Cardiovascular Risk among Transgender Persons in a Regional Electronic Health Record Registry

项目摘要/摘要 心血管疾病每年限制数百万成年人的活动和生活质量，使美国 美国有数十亿美元，占65-74岁人群所有死亡人数的40%以上，占所有死亡人数的60% 85岁及以上老年人死亡1.动脉粥样硬化性心血管疾病(ASCVD)的准确评估 风险是有效的初级预防所必需的。 需要更多关于SEP如何影响动脉粥样硬化风险的研究，特别是在性别少数群体中。 美国心脏病学会和美国心脏协会(ACC/AHA)的指南 ASCVD的预防现在统一包括使用风险评估心脏病发作和中风的风险 计算器(AHA/ACC集合队列方程(PCE))，以确定他汀类药物和 抗高血压药物，预防性治疗，已知可大幅减轻 严重的心血管事件和心血管死亡。然而，人们对其表现知之甚少 变性人的标准心血管危险因素。几十年来，研究人员一直在 有兴趣更好地了解变性人和接受 尤其是跨性别荷尔蒙疗法。回顾研究发现了一些ASCVD增加的迹象 变性人，特别是变性人妇女的发病率和死亡率，但这些审查还 结论是以前的研究质量低，样本少，测量的数量有限 ASCVD危险因素和心血管事件太少，无法得出关于心血管风险的可靠结论。 这项补充研究“区域电子健康中变性人的心血管风险” 档案登记处“是回应”NOT-OD-20-032：特别关注：行政通知“的建议 性少数群体和性别少数群体研究补充资料“。 我们先前的工作表明，在主要的ASCVD事件中，邻里水平的变异性很大程度上 (心肌梗死、中风或心血管死亡)，与事件相关的低SEP社区 利率是高SEP社区的三倍多。此外，社区SEP解释了四次 ASCVD事件发生率中邻居级别的变异量，而不是ACCF/AHA池所解释的 队列方程风险模型。这项研究的重点是检查和分解心血管风险。 和潜在的心血管危险因素在20年的区域电子健康中的变性人成年人中 记录注册表。这项工作将提供(I)对变性人ASCVD风险的了解和(Ii) 为心血管不良事件一级预防的临床决策提供支持。 此补充应用程序建议以跨学科团队为基础进行我们的分析 环境，在新建立的基于电子健康数据的前沿区域研究登记处 来自俄亥俄州东北部最大的两个医疗系统，克利夫兰诊所和大都会健康。

PROJECT SUMMARY/ABSTRACT Cardiovascular disease limits the activity and quality of life of millions of adults every year, costing the United States billions of dollars, and accounting for more than 40% of all deaths among those 65-74 and 60% of all deaths for those aged 85 and older.1 Accurate assessment of atherosclerotic cardiovascular disease (ASCVD) risk is needed for effective primary prevention. More research on how SEP affects atherosclerotic risk is needed, particularly among gender minorities. Guidelines from the American College of Cardiology and American Heart Association (ACC/AHA) for prevention of ASCVD now uniformly include the assessment of risk of heart attack and stroke using risk calculators (the AHA/ACC Pooled Cohort Equations (PCE)) to determine the appropriateness of statin and anti-hypertensive medications, preventive therapies which are known to substantially reduce the burden of serious cardiovascular events and cardiovascular death. However, too little is known about the performance of standard cardiovascular risk factors in transgender persons. For several decades, researchers have been interested in better understanding cardiovascular risk among transgender persons, and among those receiving cross-sex hormone therapy in particular. Review studies have found some indication of increased ASCVD morbidity and mortality among transgender persons, particular transgender women, but these reviews also concluded that prior studies were of low quality, had small samples, a constrained number of measured ASCVD risk factors and too few cardiovascular events to enable robust conclusions about cardiovascular risk. This supplemental study, “Cardiovascular Risk among Transgender Persons in a Regional Electronic Health Record Registry” is proposed in response to “NOT-OD-20-032: Notice of Special Interest: Administrative Supplements for Research on Sexual and Gender Minority (SGM) Populations”. Our prior work indicates a significant degree of neighborhood-level variability in major ASCVD events (myocardial infarction, stroke or cardiovascular death), with low-SEP neighborhoods associated with event rates over three times that of high-SEP neighborhoods. Moreover, neighborhood SEP explained four times the amount of neighborhood-level variation in ASCVD event rates than that explained by the ACCF/AHA Pooled Cohort Equations Risk Model. The focus of this study is on examining and decomposing cardiovascular risk and underlying cardiovascular risk factors among transgender adults in a 20-year regional electronic health record registry. This work will provide (i) an understanding of ASCVD risk in transgender persons and (ii) support for clinical decision making for primary prevention of adverse cardiovascular events. This supplemental applications proposes to conduct our analysis in a transdisciplinary team-based environment, in a newly-established, cutting-edge regional research registry, based on electronic health data from Northeast Ohio’s two largest health systems, Cleveland Clinic and MetroHealth.