Chicago Healthy Aging Low Risk MRI Angiography (CHARISMA) Study

描述（由申请人提供）：近年来，注意力已转向具有心血管疾病（CVD）有利风险因素特征（低风险; LR）的个体，定义为不吸烟、无糖尿病、低总胆固醇水平、低血压和瘦体重指数。与非LR状态的个体相比，在青年/中年（<50岁）具有LR状态的个体在其剩余寿命期间发生CVD的风险显著降低，寿命显著延长，与健康相关的生活质量显著提高，老年（>65岁）的医疗费用较低。尚不清楚青年/中年LR状态的个体是否具有类似的低水平亚临床冠状动脉粥样硬化（subCAD）和较低的左心室（LV）质量。技术的进步目前允许无创血管造影成像，其可以与使用磁共振成像（MRI）的心肌结构和功能的灵敏的无创评估相结合。本申请的总体目标是更好地定义保护年轻人免受与LR状态相关的临床CVD事件的机制。芝加哥健康老龄化研究（CHAS）是一项由NHLBI支持的研究，将重新检查1500名年龄在65-79岁的个体，这些个体最初在1967-1973年接受检查;其中600名CHAS参与者在25-44岁时为LR，900名为非LR。因此，CHAS提供了一个独特的机会，研究的后果LR/非LR状态在年轻的成年人subCAD和心脏结构和功能，使用冠状动脉MR血管造影和心脏MRI。本申请被设计为CHAS的辅助研究，并且将解决以下具体目的：1）确定年龄25-44岁的LR状态与年龄65-79岁的冠状动脉粥样硬化的MRI测量的关联; 2）确定年龄25-44岁的LR状态与年龄65-79岁的LV质量的MRI测量的关联;和3）在25-44岁LR与非LR状态的背景下，确定在65-79岁测量的亚CAD和LV质量的MRI测量与炎性标志物、身体功能和亚临床CVD的其他测量的同时测量的关联。总之，我们将使用MRI技术来检查年轻人/中年人的低风险人群，现在是65-79岁，以确定他们的subCAD和LV质量升高的负担。这项研究将填补我们对LR状态的长期后果的认识的关键空白，这可能最终导致公共卫生和预防策略的改善。公共卫生相关性：近年来，人们的注意力转向了具有良好的冠状动脉疾病（CAD）风险因素特征（低风险; LR）的个体，其定义为不吸烟，无糖尿病，低总胆固醇水平，低血压和瘦体重指数。这些个体在其剩余寿命期间大大降低了CAD发展的风险，显著延长了寿命，并显著提高了与健康相关的生活质量，并降低了老年人（>65岁）的医疗费用。然而，目前尚不清楚这些人是否从未发展动脉粥样硬化，CAD的前体，或者他们是否发展它但不会转化为临床事件，如心脏病发作。技术的进步目前允许使用磁共振成像（MRI）对冠状动脉进行成像，而不必进行侵入性心脏导管插入术。本申请的总体目标是更好地定义长期保护年轻人免受与低风险状态相关的临床CAD事件的机制。我们将对芝加哥健康老龄化研究的一个子集（约250名）参与者进行MRI，以评估冠状动脉粥样硬化的数量和心肌的大小。总之，我们将使用MRI技术来检查年轻人/中年人的低风险人群，现在是65-79岁，以确定他们的CAD负担和心脏泵功能问题。这项研究将填补我们对低风险状态的长期后果的认识方面的关键空白，这可能最终导致公共卫生和预防战略的改善。

DESCRIPTION (provided by applicant): In recent years, attention has turned to individuals who have a favorable risk factor profile (low risk; LR) for cardiovascular disease (CVD), defined by no smoking, lack of diabetes, low total cholesterol levels, low blood pressure, and lean body mass index. Compared with individuals with not-LR status, those with LR status in young adulthood/middle age (<50 years) have dramatically reduced risk for development of CVD during their remaining lifespan, substantially greater longevity, and significantly greater health-related quality of life and lower medical costs at older ages (>65 years). It is not known whether individuals with LR status in young adulthood/middle age have similarly low levels of subclinical coronary atherosclerosis (subCAD) and lower left ventricular (LV) mass. Advances in technology currently allow for non-invasive angiographic imaging, which can be combined with sensitive non-invasive assessment of myocardial structure and function using magnetic resonance imaging (MRI). The overall goal of this application is to better define the mechanisms underlying the protection against clinical CVD events associated with LR status in young adulthood. The Chicago Healthy Aging Study (CHAS) is a NHLBI-supported study that will re-examine 1500 individuals aged 65-79 years who were initially examined in 1967-1973; 600 of these CHAS participants were LR and 900 were not-LR at ages 25-44 years. Thus, the CHAS provides a unique opportunity to study the consequences of LR/not-LR status in young adulthood on subCAD and cardiac structure and function, using coronary MR angiography and cardiac MRI. The present application is designed as an ancillary study to the CHAS, and will address the following Specific Aims: 1) To determine the association of LR status at ages 25-44 years with MRI measures of coronary atherosclerosis at ages 65-79 years; 2) To determine the association of LR status at ages 25-44 years with MRI measures of LV mass at ages 65-79 years; and 3) To determine the association of MRI measures of subCAD and LV mass measured at ages 65-79 years with concurrent measures of inflammatory markers, physical functioning, and other measures of subclinical CVD, in the context of LR versus not-LR status at ages 25-44 years. In summary, we will use MRI technology to examine people who were at low risk in young adulthood/middle age and are now 65-79, to determine their burden of subCAD and of elevated LV mass. This research will fill critical gaps in our knowledge of the long-term consequences of LR status, which may ultimately lead to improvements in public health and preventive strategies. PUBLIC HEALTH RELEVANCE: In recent years, attention has turned to individuals who have a favorable risk factor profile (low risk; LR) for coronary artery disease (CAD), defined by no smoking, lack of diabetes, low total cholesterol levels, low blood pressure, and lean body mass index. These individuals have dramatically reduced risk for development of CAD during their remaining lifespan, substantially greater longevity, and significantly greater health-related quality of life and lower medical costs at older ages (>65 years). However, it is not known whether these individuals never develop atherosclerosis, the precursor of CAD, or whether they develop it but it does not convert into clinical events, such as heart attacks. Advances in technology currently allow for imaging of coronary arteries using magnetic resonance imaging (MRI) without having to perform invasive heart catheterization. The overall goal of this application is to better define the mechanisms underlying the long-term protection against clinical CAD events associated with low risk status in young adulthood. We will perform MRI to assess the amount of atherosclerosis in coronary arteries and the size of the heart muscle in a subset (approximately 250) of participants of the Chicago Healthy Aging Study. In summary, we will use MRI technology to examine people who were at low risk in young adulthood/middle age and are now 65-79 years old, to determine their burden of CAD and of problems with heart pumping function. This research will fill critical gaps in our knowledge of the long-term consequences of low risk status, which may ultimately lead to improvements in public health and preventive strategies.