Coronary Artery Risk Development in Young Adults (CARDIA) Study - CC

阿拉巴马大学伯明翰分校是2008-13年间青年冠状动脉风险发展(CARDIA)研究的协调中心。CARDIA是一项基于人口的观察性研究，对具有不同社会经济地位的非裔美国人和白人男性和女性进行研究，该研究始于1985年至2006年，调查了5115名年龄在18岁至30岁之间的年轻人。在第2、5、7、10和15年的跟踪检查获得了高保留率，收集了丰富的高质量数据和存储的与心血管疾病(CVD)病因有关的标本，并导致了168篇同行评议的出版物。在接下来的5年里，我们将继续每半年进行一次电话联系、疾病事件监测以及分析和发布活动。我们将在我们的队列中进行一项20岁的测试，他们的年龄在38-50岁。我们建议重新检查至少73%的幸存者(整个研究范围内有3650名参与者)，主要有四个目标： 1)为了确定亚临床动脉粥样硬化的发展和进展的预测因素，我们将测量风险因素水平(已建立的、新的、生活方式和心理社会)和亚临床动脉粥样硬化(冠状动脉钙化[CAC]和颈动脉内膜-中层厚度[IMT])。我们将研究危险因素的前置因素，特别关注日益流行的肥胖，探索近期和远程危险因素暴露对CAC、CAC进展和IMT的影响，并评估肥胖、糖尿病和肾损害等条件的作用，以及社会经济状况和卫生保健获得和利用的差异。 2)为了阐明心血管疾病发病机制中可能存在的种族差异，我们将比较与CAC发生率和患病率相关的因素，以及与IMT患病率相关的因素，跨危险性别组。我们将探索可能解释观察到的差异的因素。 3)为了检验炎症是否先于亚临床疾病，我们将检测炎症标志物(如C-反应蛋白)与动脉粥样硬化的CAC和IMT证据之间的关联的时间进程。我们还将确定炎症(如感染)的预测因素，以及肥胖和内脏肥胖的影响。 4)为了探讨遗传变异和基因-环境交互作用在心血管疾病发病中的作用，我们将探讨它们在危险因素病因学中的作用，并检验调控肥胖、高脂血症、血压和骨矿化等基因的等位基因变异是否与CAC和IMT有关。 此外，下一次检查将研究部分参与者的脑磁共振成像(MRI)。 这些数据，以及在单独资助的辅助研究中的发现，将使我们能够检查亚临床动脉粥样硬化在不同人群中的先兆和流行率。我们将在存在行为和生理风险因素的情况下分析易感遗传特征的作用，以检测基因与环境的交互作用，并研究这些因素在男性和女性以及非裔美国人和白人中的差异。 这些活动将充分利用CARDIA出色的数据库和标本库，以及调查团队、组织结构和质量控制程序。这项研究通过让新的科学家参与CARDIA，扩大了参与设计、分析和出版活动的调查人员队伍，并加强了CARDIA数据的传播和对非附属调查人员的分析支持。这些计划将加速我们对20年来中年风险因素和亚临床疾病先兆的理解。需要这些知识来设计预防医学政策，以应对日益严重的肥胖症流行和减轻心血管疾病的公共卫生负担，并针对最有效的特定人口亚群和环境量身定做。

The University of Alabama at Birmingham serves as the Coordinating Center for the Coronary Artery Risk Development in Young Adults (CARDIA) Study for the period 2008-13. CARDIA is a population-based observational study of African-American and white men and women of diverse socioeconomic status that began by examining 5115 young adults aged 18-30 in 1985-6. Follow up examinations at years 2, 5, 7, 10, and 15 achieved high retention rates, collected a rich set of high quality data and stored specimens bearing on the causes of cardiovascular disease (CVD), and led to 168 peer-reviewed publications. During the next 5 years we will continue semi-annual telephone contacts, disease event surveillance, and analysis and publication activities. We will carry out a year 20 exam on our cohort, who will be 38-50 years old. We propose to re-examine a't least 73% of those surviving (3650 participants study-wide) with 4 main objectives: 1) To identify predictors of development and progression of subclinical atherosclerosis, we will measure risk factor levels (established, novel, lifestyle, and psychosocial) and subclinical atherosclerosis (coronary artery calcification [CAC] and carotid intima-media thickness [IMT]). We will examine the antecedents of the risk factors with special attention to the growing epidemic of obesity, explore the effects of recent and remote risk factor exposure on CAC, on CAC progression, and on IMT, and assess the role of conditions such as obesity, diabetes and renal impairment, and of differences in socioeconomic status and health care access and utilization. 2) To elucidate possible racial differences in CVD pathogenesis, we will compare the factors associated with CAC incidence and prevalence, and with IMT prevalence, across risk-gender groups. We will explore factors that may explain observed differences. 3) To test whether inflammation precedes subclinical disease, we will examine the time course of the association between inflammatory markers (such as C-reactive protein) and CAC and IMT evidence for atherosclerosis. We will also identify predictors of inflammation (such as infection), and the impact of obesity and of visceral adiposity. 4) To assess the roles of genetic variation and gene by environment interactions in CVD pathogenesis, we will explore their role in the etiology of risk factors, and test if allelic variation in genes such as those regulating obesity, hyperlipidemia, blood pressure, and bone mineralization are associated with CAC and IMT. Additionally, the next examination will study the Brain Magnetic Resonance Imaging (MRI) in a subset of the participants. These data, as well as findings in separately funded ancillary studies, will allow us to examine the antecedents and prevalence of subclinical atherosclerosis in diverse populations. We will analyze the role of predisposing genetic traits in the presence of behavioral and physiologic risk factors in order to detect genotype-by-environment interactions, and to study how these differ in men and women, and in African-Americans and whites. These activities will take full advantage of CARDIA's outstanding database and specimen bank, and team of investigators, organizational structure, and quality control procedures. The study expands the pool of investigators contributing to design, analysis and publication activities by involving new scientists in CARDIA, and enhances dissemination of CARDIA data and analytic support to non-affiliated investigators. These plans will accelerate the growth of our understanding of the 20-year antecedents of middle-aged risk factors and subclinical disease. This knowledge is needed for designing preventive medicine policies that address the growing epidemic of obesity and reduce the public health burden of CVD, and that are tailored to specific population subgroups and settings where they will be most effective.