WTC-Heart: A Cohort Study of Heart Diseases in Word Trade Center Responders

描述(由申请人提供)：根据初步证据，暴露在9/11世界贸易中心(WTC)灾难中会增加心血管疾病(CVD)的风险。WTC-心脏队列研究成立于2011年，严格评估了这种潜在的心血管疾病对幸存的救援人员和志愿者(响应者)的影响。队列年龄中值为45岁。我们建议完成一项为期两年的后续行动，并为其长期后续行动制定一项可持续战略。使用招募的和目前跟踪的WTC-心脏队列，目标是：1)评估两年的冠心病(CHD)和一般心血管疾病风险；2)将冠心病和心血管疾病的Framingham心脏研究(FHS)评分与观察到的WTC-心脏风险进行比较；WTC-心脏评估但不包括在FHS评分中的额外风险因素是a)暴露在9/11尘埃云中，b)创伤后应激障碍和抑郁；3)比较55岁以上WTC响应者的CHD风险与投资队列的风险，包括没有直接暴露在世贸中心遗址空气污染和精神压力中的纽约华盛顿高地居民；4)建立基于住院和死亡登记的被动跟踪程序，并确定从主动跟踪切换到被动跟踪的潜在偏差。世界贸易中心-心脏(N=6,492)包括在世界贸易中心健康计划(WTCHP)Mt.年度监测访问中积极招募的应答者。西奈半岛和北岸遗址。心血管疾病的决定因素，包括血脂、9/11暴露、抑郁和可能的创伤后应激障碍，在登记之日进行了测量。血压、BMI和腰围评估的测量都是标准化的。对事件和复发的心血管疾病的持续跟进包括年度筛查、面谈和医疗记录审查。使用基线特征和随访结果计算两年内预测的冠心病风险和观察到的风险。在为期两年的随访结束时，将与投资队列进行比较。截至2013年11月，3300名参与者(占队列的50%)的后续行动已经完成。头几个月的回复率在50%以上。通过问卷和个人访谈确定了37起事件CVD事件。这项拟议的研究将：1)继续主动随访2年，以获得两年的CHD和CVD风险评估，并将其与FHS评分进行比较；2)建立基于住院和死亡数据联系的长期被动随访程序。如果9/11应答者的长期心血管健康受到超过心血管疾病风险通常决定因素的影响，我们可能会提出修订的WTC评分来识别高危应答者并更有效地指导治疗。这一评估工具不仅将指导WTC应急人员的护理，还将指导对受未来灾难影响的平民的医疗监测。

DESCRIPTION (provided by applicant): From preliminary evidence, exposure to the 9/11 World Trade Center (WTC) disaster increases risk of cardiovascular diseases (CVD). The WTC-Heart cohort study, established in 2011, rigorously assesses this potential CVD effect in surviving rescue workers and volunteers (responders). Cohort median age is 45. We propose to complete a two-year follow-up and install a sustainable strategy for its long-term follow-up. Using the recruited and currently followed-up WTC-Heart cohort, objectives are: 1) assess the two-year coronary heart disease (CHD) and general CVD risks; 2) compare the Framingham Heart Study (FHS) scores for CHD and CVD with the observed WTC-Heart risks; extra risk factors assessed by WTC-Heart but not included in the FHS score are a) exposure to the 9/11 dust cloud and b) PTSD and depression; 3) compare the CHD risk of WTC responders aged over 55 to that of the INVEST cohort, comprised of Washington Heights, NYC residents who were not directly exposed to the air pollution and mental stress at Ground Zero; 4) install a passive follow-up procedure based on hospitalization and death registries, and determine the potential bias related from switching from an active to a passive follow-up. WTC-Heart (N=6,492) comprises responders actively recruited at annual monitoring visits at the World Trade Center Health Program (WTCHP) Mt. Sinai and North Shore sites. Determinants of cardiovascular disease, including blood lipids, 9/11 exposure, depression, and probable PTSD were measured on the date of enrollment. Measures of blood pressure, BMI, and waist circumference assessments were standardized. An on-going follow-up for incident and recurrent CVD consists of annual screenings, interviews, and medical record review. The 2-year predicted risk of CHD and the observed risk will be calculated using baseline characteristics and the results of the follow-up. Comparisons with the INVEST cohort will be done at the end of the 2-year follow-up. As of November 2013, follow-up is complete for 3,300 participants (50% of the cohort). Response rates are above 50% for the first months. Thirty-seven incident CVD events were identified through questionnaire and personal interviews. The proposed study will: 1) continue the active follow-up for another 2 years to obtain a two-year CHD and CVD risk estimates and compare them with FHS scores; and 2) install procedures for a long-term passive follow-up based on linkage with hospitalization and mortality data. In the event that the long-term cardiovascular health of 9/11 responders is impacted above and beyond the usual determinants of cardiovascular disease risk, we may propose a revised WTC-score to identify high-risk responders and guide treatment more effectively. This assessment tool will not only guide care for WTC responders, but also guide medical surveillance of civilians affected by future disasters.