Young Women With Acute Myocardial Infarction

描述（由申请人提供）：急性心肌梗死（AMI）的年轻女性代表缺血性心脏病风险的极端表型，同时，与年龄相似的男性相比，构成了一个巨大的未充分研究的死亡风险组。这种不利的风险和不充分的调查相结合，提供了一个至关重要的机会，以解决与AMI的年轻女性的护理和结果，发现其预后的关键生物和环境的决定因素。因此，我们提出了第一个大型的，全面的，观察性研究的年轻女性急性心肌梗死（YWAMI）。YWAMI将包括2,000名18-55岁的AMI女性和1,000名来自美国和加拿大88家医院的男性对照组，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、结局研究、流行病学、统计学、遗传学、生物标志物研究、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）描述AMI后结局的性别差异（包括死亡率、住院率和健康状况）; 2）确定人口统计学、临床和心理社会风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、生物标志物和遗传变异）患病率的性别差异。我们将详细描述这些差异，并阐明导致结果差异的生物和环境因素。所有四个目标的分析将用于为年轻AMI患者开发临床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。我们还将从每个受试者中提取血清和DMA，为年轻女性和男性AMI分子生物学的预期未来研究创造资源。我们将与美国心脏病学会、美国心脏协会和VHA公司合作。传播这项研究的结果，可用于改善年轻女性和男性AMI患者的预防、护理和结局。公共卫生影响：总体而言，尽管年轻女性心脏病的死亡人数与乳腺癌一样多，但很少有研究涉及影响其结果的生物，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，最全面的研究，以确定其康复的关键决定因素，并发现有助于我们改善护理的知识。

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.