychosocial risk factors; 3) determine sex differences in quality of care; and 4) determine sex differences in the prevalence of selected biological factors (including sex hormones, biomarkers and genetic variations). We will characterize these differences in great detail and elucidate the biological and environmental factors that are responsible for disparities in outcomes. The analyses from all four aims will be used to develop clinically useful risk-stratification models for young AMI patients, explain sex differences in outcomes and identify targets for intervention. We will also bank serum and DMA from each subject, creating a resource for anticipated future studies of the molecular biology of AMI in young women and men. We will work with the American College of Cardiology, the American Heart Association and VHA, Inc. to disseminate findings from this study that can be used to improve the prevention, care, and outcomes for young women and men with AMI. Public Health Implications: Overall, although heart disease in young women accounts for as many deaths as breast cancer, few studies have addressed the biological, environmental and social factors that influence their outcome. Young women with heart attacks have a higher risk of dying than similarly aged men. We propose to conduct the largest, most comprehensive study of young women with heart attacks to identify the key determinants of their recovery and discover knowledge that will assist us in improving their care.