Precursors of Stroke Incidence and Prognosis

中风发生率和预后的前兆

• 批准号: 7864159
• 负责人: PHILIP A WOLF
• 金额: $ 82.44万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 1981
• 资助国家: 美国
• 起止时间: 1981-12-01 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7864159
• 关键词: Adult; Ankle; Aorta; Atherosclerosis; Biological Markers; Blood Vessels; Brain; Brain Injuries; Calcium; Cardiac; Cardiovascular system; Carotid Stenosis; Cause of Death; Cerebrum; Cessation of life; Clinical; Cognition; Cognitive; Collaborations; Communities; Computer Simulation; Coronary; Data; Disease; Documentation; Echocardiography; Elderly; Epidemiologic Studies; Event; Exposure to; Family; Framingham Heart Study; Functional disorder; Funding; Funding Agency; Gene Expression; Generations; Genes; Genetic; Genetic Variation; Goals; Health; Heart; Hemostatic function; Heritability; Hospitals; Image; Impaired cognition; Incidence; Incidence Study; Individual; Infarction; Inflammation; Injury; Institutionalization; Investigation; Lipids; Lobar; Magnetic Resonance Imaging; Measures; Medial; Meta-Analysis; Modeling; Moods; Neurologic; Obesity; Outcome; Participant; Pathway interactions; Pattern; Persons; Physical Function; Physical activity; Predisposition; Prevalence; Preventive; Proteomics; Public Health; Recurrence; Reporting; Resources; Risk; Risk Factors; Sampling; Scanning; Social Network; Source; Stroke; Stroke prevention; Structure; Techniques; Thick; Thrombosis; Time; Transient Ischemic Attack; Ultrasonography; United States; United States National Institutes of Health; Update; Variant; Vascular Diseases; Ventricular; Work; X-Ray Computed Tomography; adipokines; adjudicate; adverse outcome; aging population; arterial stiffness; base; brachial artery; cohort; disability; endophenotype; gene discovery; genome wide association study; glucose metabolism; high risk; improved; indexing; innovation; insight; lifestyle factors; lifetime risk; metabolomics; mortality; nervous system disorder; novel; offspring; outcome forecast; prospective; public health relevance; trend; white matter

DESCRIPTION (provided by applicant): Stroke is the 3rd leading cause of death in the United States and is the major disabling neurological disease of adults, particularly the elderly. Risk factors predisposing to stroke have been identified through prospective epidemiologic studies including the Framingham Heart Study. Control of stroke risk factors has guided preventive efforts and has led to significant reduction in death and disability from stroke; however, much work remains to be done. Since 1981, the Precursors of Stroke Incidence and Prognosis study has enabled us to identify risk factors for stroke, report on secular trends, lifetime risk and manifestations of stroke and of specific stroke subtypes using consistent clinical and imaging criteria. Twelve hundred nineteen completed strokes have been documented to date. We plan to maintain surveillance and identify incident and recurrent strokes in this 3 generation community- based epidemiologic study and to personally evaluate subjects at the time of stroke in the local hospital, and at 3, 6, 12 and 24 months. We will systematically assess neurological, imaging (MRI & MRAs), functional, cognitive and mood outcomes in these subjects and provide estimates of lifetime risk, secular trends in stroke risk factors, incidence and recurrence, case fatality, disability, and institutionalization. In this renewal we propose to utilize an extensive panel of biomarkers, measured prior to stroke and to relate genoptypic data from a 550K Genome Wide Association study to stroke incidence and outcomes. These exciting and innovative additions are available as a result of funding from other NIH sources to the Framingham Heart Study and hold promise to add new insights to the identification of stroke susceptibility. In addition, a wealth of previously collected subclinical vascular disease measures are available including: echocardiography, carotid ultrasound, MRI and CT scans of the heart and aorta; vascular function studies - arterial stiffness, ankle-brachial index and brachial artery reactivity; and baseline and repeated quantitative brain MR scans, including silent strokes on >2,400 Offspring subjects. These indicators of subclinical cardiac and vascular disease may greatly enhance our ability to identify susceptible stroke-prone individuals. It is anticipated that adding this wide array of biomarker, GWA and subclinical disease data to conventional and newer risk factor measures will facilitate better stroke prediction by an improved Stroke Risk Profile. PUBLIC HEALTH RELEVANCE: The public health burden of stroke is substantial in our aging population. The goal of this renewal application is to continue to prospectively identify health and genetic factors that contribute to placing a person at high risk of stroke. Understanding these interactions will advance our ability to formulate strategies to prevent stroke and minimize disability resulting from stroke.

描述（由申请人提供）：中风是美国第三大死亡原因，是成年人，尤其是老年人的主要致命神经系统疾病。通过前瞻性流行病学研究（包括弗雷明汉心脏研究），已经确定了中风的危险因素。中风危险因素的控制引导了预防措施，并导致中风的死亡和残疾大大减少；但是，还有很多工作要做。自1981年以来，中风发生率和预后研究的前体使我们能够使用一致的临床和成像标准来确定中风的风险因素，报告世俗趋势，终生风险和中风的表现以及特定的中风子类型。迄今为止，已经记录了十二百九十十九的中风。我们计划维持监视，并在这项基于社区的三代流行病学研究中确定事件和复发性中风，并在当地医院中风时亲自评估受试者，并在3、6、12和24个月内进行评估。我们将系统地评估这些受试者中神经系统，成像（MRI和MRA），功能，认知和情绪结果，并提供终生风险，中风风险因素的世俗趋势，发病率和复发，病例死亡，残疾和制度化的估计。在此续约中，我们建议利用一系列的生物标志物，在中风之前测量，并将基因型数据从550K基因组宽的关联研究中与中风发生率和结果相关联。这些令人兴奋和创新的补充是由于其他NIH来源到Framingham Heart研究的资金而获得的，并有望为识别中风易感性的识别增添新的见解。此外，还有大量先前收集的亚临床血管疾病措施，包括：超声心动图，颈动脉超声，MRI和CT心脏和主动脉的CT扫描；血管功能研究 - 动脉刚度，脚踝 - 桥梁指数和臂动脉反应性；基线和重复的定量脑MR扫描，包括对2400个后代受试者的无声中风。这些亚临床心脏和血管疾病的指标可能会大大增强我们识别易感中风的个体的能力。可以预计，将这种广泛的生物标志物，GWA和亚临床疾病数据添加到常规和较新的风险因素度量中，将通过改善的中风风险概况促进更好的中风预测。公共卫生相关性：中风的公共卫生负担在我们老龄化的人口中很大。这种更新应用的目标是继续确定有助于使某人处于高风险的健康和遗传因素。了解这些相互作用将提高我们制定策略以防止中风并最大程度地减少中风导致的残疾的能力。