Young Women With Acute Myocardial Infarction

描述（由申请人提供）：患有急性心肌梗死（AMI）的年轻女性在缺血性心脏病风险中代表了一种极端的表型，同时，与同样年龄的男性相比，构成了一个巨大的未充分研究的群体，其死亡率风险过高。这种不良风险和不充分的调查相结合，为解决年轻AMI女性的护理和结果提供了一个至关重要的机会，以揭示其预后的关键生物学和环境决定因素。因此，我们建议对年轻女性AMI （YWAMI）进行首次大型、全面的观察性研究。YWAMI将包括2 000名年龄在18-55岁之间的妇女，以及来自美国和加拿大88家医院的1 000名男性，为期3年。为了实现这些目标，我们在心血管疾病的性别差异、结局研究、流行病学、统计学、遗传学、生物标志物研究、健康状况测量、社会心理研究、心脏病学和急诊医学方面组建了一支领先的研究团队。我们的具体目标是：1)表征AMI后结局的性别差异（包括死亡率、住院率和健康状况）；2)确定人口统计学、临床和社会心理危险因素患病率的性别差异；3)确定护理质量的性别差异；4)确定所选生物因素（包括性激素、生物标志物和遗传变异）患病率的性别差异。我们将非常详细地描述这些差异，并阐明导致结果差异的生物和环境因素。来自所有四个目标的分析将用于为年轻AMI患者开发临床有用的风险分层模型，解释结果的性别差异并确定干预目标。我们还将收集每位受试者的血清和DMA，为预期的未来年轻女性和男性AMI分子生物学研究创造资源。我们将与美国心脏病学会、美国心脏协会和VHA公司合作，传播这项研究的发现，这些发现可用于改善年轻女性和男性AMI的预防、护理和预后。公共卫生影响：总体而言，尽管年轻女性因心脏病死亡的人数与乳腺癌一样多，但很少有研究涉及影响其结果的生物、环境和社会因素。患心脏病的年轻女性比同样年龄的男性死亡的风险更高。我们建议对患有心脏病的年轻女性进行最大规模、最全面的研究，以确定她们康复的关键决定因素，并发现有助于我们改善她们护理的知识。

DESCRIPTION (provided by applicant): Young women with an acute myocardial infarction (AMI) represent an extreme phenotype in ischemic heart disease risk and, at the same time, constitute a large understudied group with excess mortality risk compared with similarly aged men. This combination of adverse risk and inadequate investigation provides a critically important opportunity to address the care and outcomes of young women with AMI to uncover key biological and environmental determinants of their prognosis. Accordingly, we propose the first large, comprehensive, observational study of young women with AMI (YWAMI). YWAMI will include 2,000 women, 18-55 years of age, with AMI and a comparison cohort of 1,000 men enrolled over 3 years from 88 hospitals across the United States and in Canada. To accomplish these aims we have assembled a team of leading researchers in sex disparities in cardiovascular disease, outcomes research, epidemiology, statistics, genetics, biomarker research, health status measurement, psychosocial research, cardiology, and emergency medicine. Our Specific Aims are to: 1) characterize sex differences in outcomes following AMI (including mortality, hospitalization and health status); 2) determine sex differences in the prevalence of demographic, clinical, and psychosocial risk factors; 3) determine sex differences in quality of care; and 4) determine sex differences in the prevalence of selected biological factors (including sex hormones, biomarkers and genetic variations). We will characterize these differences in great detail and elucidate the biological and environmental factors that are responsible for disparities in outcomes. The analyses from all four aims will be used to develop clinically useful risk-stratification models for young AMI patients, explain sex differences in outcomes and identify targets for intervention. We will also bank serum and DMA from each subject, creating a resource for anticipated future studies of the molecular biology of AMI in young women and men. We will work with the American College of Cardiology, the American Heart Association and VHA, Inc. to disseminate findings from this study that can be used to improve the prevention, care, and outcomes for young women and men with AMI. Public Health Implications: Overall, although heart disease in young women accounts for as many deaths as breast cancer, few studies have addressed the biological, environmental and social factors that influence their outcome. Young women with heart attacks have a higher risk of dying than similarly aged men. We propose to conduct the largest, most comprehensive study of young women with heart attacks to identify the key determinants of their recovery and discover knowledge that will assist us in improving their care.