Restless Legs Syndrome, Cardiovascular Risk Factors, and Cardiovascular Events

描述(由申请人提供)：这是重新提交的拨款提案R01 HL091880-01，“不宁腿综合症，心血管危险因素和心血管疾病。”这项建议有三个具体目标：1)评估不宁腿综合征(RLS)与心血管疾病(CVD)流行危险因素之间的关联；2)评估RLS与普遍流行的整体和特定类型心血管疾病的关联；以及3)评估RLS与事件总体和特定类型心血管疾病的关联。RLS是一种常见的神经疾病，其特征是双腿有不适的感觉，并渴望移动它们以缓解痛苦。由于不活动和躺着会加剧症状，RLS患者通常会睡眠不足、精疲力竭和疲劳。职业表现、社会活动和家庭生活严重受损。大多数患病率估计表明，7%至10%的人口患有RLS，尽管症状频率不同。然而，RLS可能被低估了。尽管1995年发表了所谓的RLS最低标准及其2003年修订本，加速了RLS的流行病学研究，但人们对该病的发病和病程及其对人口水平的影响仍然知之甚少。最近，有研究表明，RLS与更不利的心血管危险因素有关，包括吸烟、高血压、夜间血压变化和糖尿病的发生率更高。由于这些观察是在横断面研究中进行的，然而，目前尚不清楚RLS是不利危险因素的原因还是结果。所有这些心血管疾病因素都会增加随后发生心血管事件的风险。因此，RLS不仅与CVD的危险因素有关，而且与随后的CVD事件有关。我们建议在三个大规模的、特征良好的前瞻性队列研究中研究这些问题，这些研究包括20,000名男性(医生健康研究I和II)和33,000名女性(女性健康研究)，分别进行了21年、9年和12年的跟踪调查。在所有三项研究中，国际RLS研究组在流行病学研究中确定RLS的最低诊断标准都包括在自我管理的问卷中。由于所有研究最初都被设计为心血管疾病和癌症的一级预防试验，有关这些结果的信息非常好，并且所有事件都通过医疗记录审查得到确认。此外，所有参与者在基线和随访期间提供了关于大量生活习惯、饮食、病史和个人特征的高质量信息。因此，这三项针对男性和女性的前瞻性队列研究为研究RLS、CVD危险因素和CVD事件之间的相互关系提供了一个独特的机会。由于大多数信息已经收集完毕，并且正在进行的数据收集已嵌入正在进行的NIH资助的项目中，我们可以建议以非常经济高效的方式研究这些问题。与公共卫生相关：大约10%的人口患有不宁腿综合症(RLS)，这是一种神经疾病，特征是双腿有不适的感觉，并渴望移动它们以缓解痛苦。最近，有研究表明，RLS与心血管疾病(CVD)更不利的风险相关。因此，问题出现了：RLS患者是否不仅有更高的心血管危险因素患病率，而且他们是否也面临随后发生CVD事件的更高风险。因此，这项赠款提案要求提供资金，以研究RLS、CVD风险因素以及CVD事件之间的关联。

DESCRIPTION (provided by applicant): This is a resubmission of grant proposal R01 HL091880-01, "Restless Legs Syndrome, Cardiovascular Risk Factors, and Cardiovascular Disease." This proposal has three specific aims: 1) to evaluate the association between restless legs syndrome (RLS) and prevalent risk factors for cardiovascular disease (CVD); 2) to evaluate the association between RLS and prevalent overall and specific types of CVD; and 3) to evaluate the association between RLS and incident overall and specific types of CVD. RLS is a common neurological disorder characterized by unpleasant sensations of the legs and an urge to move them for relief. Because symptoms are intensified by inactivity and lying down, RLS patients are often sleep deprived, exhausted and fatigued. Occupational performance, social activities, and family life are severely impaired. Most prevalence estimates indicate that between 7% and 10% of the population suffers from RLS, although with different symptom frequencies. However, RLS is probably underdiagnosed. Despite the publication of the so-called minimal criteria for RLS in 1995 and their 2003 revision, which accelerated epidemiologic RLS research, still little is known about the onset and course of the disease and its consequences on a population level. Recently, it has been suggested that RLS is associated with a more unfavorable cardiovascular risk factor profile, including higher prevalences of smoking, hypertension, nocturnal blood pressure changes, and diabetes. Since these observations were made in cross-sectional studies, it is, however, unclear whether RLS is a cause or a consequence of an unfavorable risk factor profile. All of these CVD factors increase the risk of subsequent CVD events. Thus, it is plausible that RLS is not only associated with risk factors for CVD but also with subsequent CVD events. We propose to study these questions in three large-scale, well-characterized, prospective cohort studies of over 20,000 men (Physicians' Health Study I and II) and 33,000 women (Women's Health Study) with over 21, 9, and 12 years of follow-up, respectively. In all three studies, the minimal diagnostic criteria of the International RLS Study Group to ascertain RLS in epidemiologic studies were included in self-administered questionnaires. Since all studies were originally designed as primary prevention trials of CVD and cancer, information about these outcomes is excellent, and all events were confirmed by medical record review. Furthermore, all participants provided high-quality information about a large number of lifestyle habits, diet, medical history, and personal characteristics at baseline and during follow- up. Thus, these three prospective cohort studies of men and women provide a unique opportunity to study the interrelationships between RLS, risk factors for CVD, and CVD events. Since most information has already been collected and ongoing data collection is imbedded in ongoing NIH funded projects, we can propose to study these questions in a very cost-effective way. PUBLIC HEALTH RELEVANCE: About 10% of the population suffers from Restless Legs Syndrome (RLS), a neurological disorder characterized by unpleasant sensations of the legs and an urge to move them for relief. Recently, it has been suggested that RLS is associated with a more unfavorable risk profile for cardiovascular disease (CVD). Thus, the question arises as whether patients with RLS have not only a higher prevalence of CVD risk factors but whether they are also at increased risk for subsequent CVD events. Thus, this grant proposal request funding to study the association between RLS, CVD risk factors as well as CVD events.