Potential future benefits of cardiovascular risk factor control in today’s young adults

 描述(申请人提供)：约有1300万年轻人(20-39岁)患有高胆固醇，约600万人患有高血压。最近的治疗指南不鼓励对年轻人进行高血压或高胆固醇的治疗。胆固醇治疗指南尤其如此，该指南基于心血管疾病的短期(10年)风险。然而，越来越多的证据表明，青年时期的高血压或胆固醇是晚年心血管疾病的有力预测因素，即使在考虑了晚年的生活风险因素水平后也是如此。在这个项目中，我们建议通过将生活过程、与年龄相关的风险因素轨迹和年轻人风险因素暴露的影响纳入到年轻人心血管疾病风险的微观模拟模型中，来建立这一证据。我们组建了一个由心血管疾病流行病学、生物统计学、卫生经济评估和计算机模拟建模专家组成的团队，以评估治疗和控制美国年轻人高血压或胆固醇的增量价值。我们的目标是利用这些专业知识和这些方法来：·估计青年时期早期高血压和胆固醇治疗和控制的潜在健康益处(获得的寿命年数)，考虑到早期生活中暴露于这些风险因素避免的累积动脉粥样硬化损害，以及·预测2015年至2050年患有糖尿病前期的年轻人早期血压和胆固醇治疗和控制的潜在健康益处。我们假设，与根据40岁后10年的风险控制血压和胆固醇相比，在40岁之前治疗和控制高血压和胆固醇，在质量调整的生命年中会产生更好的终生收益。然而，我们预计这些好处将对不良事件发生率和与多年来坚持健康的生活方式选择或每天服用预防性药物相关的任何潜在生活质量下降非常敏感。相关性：这一结果 这项研究可能会改变患者、医疗保健提供者、付款人和临床指南制定者对心血管疾病风险的看法，以及年轻人早期初级预防的可能性，并最终可能有助于延长寿命。 美国成年人的心血管健康状况。这一结果有可能影响对临床实践指南的修改，并鼓励以工作场所为基础的预防计划和其他针对年轻人心血管健康促进的计划。

 DESCRIPTION (provided by applicant): About 13 million young adults (ages 20-39 years) have high cholesterol and about six million have high blood pressure. Recent treatment guidelines have discouraged treatment of high blood pressure or high cholesterol in young adults. This is particularly true of cholesterol treatment guidelines, which are based on short-term (ten year) risk for cardiovascular disease. However, evidence is accumulating that high blood pressure or cholesterol in the young adult years is a strong predictor of later life cardiovascular disease, even after accounting for later life risk factors levels. For this project,we propose to build on this evidence by incorporating life course, age-related risk factor trajectorie and impact of young adult risk factor exposures into a microsimulation model of cardiovascular disease risk in young adults. We have assembled a team of experts in cardiovascular disease epidemiology, biostatistics, health economic evaluation, and computer simulation modeling in order to evaluate the incremental value of treating and controlling high blood pressure or cholesterol in U.S. young adults. We aim to use this expertise and these methods in order to: • Estimate the potential health benefits (life years gained) of early high blood pressure and cholesterol treatment and control during young adulthood, accounting for avoided cumulative atherosclerotic damage from early life exposures to these risk factors, and • Project the potentil health benefits of early blood pressure and cholesterol treatment and control in young adults with pre-diabetes from 2015 to 2050. We hypothesize that treatment and control of high blood pressure and cholesterol before age 40 years would yield superior lifetime gains in quality-adjusted life years compared with controlling BP and cholesterol according to 10-year risk after age 40 years. However, we anticipate that these benefits will be very sensitive to adverse event rates and any potential quality of life decrement associated with years of adhering to healthful lifestyle choices or taking preventive medications on a daily basis. Relevance: The results of this study may change the way patients, health care providers, payers, and clinical guideline makers perceive CVD risk and the potential for early primary prevention in young adults, and may eventually contribute towards improved lifetime cardiovascular health in U.S. adults. The results have the potential to influence modifications to clinical practice guidelines and encourage worksite-based and other prevention programs targeted at young adult cardiovascular health promotion.