Identifying Epidemiological Risk Factors for Abdominal Aortic Aneurysm

确定腹主动脉瘤的流行病学危险因素

• 批准号: 8438504
• 负责人: Weihong Tang
• 金额: $ 68.69万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-04-01 至 2015-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8438504
• 关键词: Abdomen; Abdominal Aortic Aneurysm; Address; Adult; Affect; African American; Atherosclerosis; Biological; Biological Markers; Blood specimen; Cardiac; Categories; Cause of Death; Cessation of life; Clinical; Cohort Studies; Communities; Complex; Cross-Sectional Studies; Data; Disease; Elderly; Epidemiologic Studies; Epidemiology; Etiology; Extracellular Matrix; Extracellular Matrix Degradation; General Population; Hospital Records; Individual; Inflammation; Life; Measures; Medicare; Operative Surgical Procedures; Participant; Plasma; Prevalence; Prevention; Prospective Studies; Protocols documentation; Public Health; Risk; Risk Factors; Role; Rupture; Ruptured Abdominal Aortic Aneurysm; Sampling; Testing; Thrombosis; Time; Ultrasonography; Woman; abdominal aorta; base; cardiovascular risk factor; clinical Diagnosis; cohort; cost; cost effective; effective intervention; follow-up; human old age (65+); improved; insight; men; middle age; mortality; novel; population based; prevent; prospective; public health relevance; repaired

DESCRIPTION (provided by applicant): Abdominal aortic aneurysm (AAA) is a common disease in the elderly and an important public health problem. Ruptured AAA is associated with a 65% to 85% mortality rate and ranked one of the leading causes of death in the elderly. Elective surgery or endovascular repair for identified large AAA are the only effective interventions for AAA and there are no specific pharmacological agents that have been shown to be effective in preventing or reducing AAA progression in the general population. The etiology of AAA is complex and not well understood. Although traditional cardiovascular risk factors have been associated with the risk of AAA, their importance in the etiology of AAA is not well established. Furthermore, the novel etiopathogenic mechanisms such as extracellular matrix remodeling and degradation, inflammation, and thrombosis have been hypothesized but their roles are not appropriately determined. We propose to take advantage of the planned cardiac ultrasound exams in the Atherosclerosis Risk in Communities (ARIC) Study to perform an ultrasound examination of the abdominal aorta to identify undiagnosed AAA cases in this large population-based cohort. In addition, these will be pooled with 265 existing cases already identified through hospital records and those to be identified through Medicare linkage. Utilizing the risk factor and plasma samples already collected in ARIC at baseline, we will conduct epidemiological studies of AAA in this large prospective cohort that has been followed for more than 20 years. The specific aims of this application are: 1) to perform an ultrasound examination of the abdominal aorta in approximately 6,886 ARIC participants, 25% African-Americans, who will be 67-89 years and expected to attend the next ARIC exam in 2011-13. Based on a prevalence estimate of 6.1% asymptomatic AAA in men and 1.7% in women older than 65 years, we anticipate to identify 235 undiagnosed AAA cases in the ARIC cohort. With the previously diagnosed clinical cases during 1987-2011, we expect a total of 475 AAAs. 2) To investigate the associations of AAA with potential novel risk factors previously measured in ARIC or to be measured in stored blood samples collected at ARIC baseline in 1987- 89. Specifically, we will evaluate novel biomarkers in the following categories: (a) extracellular matrix remodeling; (b) extracellular matrix degradation; (c) inflammation; and (d) thrombosis. This study will be the first to comprehensively evaluate the role of novel risk factors in the etiology of AAA in a large, population- based cohort of middle-aged adults followed for more than 20 years. Conducting this study within ARIC takes advantage of ARIC's extensively characterized cohort, existing biological samples available at no cost to the current project, and provides a particularly rapid and cost-effective way to establish an AAA cohort as the abdominal ultrasound protocol is readily added to the cardiac ultrasound to be performed in the 2011-13 ARIC exam.

描述（由申请人提供）：腹部主动脉瘤（AAA）是老年人的常见疾病，也是一个重要的公共卫生问题。 AAA破裂的死亡率与65％至85％的死亡率有关，并将老年人的主要死亡原因之一排名。鉴定出大型AAA的选修手术或血管内修复是AAA的唯一有效干预措施，并且没有特定的药理学剂可有效预防或减少普通人群中的AAA进展。 AAA的病因很复杂，尚不清楚。尽管传统的心血管危险因素与AAA的风险有关，但它们在AAA病因中的重要性并没有很好地确定。此外，已经假设了新型的疗法机制，例如细胞外基质重塑和降解，炎症和血栓形成，但其作用尚未适当确定。我们建议在社区（ARIC）研究的动脉粥样硬化风险中利用计划的心脏超声检查，以对腹主动脉进行超声检查，以鉴定此大型基于人群的同类群体中未诊断的AAA病例。此外，这些将与已经通过医院记录确定的265例现有案件合并，并通过Medicare链接确定这些病例。利用基线ARIC中已经收集的危险因素和血浆样本，我们将在这个大型前瞻性队列中对AAA进行流行病学研究，该研究已有20多年了。本应用的具体目的是：1）在约6,886名ARIC参与者中对腹主动脉进行超声检查，25％的非裔美国人，他们将达到67 - 89年，并预计将在2011 - 13年参加下一次ARIC考试。基于男性无症状AAA的患病率估计值为65岁以上的女性1.7％，我们预计在ARIC队列中将确定235例未诊断的AAA病例。在1987 - 2011年期间先前诊断出的临床病例的情况下，我们预计总共有475个AAA。 2）研究AAA与先前在ARIC中测量的潜在新型风险因素的关联，或在1987年至89年在ARIC基线收集的存储的血液样本中测量。 （b）细胞外基质降解； （c）炎症； （d）血栓形成。这项研究将是第一个全面评估新型危险因素在AAA病因中的作用，在基于人群的大型中年成年人同类中，随后持续了20多年。在ARIC中进行这项研究利用了ARIC的广泛特征的队列，现有的生物样品无需用于当前项目，并提供了一种特别快速且具有成本效益的方式来建立AAA队列，因为腹部超声协议很容易添加到心脏超声中，可以在2011 - 13 ARIC ARIC考试中进行。