Atrial Fibrillation in MESA and JHS

描述(申请人提供)：动脉粥样硬化的多种族研究(MESA)和杰克逊心脏研究(JHS)都是NHLBI资助的队列研究，于2000年开始招募，旨在通过准确测量心血管疾病、其风险因素及其结果来调查不同种族/民族的美国人动脉粥样硬化的发病机制。为了提高这些重要研究的科学生产率，我们建议建立一个MESA-JHS房颤(AF)联合工作组，以促进将检查和事件监测数据与联邦医疗保险索赔数据结合在一起的研究。随着MESA和JHS参与者步入60多岁和70多岁，房颤正在成为一个重要的健康问题。这两项研究中确定的事件已经包括心肌梗死、中风和心力衰竭，但房颤的确定还不够成熟。根据我们在心血管健康研究中识别房颤的经验，我们将与MESA和JHS协调中心合作，根据队列检查、事件监测以及住院和门诊医疗保险索赔数据准备房颤事件文件。房颤事件文件将被纳入MESA和JHS数据库，增加一个至关重要的心血管结局。我们提出了与房颤相关的具体目标，这些目标是有重点和创新的，来自MESA和JHS的现有数据和新数据将为此做出新的贡献。这些分析将在我们的AF工作组中由早期调查人员在经验丰富的调查人员的指导下进行。首先，我们假设较大的心包脂肪储备与较大的左房容量和较大的左房纵向扩大相关。其次，我们假设较大的心包脂肪储备与发生的房颤有关。这两项分析都将根据肥胖、高血压和其他心血管危险因素进行调整。如果我们的假设是正确的，结果将激励未来对影响血脂水平、脂代谢、体重或血糖的干预或药物的研究，这些干预或药物也可能改变心包脂肪沉积，潜在地防止进行性心房重构和房颤。对心包脂肪、左房纵向扩大和房颤的分析将作为我们工作组与房颤相关的其他分析和辅助研究的跳板。我们的工作结合了联邦医疗保险索赔数据以识别房颤事件，也将作为分析其他健康结果的模型，这些结果可以使用联邦医疗保险索赔数据轻松识别。首席调查员是国际公认的房颤流行病学专家，在使用NHLBI队列中的医疗保险索赔数据、高生产率以及研究生和早期调查人员的指导方面有着良好的工作记录。

DESCRIPTION (provided by applicant): The Multi-Ethnic Study of Atherosclerosis (MESA) and the Jackson Heart Study (JHS) are both NHLBI-funded cohort studies that began recruitment in 2000 and were designed to investigate the pathogenesis of atherosclerosis in Americans of diverse races/ethnicities by providing accurate measurement of cardiovascular disease, its risk factors, and its outcomes. To enhance scientific productivity from these important studies, we propose to establish a joint MESA-JHS Atrial Fibrillation (AF) Working Group to foster research that brings together exam and events surveillance data with Medicare claims data. As MESA and JHS participants reach their late 60s and 70s, AF is becoming an important health problem. Events ascertainment in both studies already includes myocardial infarction, stroke, and heart failure, but AF ascertainment is underdeveloped. Based on our experience with identifying AF in the Cardiovascular Health Study, we will work with the MESA and JHS Coordinating Centers to prepare AF events files based on data from the cohort exams, events surveillance, and inpatient and outpatient Medicare claims data. The AF events files will be incorporated into the MESA and JHS databases, adding a critically important cardiovascular outcome. We propose specific aims related to AF that are focused and innovative, and for which existing and new data from MESA and JHS are poised to make novel contributions. These analyses will be undertaken in our AF Working Group by early stage investigators with mentorship from experienced investigators. First, we hypothesize that larger pericardial fat depots are associated with larger left atrial volume and with greater longitudinal left atrial enlargement. Second, we hypothesize that larger pericardial fat depots are associated with incident atrial fibrillation. Both analyses will be adjusted for obesity, hypertension, and other cardiovascular risk factors. If our hypotheses are correct, the results will motivate future studie of interventions or medications that affect lipid levels, lipid metabolism, weight, or blood glucos, and that may also alter pericardial fat deposition, potentially preventing progressive atrial remodeling and AF. The analyses of pericardial fat, longitudinal left atrial enlargement, and AF will serve as a springboard for additional analyses and ancillary studies related to AF from our Working Group. Our work incorporating Medicare claims data to identify AF events will also serve as a model for analyses of other health outcomes that can be readily identified using Medicare claims data. The Principal Investigator is an internationally recognized expert in the epidemiology of AF, with a track record of work using Medicare claims data in NHLBI cohorts, high productivity, and mentorship of graduate students and early stage investigators.