Epidemiologic Study of Ethnicity and Lifetime Risks for Cardiovascular Disease

描述（由申请人提供）：目前的临床实践预防指南依赖于10年内心血管疾病（CVD）或冠心病（CHD）发展的绝对风险估计，以使治疗强度与风险程度相匹配。然而，许多人患心血管疾病的10年风险较低，但终生风险较高。因此，国家胆固醇教育计划成人治疗小组III （NCEP ATP-III）建议在决定药物治疗时考虑长期和终生风险。迄今为止，在纯白人队列中进行的有限数量的研究已经检查了心血管疾病事件的终生风险。没有关于其他种族人群心血管疾病终生风险的数据。终生风险方法通过考虑发生有关疾病的风险以及相互竞争的死亡原因的风险，估计死亡前发生某种疾病的绝对风险。由于心血管疾病发病率和竞争死亡原因在终生风险估计中都被考虑在内，因此心血管疾病的终生风险在具有不同风险因素负担和不同非心血管疾病死亡率的种族群体之间可能存在很大差异。我们建议从多个大型流行病学队列研究中产生和汇总估计，以比较不同种族之间心血管疾病的终生风险。拟议研究的队列包括社区动脉粥样硬化风险、弗雷明汉心脏、檀香山心脏、波多黎各心脏健康、CARDIA、心血管健康、人民天然气、西部电力、芝加哥心脏协会工业检测项目、妇女健康倡议观察研究、MRFIT筛查者等，包括50多万人。所得的CVD终生风险数据将有助于估计现在和未来的CVD人群负担，比较种族/民族内部和之间CVD和其他常见疾病的终生风险，加强风险沟通，并有可能帮助确定新的CVD高危人群。这一应用代表了一种分析现有数据的新方法，可能对非白人种族群体的心血管疾病流行病学产生实质性的新见解。

DESCRIPTION (provided by applicant): Current clinical practice prevention guidelines rely on estimates of the absolute risk for development of cardiovascular disease (CVD) or coronary heart disease (CHD) within 10 years, in order to match the intensity of therapy to the magnitude of risk. However, many individuals have low 10-year risks but elevated lifetime risks for CVD. The National Cholesterol Education Program's Adult Treatment Panel III (NCEP ATP-III) therefore recommends consideration of long-term and lifetime risks in decisions regarding drug therapy. To date, a limited number of studies performed in exclusively white cohorts have examined lifetime risks for CVD events. No data are available regarding lifetime risks for CVD among other ethnic groups. Lifetime risk methods estimate the absolute risk for development of a disease prior to dying, by accounting for the risk of developing the disease of interest as well as the risk for competing causes of death. Since both CVD incidence and competing cause of death are considered in lifetime risk estimation, lifetime risks for CVD may vary considerably between ethnic groups with differing risk factor burdens and diverse rates of death from non-CVD causes. We propose to generate and pool estimates from multiple large epidemiologic cohort studies to compare lifetime risks for CVD between different ethnicities. Among the cohorts to be included in the proposed study are the Atherosclerosis Risk in Communities, Framingham Heart, Honolulu Heart, Puerto Rico Heart Health, CARDIA, Cardiovascular Health, People's Gas, Western Electric, Chicago Heart Association Detection Project in Industry, and Women's Health Initiative Observational Studies, MRFIT screenees, and others, comprising over 500,000 individuals. The resulting data on lifetime risks for CVD will be useful in estimating the population burden of CVD now and in the future, in comparing lifetime risks for CVD and other common diseases within and between race/ethnic groups, and in enhancing risk communication, and they have the potential to help identify new populations of patients at risk for CVD. This application represents a novel approach to analyzing existing data that is likely to yield substantial new insights into the epidemiology of CVD among non-white ethnic groups.