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

描述（由申请人提供）：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冠心病差异已被证明具有挑战性。该项目旨在解决这一需求。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，是基于对冠心病全球风险的评估。在不久的将来，血压治疗指南也可能纳入全球冠心病风险评估。然而，除了年龄和性别之外，关键的社会人口特征，如社会经济地位、种族和民族、婚姻状况（称为社会风险因素）并未用于估计全球风险，尽管有证据表明它们独立于Framingham风险评分（FRS）预测冠心病风险。该项目的总体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，为缩小冠心病的差异提供了潜力。为此，我们提出以下具体目标：目标1：开发和验证纳入社会风险的冠心病预测模型。目的2：评估独立于行为危险因素和CRP的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4：根据社会风险评估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ATP +社会风险指南的实施对冠心病风险社会差异的潜在影响。目的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。目标2将使用ARIC和NHANES II数据进行检查。目标3-5将使用NHANES 1988-1994和1999-2006的数据。具体而言，包括社会风险在内的全球风险评估将应用于这些样本，以估计对冠心病预防治疗资格的影响。最终目标将模拟使用该工具来估计对差异的影响。使用这一工具，并认识到其基础范式，其意义超出了扩大社会风险人群接受药物治疗的资格。实施这样一个全球风险工具最终可能有助于证明实施更密集的行为干预措施是合理的，这些干预措施侧重于对社会风险最高的人进行饮食、运动、戒烟和药物依从性。

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.