Epidemiologic Study of Sick Sinus Syndrome

描述（由申请人提供）：病窦综合征（SSS）是一种以症状性窦房结功能障碍为特征的疾病。SSS占美国和其他西方国家起搏器植入适应症的30-50%。尽管有其负担和相关费用，但以前没有研究探讨一般人群中SSS的发病率和风险因素。如果确定了可改变的风险因素，SSS在许多人中可能是可以预防的。同样，关于SSS对心血管疾病和死亡率总体风险影响的信息有限。我们建议使用来自社区动脉粥样硬化风险（ARIC）研究和心血管健康研究（CHS）的可用数据，这两项研究是美国两个基于社区的前瞻性队列，包括21，680名男性和女性，白人和非洲裔美国人，基线年龄为45岁及以上，以解决以下目标：（1）计算ARIC和CHS中SSS的年龄、性别和种族特异性发病率，并估计美国每年发生的SSS事件总数;（2）确定与SSS发病率相关的生活方式、临床变量和生物标志物，并开发有助于预测无症状个体未来SSS风险的工具;（3）评估SSS发生率与其他心血管结局（冠心病、心力衰竭、房颤）和总死亡率的相关性。作为一个探索性的目标，我们将探索SSS的遗传决定因素，使用候选基因和全基因组的方法。将研究的风险因素包括但不限于社会经济变量、吸烟、体力活动、饮食、吸烟、体重指数和其他肥胖指标、血压、糖尿病、血胆固醇、心电图参数和心血管疾病史（冠心病、心力衰竭和中风）或慢性肾病。感兴趣的生物标志物包括：C反应蛋白、NT-proBNP和肌钙蛋白T。SSS事件将从住院出院代码和Medicare（来自Medicare和Medicaid服务中心（CMS））数据中识别。总体而言，我们的研究将包括来自不同种族/民族和地理背景的20，000多人的样本，随访近20年。我们预计将确定400多起SSS事件。这项研究为了解老年人心脏病的流行病学和发病机制提供了有效的方法，并将为制定SSS的预防策略提供相关数据，并促进我们对心脏电生理学的了解。

DESCRIPTION (provided by applicant): Sick sinus syndrome (SSS) is a disorder characterized by symptomatic dysfunction of the sinoatrial node. SSS accounts for 30-50% of indications for pacemaker implantations in the US and other Western countries. Despite its burden and associated costs, no previous studies have explored the incidence and risk factors for SSS in the general population. If modifiable risk factors are identified, the possibility exists that SSS might be preventable in many individuals. Similarly, limited information exists on the impact of SSS on the overall risk of cardiovascular disease and mortality. We propose to use available data from the Atherosclerosis Risk in Communities (ARIC) Study and the Cardiovascular Health Study (CHS), two community-based prospective cohorts in the US including 21,680 men and women, whites and African-Americans, aged 45 and older at baseline, to address the following aims: (1) To calculate the age, gender and race-specific incidence of SSS in ARIC and CHS, and estimate the total annual number of SSS events occurring in the US; (2) To identify lifestyles, clinical variables and biomarkers associated with the incidence of SSS, and to develop tools that help to predict the future risk of SSS in asymptomatic individuals; (3) To evaluate the association of SSS incidence with the subsequent risk of other cardiovascular outcomes (coronary heart disease, heart failure, atrial fibrillation) and total mortality. As an exploratory aim, we will explore genetic determinants of SSS using candidate gene and genome-wide approaches. Risk factors that will be studied include, but are not limited to, socioeconomic variables, smoking, physical activity, diet, smoking, body mass index and other adiposity measures, blood pressure, diabetes, blood cholesterol, electrocardiographic parameters, and history of cardiovascular disease (coronary heart disease, heart failure, and stroke) or chronic kidney disease. Biomarkers of interest include: C-reactive protein, NT-proBNP, and troponin T. SSS incident events will be identified from hospitalization discharge codes and Medicare (from the Center for Medicare and Medicaid Services (CMS)) data. Overall, our study will include a sample of more than 20,000 individuals from a diverse racial/ethnic and geographical background followed for almost 20 years. We expect to identify more than 400 incident cases of SSS. The proposed research constitutes an efficient approach to understand the epidemiology and etiopathogenesis of a relatively common cardiac condition in the elderly, and will provide relevant data to develop preventive strategies for SSS and foster our knowledge of cardiac electrophysiology.