The natural history of cardiovascular health in U.S. populations

描述(由申请人提供)：理想心血管健康(CVH)是美国心脏协会最近定义和采用的一个新概念，旨在制定到2020年及以后促进健康和减少疾病的国家目标。CVH强调在整个生命过程中保持低风险状态，并通过测量和分类(理想、中等、差)七项CVH指标(不吸烟、体重、体力活动、饮食、总胆固醇、血压和血糖)来实施。尽管在整个生命周期内保持理想的CVH可以消除美国70%的心血管疾病(CVD)流行，但只有不到1%的美国人成功地维持了所有七项CVH指标的理想水平。次优的CVH特征在美国少数群体中尤其普遍，他们比非少数群体更早达到中等或较差的CVH指标水平。然而，少数群体成员在理想、中等和较差水平的CVH指标之间过渡的年龄尚未被描述。从理想到中等和较差水平的CVH指标的早期过渡一直与心血管发病率和死亡率密切相关，这一事实为这一健康差异研究提供了一些迫切性。一个类似的需要是估计适度但可实现的维持理想水平的概率增加对整个人口的好处 整个生命过程中的CVH指标，因为在美国人群中，中等或较差的CVH指标水平非常高，这使得完全消除这两个分类的可能性很小。然而，这两个知识差距仍然没有得到解决，这可能反映了缺乏大规模的、当代的和纵向的基于人群的研究，这些研究包括美国主要的种族/民族，并涵盖了从青春期到成年后期的整个高危年龄阶段。在这项应用中，我们通过利用现有的横截面数据和最先进的马尔可夫模型来应对这些挑战，以估计在大约35,000名非裔美国人、西班牙裔/拉丁裔、美国印第安人和高加索美国参与者中，按种族/民族和性别分层的年龄特定的CVH指标在理想、中等和较差水平之间过渡的概率。然后，估计的转移概率将与已发表的干预和纵向队列研究的结果合并，以计算与干预相关的种族/民族和性别相关的心血管疾病减少，这些干预增加了保持理想CVH的美国人口的比例。总而言之，这项研究的结果将为公共卫生和干预计划提供信息，旨在在最有可能失去CVH的年龄段推广理想的CVH。对非洲裔美国人、西班牙裔/拉丁裔和美国印第安人群体的关注进一步增加了这一创新提议的意义，因为这些群体比欧洲裔美国人更早达到中等和较差的CVH特征，并承担着下游心、肾和脑血管疾病表现的更高负担。

DESCRIPTION (provided by applicant): Ideal cardiovascular health (CVH) is a novel concept recently defined and adopted by the American Heart Association to set national goals for health promotion and disease reduction through 2020 and beyond. CVH emphasizes the maintenance of a low-risk profile throughout the life course and is operationalized through measurement and classification (ideal; intermediate; poor) of seven CVH metrics (nonsmoking, body weight, physical activity, diet, total cholesterol, blood pressure, and blood glucose). Although maintenance of ideal CVH across the lifespan may eliminate ¿ 70% of the U.S. cardiovascular disease (CVD) epidemic, fewer than 1% of Americans successfully maintain ideal levels of all seven CVH metrics. Suboptimal CVH profiles are especially prevalent among U.S. minority groups, who attain intermediate and poor levels of CVH metrics earlier in life than their non-minority counterparts. However, the ages at which members of minority populations transition between ideal, intermediate and poor levels of CVH metrics have not been described. The fact that early transitions from ideal to intermediate and poor levels of CVH metrics have been strongly and consistently associated with cardiovascular morbidity and mortality lends some urgency to this line of health disparities research. A parallel need is estimation of the populatio-wide benefits of modest, but achievable increases in the probability of maintaining ideal levels of CVH metrics across the life course, as the very high prevalence of intermediate or poor CVH metric levels in U.S. populations makes complete elimination of these two classifications highly unlikely. However, these two knowledge gaps remain unaddressed, likely reflecting a lack of large, contemporary, and longitudinal population-based studies that include the major U.S. race/ethnic groups and cover the entire at-risk age epochs that span adolescence to late adulthood. In this application we respond to these challenges by leveraging extant cross-sectional data and state of the art Markov models to estimate the race/ethnic- and sex-stratified age-specific probabilities of transitioning between ideal, intermediate and poor levels of CVH metrics among approximately 35,000 African American, Hispanic/Latino, American Indian, and Caucasian U.S. participants. The estimated transition probabilities will then be merged with results from published intervention and longitudinal cohort studies to calculate race/ethnic- and sex- specific reductions in CVD associated with interventions that increase the proportion of the U.S. population maintaining ideal CVH. Together, results from this study will inform public health and intervention programs aimed at promoting ideal CVH in the age groups most at risk for its loss. A focus on African American, Hispanic/Latinos, and American Indian populations adds further significance to this innovative proposal, as these populations attain intermediate and poor CVH profiles earlier than European Americans and shoulder elevated burdens of the downstream cardio-, renal- and cerebrovascular disease manifestations.