A longitudinal cohort study to evaluate cardiovascular risk factors and disease in Haiti - 2

摘要：心血管疾病（CVD）是全球死亡的主要原因， 低收入和中等收入国家（LMIC）。然而，对中低收入国家心血管疾病的流行病学知之甚少， 缺乏基于人口的本地数据。2018年，我们建立了海地CVD队列（HL 143788）， 该地区第一个基于人群的纵向CVD队列，以估计裁定的CVD患病率 风险因素、疾病及其与贫穷相关的社会和环境决定因素的关系。我们 成功招募了3，005名海地人，并发现： 环境 (HF), 国家 1)30.4%有高血压（HTN）; 2）压力，高盐饮食， 铅暴露与血压升高有关; 3）11.6%有心力衰竭 <40岁的成年人发病率更高（该数据已告知 HTN指南和CVD治疗干预。 海地4.5%，美国0.3%）。 随着R 01的更新，我们可以扩展以下内容- 从这个特征良好的队列中增加到约22，000 PY，以采集至关重要的发生率数据， 风险因素，事件和贫困相关的决定因素需要告知CVD预防。我们估计 各分层的发病率，并确定高风险亚组和人群水平的可改变因素， 成为未来循证CVD预防的目标。这项研究是独特的定位，以解决假设 LMIC和年轻黑人人群中的CVD特异性，美国的数据很少。我们 假设不受控制HTN会增加年轻人发生HF的风险， 膳食盐是与CVD事件相关的主要人群水平可改变因素。我们的具体目标是： 1.确定海地CVD队列中CVD风险因素和裁定事件的7年发生率。 CVD风险因素包括HTN、糖尿病、肥胖、高脂血症、肾病、不良饮食、吸烟， 缺乏运动和炎症CVD事件包括HF、中风、短暂性脑缺血发作、心绞痛， 心肌梗死和CVD死亡率。 2.确定CVD风险因素和事件的预测因素，包括与贫困相关的社会和 环境决定因素我们将确定未来可修改的预测因子和高风险亚组。 个体水平干预，在10-50%的暴露中检测最小HR ≥1.2的把握度 普遍性。我们将使用人群归因风险识别人群水平的可修改因素。 3.描述当地情况，以确定最佳实施战略，供未来使用- 在个人和群体水平上预防CVD的干预措施。我们将使用混合方法 包括多部门定性访谈和调查，以了解影响 今后针对目标1-2中的定量数据采取干预措施。 这项研究对于在中低收入国家抗击心血管疾病流行至关重要， 卫生部，并将告知我们对心血管疾病健康差距的理解在世纪。

ABSTRACT: Cardiovascular disease (CVD) is the leading cause of death globally, with 80% of the burden in low- and middle-income countries (LMICs). Yet, the epidemiology of CVD in LMICs is poorly understood given the absence of population-based local data. In 2018, we established the Haiti CVD Cohort (HL143788), the first population-based longitudinal CVD cohort in the region to estimate the prevalence of adjudicated CVD risk factors, diseases, and their association with poverty-related social and environmental determinants. We successfully enrolled 3,005 Haitians and found: environmental (HF), national 1) 30.4% had hypertension (HTN); 2) stress, high salt diet, and lead exposure were associated with increased blood pressure; and 3) 11.6% had heart failure with higher rates among adults <40 years ( This data has informed HTN guidelines and interventions for CVD treatment. 4.5% in Haiti vs 0.3% in the US). With renewal of this R01, we can extend follow- up of this well-characterized cohort to ~22,000 PY to capture critically important incidence data spanning risk factors, events, and poverty-related determinants needed to inform CVD prevention. We will estimate incidence rates across strata and identify high-risk subgroups and population-level modifiable factors that can be targets for future evidence-based CVD prevention. This study is uniquely positioned to address hypotheses specific to CVD in LMICs and among young Black populations, where data in the US is sparse. We hypothesize uncontrolled HTN increases risk for incident HF in young adults, and environmental lead and high dietary salt are major population-level modifiable factors associated with incident CVD. Our Specific Aims are: 1. Determine the 7-year incidence of CVD risk factors and adjudicated events in the Haiti CVD Cohort. CVD risk factors include HTN, diabetes, obesity, hyperlipidemia, kidney disease, poor diet, smoking, physical inactivity, and inflammation. CVD events include HF, stroke, transient ischemic attack, angina, myocardial infarction, and CVD mortality. 2. Identify predictors of incident CVD risk factors and events, including poverty-related social and environmental determinants. We will identify modifiable predictors and high-risk subgroups for future individual-level interventions, with power to detect minimal HRs ≥1.2 across exposures with 10-50% prevalence. We will identify population-level modifiable factors using population attributable risks. 3. Characterize the local context to identify optimal implementation strategies for future evidence- based interventions to prevent CVD at the individual and population level. We will use mixed methods including multisector qualitative interviews and surveys to understand the contextual factors influencing the implementation of future interventions targeting quantitative data in Aims 1-2. This research is essential for fighting the CVD epidemic in LMICs, is enthusiastically supported by the Haitian Ministry of Health, and will inform our understanding of CVD health disparities in the 21st century.