Generating novel predictive models to estimate the risk of future ASCVD & Dementia in older adults

生成新的预测模型来估计未来 ASCVD 的风险

基本信息

批准号：
10474464
负责人：
Michael Nanna
金额：
$ 16.75万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-01 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10474464
关键词：
Aging Alzheimer&apos s Disease Alzheimer&apos s disease risk Antihypertensive Agents Atherosclerosis Benefits and Risks Blood Pressure Calibration Cardiology Cardiovascular Diseases Caring Cause of Death Cognition Cognitive Communities Data Data Set Decision Making Dementia Diabetes prevention Discrimination Disease Outcome Elderly Electronic Health Record Epidemiology Etiology Event Foundations Freedom Funding Future Geriatrics Goals Grant Guidelines Hyperlipidemia Hypertension Impaired cognition Individual Internet Intervention Intervention Trial K-Series Research Career Programs Lipids Marital Status Measures Medical Mental Depression Mentorship Modeling Morbidity - disease rate National Heart, Lung, and Blood Institute Obesity Older Population Operative Surgical Procedures Patients Persons Population Prevalence Prevention Prevention therapy Preventive Preventive care Preventive therapy Preventive treatment Primary Prevention Public Health Reasons for Geographic And Racial Differences in Stroke Research Research Personnel Risk Risk Assessment Risk Estimate Risk Factors Smoking Socioeconomic Status Specialist Therapeutic Time Training United States Validation Visit Work aged atherosclerosis risk base blood pressure control blood pressure intervention cardiovascular disorder risk cholesterol control clinical care clinical practice clinical risk cognitive function cohort dementia risk disability evidence base functional status high risk interest mild cognitive impairment model building model development mortality novel older patient patient oriented predictive modeling preventive intervention randomized trial response risk prediction risk stratification shared decision making tool treatment strategy young adult

项目摘要

Response to Grants for Early Medical/Surgical Specialists' Transition to Aging Research (GEMSSTAR) Competition Title: Generating novel predictive models to estimate the risk of future ASCVD & Dementia in older adults Project Summary/Abstract: A person’s baseline risk determines to a large extent their anticipated benefit from many preventive treatments. Older patients desire to live longer while maintaining cognitive function and freedom from dementia, including Alzheimer’s disease, the #1 cause of morbidity and disability in older adults. Older adults also prioritize avoiding atherosclerotic cardiovascular disease (ASCVD), the #1 killer of older adults. Importantly, many risk factors for Alzheimer’s disease and dementia also increase risk for ASCVD. Alzheimer’s disease is the most common etiologic basis for incident mild cognitive impairment and dementia in older adults and can be identified as the cause in 70-75% of cases. Thus, providing older patients with personalized risk estimates for both dementia, including Alzheimer’s disease, and ASCVD could facilitate a comprehensive, evidence-based and patient-centered approach to therapeutic decision making in older adults. Unfortunately, current risk models were derived in younger adults, and fail to accurately predict risk in older adults. Second it remains unclear whether existing ASCVD risk models can also predict dementia risk and vice versa. Finally, to date, no one has evaluated whether these risk estimates help stratify therapeutic benefits of intervention in older adults. Leveraging a mentorship team of world experts in geriatrics, cardiology, and epidemiology, I will utilize data from subjects ≥75 years old from the National Heart, Lung, and Blood Institute (NHLBI) Pooled Cohorts in order to develop a clinical risk model to estimate risk of dementia, including Alzheimer’s disease, at 5 years from the selected baseline visit (Aim 1). In parallel, we will develop a clinical risk model to estimate the risk of ASCVD over the same time period in the same population of individuals ≥75 years old. In addition to traditional risk factors, we will derive these models using a novel set of candidate predictors not previously included in prior risk models including baseline cognition, functional status, depression, and mobility. Both models will then be externally validated using data from the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort (Aim 2). Finally, we will apply our model to patients ≥75 years old from the Systolic Blood Pressure Intervention Trial (SPRINT) in order to determine whether therapeutic benefit from intensive vs. conservative anti-hypertensive therapy in older adults differs across levels of predicted risk (Aim 3). Once developed and validated, we will develop an electronic health record-based version of the model for widespread dissemination and use in clinical care. The training I will receive through this work will give me expertise in model building and deployment and broaden my research interest in dementia including Alzheimer’s disease. It will also lay the groundwork for a future application for the Paul B. Beeson Emerging Leaders Career Development Award and other independent funding, with the ultimate goal of becoming an independent clinician-researcher focused on the care of older adults.

回应早期医学/外科专家向老化研究（GEMSSTAR）竞争的赠款标题：生成新颖的新型预测模型，以估计老年人未来ASCVD和痴呆症的风险项目摘要/摘要：一个人的基准风险决定了许多众多众多的范围。）疾病和痴呆症也增加了ASCVD的风险。对阿尔茨海默氏病的痴呆症估计以及ASCVD都可以促进以循证为中心的以患者为中心的治疗方法来制定老年人的治疗方法。反之亦然。临床风险模型估计痴呆症的风险，包括从选定的基线访问开始5年（AIM 1），我们将开发一个临床风险模型，以估计同一个人≥75Yeaars的同一时期。除了风险外，使用Anovel设置的模型candidididididididididididors在先前的风险模型中没有预测，包括基线认知，功能状态和移动性。为了确定与保存的密集型疗法的≥75例，从系统血液中差的Yeaars（SPRINT）中的模型。我们将开发基于ANN的健康记录，以供广泛的典型宣传，并在临床护理中使用。成为一名专注于老年人照顾的独立临床医生的奖项和其他独立资金目标。

项目成果

期刊论文数量（8）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Obesity and Undernutrition in Acute Myocardial Infarction.

急性心肌梗死中的肥胖和营养不良。

DOI：
10.1016/j.amjcard.2023.07.111
发表时间：
2023
期刊：
The American journal of cardiology
影响因子：
0
作者：
Mangalesh,Sridhar;Nanna,MichaelG
通讯作者：
Nanna,MichaelG

An age-old dilemma: Defining the optimal revascularization approach in older adults.

DOI：
10.1111/jgs.17831
发表时间：
2022-08
期刊：
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
影响因子：
6.3
作者：
Hanna, Jonathan M.;Nanna, Michael G.
通讯作者：
Nanna, Michael G.

Readmission and In-Hospital Outcomes After Transcatheter Aortic Valve Replacement in Patients With Dementia.

痴呆症患者经导管主动脉瓣置换术后的再入院和院内结果。

DOI：
10.1016/j.carrev.2022.08.016
发表时间：
2023
期刊：
Cardiovascular revascularization medicine : including molecular interventions
影响因子：
0
作者：
Park,DaeYong;Sana,MuhammadKhawar;Shoura,Sami;Hammo,Hasan;Hu,Jiun-Ruey;Forrest,JohnK;Lowenstern,Angela;Cleman,Michael;Ahmad,Yousif;Nanna,MichaelG
通讯作者：
Nanna,MichaelG

Choice of antihypertensive agent in isolated systolic hypertension and isolated diastolic hypertension: A secondary analysis of the ALLHAT trial.

单纯性收缩期高血压和单纯性舒张期高血压的抗高血压药物选择：ALLHAT 试验的二次分析。