Infection and Stroke in Mexican Americans

在美国，中风是导致成年人死亡和残疾的第三大原因。每年有近80万人患中风，超过14.3万人因此死亡。西班牙裔美国人是美国增长最快的少数族裔，也是人数最多的少数族裔。大多数拉美裔美国人是墨西哥裔。墨西哥裔美国人（MAs）患中风的风险增加，尤其是在残疾影响最大的年轻时。MAs卒中风险增加的原因尚不完全清楚，但传统的风险因素不太可能完全解释该人群卒中负担增加的原因。慢性感染性病原体已被认为是卒中和卒中预后不良的危险因素，尽管证据仍不确定，而且尚未在MAs中进行研究。由于慢性感染在白人中比非西班牙裔白人更普遍，这一风险因素对这一人群可能特别重要。在萨克拉门托地区拉丁裔老龄化研究（SALSA）的参与者中，拟议的论文研究旨在研究慢性感染与卒中事件和卒中后功能结果之间的联系。这项研究将在几个关键方面扩展目前对感染和中风的认识：1)通过检查抗体对几种感染因子的反应与感染血清状态作为中风的独立危险因素；2)通过检查抗体反应可能影响中风风险的潜在机制，包括炎症途径。3)通过调查抗体反应与脑卒中后功能结局的关系，4)通过专门关注已知经历更大卒中负担和更大感染负担的MA人群。在考虑了传统的危险因素后，认识到感染会增加卒中风险，这可能对预防MAs卒中和减少该人群卒中健康差异具有重要意义。除了推动这一关键领域的科学发展外，拟议的奖学金将提供严格的培训，包括课程和研讨会/讲习班，与中风神经学家和流行病学家的互动，以及基于人群的研究和实验室方法的实践培训，这些都是将申请人从博士生发展为独立研究者所需要的，她将致力于研究中风及其决定因素，包括感染。

Stroke is the third leading cause of death and leading cause of disability in adults in the US. Nearly 800,000 people suffer a stroke annually, and more than 143,000 deaths occur as a result. Hispanic Americans are the fastest growing minority population in the US, as well as the most numerous. The majority of Hispanic Americans are of Mexican descent. Mexican Americans (MAs) have an increased risk of stroke especially at younger ages when disability has the greatest impact. Reasons for increased stroke risk in MAs are not fully understood but traditional risk factors are not likely to fully account for the increased stroke burden in this population. Chronic infectious pathogens have been proposed as risk factors for stroke and for poor stroke outcome, although the evidence remains inconclusive and studies have not been done in MAs. As chronic infections are more prevalent in MAs than their non-Hispanic white counterparts, this risk factor may be particularly important for this population. The proposed dissertation research seeks to examine the links between chronic infection and incident stroke and post-stroke functional outcome, among participants from the Sacramento Area Latino Study on Aging (SALSA). This research will extend current knowledge of infection and stroke in several critical ways:1) by examining antibody response to several infectious agents versus infection serostatus as independent risk factors for stroke, 2) by examining the underlying mechanisms, including inflammatory pathways, by which antibody response may influence stroke risk, 3) by investigating the association of antibody response to post-stroke functional outcomes and 4) by focusing specifically in a MA population known to experience a greater stroke burden as well as a greater infection burden. The recognition that infection increases stroke risk after accounting for traditional risk factors may have important implications for the prevention of stroke in MAs and for reducing the stroke health disparity in this population. In addition to advancing the science in this critical area, the proposed fellowship will provide the rigorous training, including coursework and seminars/workshops, interaction with stroke neurologists and epidemiologists and hands-on training in population-based studies and laboratory methods, needed to develop the applicant from a doctoral student to an independent investigator who will devote her research career to the study of stroke and its determinants, including infection.