Cerebrovascular Disease and its Consequences in the Strong Study Cohort

描述（由申请方提供）：脑血管疾病（CBVD）是发病率和死亡率的主要原因，与认知和运动障碍以及抑郁症有关。磁共振成像（MRI）在大型队列研究中重新定义了CBVD，如心血管健康研究（CHS）和社区动脉粥样硬化风险（ARIC）。在CHS和ARIC中，MRI显示，在没有已知中风或短暂性脑缺血发作的人群中，脑部异常的患病率很高，特别是白色物质高信号、梗死和出血。此外，明显的CBVD，如中风，明显低于隐性MRI定义的脑部疾病。然而，这些隐性发现并不是衰老的良性表现，因为它们与运动功能和认知受损、抑郁以及随后中风和死亡风险的显著增加有关。这些研究令人信服地证明，临床定义的CBVD大大低估了CBVD的真实人群负担。我们对美洲印第安人（AI）心血管疾病的了解大部分来自强心研究（SHS），这是一项前瞻性研究，对来自13个部落的4，549名老年人进行了18年的随访。它进行了体格检查，实验室和心脏研究，以及图表审查，以描述危险因素，患病率和心血管疾病发病率和死亡率的发生率。最近的分析估计，SHS中年龄和性别调整的卒中发病率为679/100，000人，调整为美国成年人群的年龄和性别分布。这一发生率是在一般人群中观察到的两倍以上，表明AI正在经历CBVD的流行。然而，AI未纳入CHS或ARIC或其他基于社区的CBVD研究，SHS未进行MRI。我们将完成临床和MRI评价，以重新评估风险和保护因素，并在SHS中描述MRI定义的CBVD。利用这些来自存活队列成员的数据，我们将解决我们的特定目标，即：1）估计患病率并量化脑MRI结果定义的CBVD程度，特别是白色高信号、梗死、脑梗死和脑萎缩; 2）评估风险因素与普遍MRI定义的CBVD的关系，如人口统计学、生活方式、临床、实验室、超声心动图，和超声测量，以及文化适应和印度遗产程度的独特影响;和3）记录MRI定义的CBVD与运动缺陷、认知障碍和抑郁症状的关联强度，并确定它们是否独立于人口统计学、生活方式和实验室测量。卒中发生率升高表明，AI可能遭受隐性CBVD的巨大负担。作为一个已经严格评估CVD的AI样本，SHS队列是研究CBVD及其表现的理想选择。在最初的4，549名成员中，只有约1，950名成员活着并能够参与;自上次提交以来，已有283人死亡。认可机构未能有其他机会获得有关CBVD的知识。现在迫切需要启动这项研究，因为随着时间的推移，原始队列中存活下来的成员越来越少。公共卫生相关性：强心研究队列中的脑血管疾病及其后果美洲印第安人口是我们社会中增长最快的部分之一。最近的资料表明，美国印第安人中风的频率至少是白色美国人的2-3倍。中风和其他脑血管疾病造成的损害可以在MRI（或大脑）扫描中看到。核磁共振成像也揭示了许多“无声”中风，从来没有明显的人或他们的医生。这项研究将检查美洲印第安人的大脑损伤所造成的明显和“沉默”中风。美洲印第安人正在经历脑血管疾病的流行，考虑到中风造成的费用和残疾，这将在未来几年成为一个惊人的公共卫生问题。

DESCRIPTION (provided by applicant): Cerebrovascular disease (CBVD), a leading cause of morbidity and mortality, is linked to cognitive and motor impairment, and depression. Magnetic resonance imaging (MRI) has redefined CBVD in large cohort studies, such as the Cardiovascular Health Study (CHS) and Atherosclerosis Risk in Communities (ARIC). In CHS and ARIC, MRI revealed high prevalences of brain abnormalities, specifically white matter hyperintensities, infarcts, and hemorrhages, in populations without known stroke or transient ischemic attack. Further, overt CBVD, such as stroke, was strikingly less common than covert MRI-defined brain disease. The covert findings were not, however, benign accompaniments of aging as they were associated with impaired motor function and cognition, depression, and a striking increase in the risk of subsequent stroke and death. These studies have convincingly demonstrated that clinically-defined CBVD dramatically underestimates the true population burden of CBVD. Much of what we know about cardiovascular disease in American Indians (AIs) comes from the Strong Heart Study (SHS), a prospective study of 4,549 older adults from 13 tribes followed over 18 years. It conducted physical exams, laboratory and cardiac studies, and chart reviews to describe risk factors, prevalence, and incidence of cardiovascular disease morbidity and mortality. Recent analyses estimated the age- and gender- adjusted stroke incidence in the SHS as 679/100,000 persons, adjusted to the age and sex distribution of the U.S. adult population. This incidence is over twice that observed in the general population indicating AIs are experiencing an epidemic of CBVD. AIs, however, were not included in CHS or ARIC or the other community- based studies of CBVD, and the SHS did not perform MRIs. We will complete a clinical and MRI evaluation to re- assess risk and protective factors and describe MRI-defined CBVD in the SHS. With these data from surviving cohort members, we will address our Specific Aims which are to: 1) estimate the prevalence and quantify the extent of CBVD defined by brain MRI findings, specifically white matter hyperintensities, infarcts, hemorrhages, and cerebral atrophy; 2) assess the relationship of risk factors with prevalent MRI-defined CBVD such as demographic, lifestyle, clinical, laboratory, echocardiographic, and ultrasound measures, and the unique influence of acculturation and degree of Indian heritage; and 3) document the strength of associations of MRI- defined CBVD with motor deficits, cognitive impairment, and depressive symptoms, and establish if they are independent of demographic, lifestyle, and laboratory measures. The elevated stroke rates suggest that AIs may be suffering from a large burden of covert CBVD. As an AI sample in which CVD has been rigorously assessed, the SHS cohort is ideal for investigating CBVD and its manifestations. Of the original cohort of 4,549 members, only ~1,950 members will be alive and able to participate; 283 have died since the last submission. Other opportunities to gain knowledge on CBVD among AIs are not forthcoming. There is an urgent need to initiate this study now since as every year passes, fewer members of the original cohort survive. PUBLIC HEALTH RELEVANCE: Cerebrovascular Disease and its Consequences in the Strong Heart Study Cohort The American Indian population is one of the fastest growing segments of our society. Recent information has shown that American Indians have strokes at least 2-3 times more often as White Americans. The damage created by strokes, and other cerebrovascular diseases, can be seen on an MRI (or brain) scan. MRIs also reveal many "silent" strokes that are never apparent to the person or their doctor. This study will examine American Indians for damage to the brain caused by both apparent and "silent" strokes. The American Indian population is experiencing an epidemic of cerebrovascular disease, which given the cost and disability caused by strokes, promises to be a staggering public health issues in the years to come.