Profiling Cardiovascular Events and Biomarkers in the Very Old to Improve Personalized Approaches for the Prevention of Cardiac and Vascular Disease

分析老年人的心血管事件和生物标志物，以改进预防心脏和血管疾病的个性化方法

• 批准号: 9277554
• 负责人: CHRISTIE Mitchell BALLANTYNE
• 金额: $ 79.42万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-01 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9277554
• 关键词: Address; Adult; Adverse effects; Age; Aging; Algorithms; American; Atherosclerosis; Atherosclerosis Risk in Communities; Benefits and Risks; Biological Markers; Blood Pressure; Brain natriuretic peptide; Cardiac; Cardiology; Cardiovascular Diseases; Cardiovascular system; Cholesterol; Clinical; Clinical Management; Clinical Trials; Cognitive aging; Coronary heart disease; Data; Decision Making; Dementia; Development; Disease; EFRAC; Elderly; Equation; Event; Fibrosis; Galectin 3; Guidelines; Heart failure; High Prevalence; Hospitalization; Impaired cognition; Incidence; Individual; Inflammation; Injury; Intervention Trial; Knowledge; Lead; Left Ventricular Ejection Fraction; Life Style; Lipids; Measurement; Measures; Medical; Medicare; Myocardial Infarction; N-terminal; Older Population; Organ; Participant; Patients; Performance; Physicians; Population; Prevention; Prevention trial; Preventive; Primary Prevention; Process; Provider; Public Health; Recommendation; Risk; Risk Assessment; Risk Factors; Risk Reduction; Stress; Stroke; Troponin I; Troponin T; Tumorigenicity; Vascular Diseases; Visit; Work; aged; base; cardiovascular disorder prevention; cardiovascular disorder risk; circulating biomarkers; cohort; high risk; high risk population; improved; inflammatory marker; middle age; mortality; novel marker; outcome forecast; patient population; personalized approach; population based; tool

Although older individuals have the highest absolute risk for cardiovascular disease (CVD) events, U.S. cholesterol and blood pressure guidelines recommend lower-intensity, less-aggressive treatment in this high- risk population based on limited clinical trial data and potential for more side effects. The current risk prediction equation does not include individuals aged >79 years, nor does it include heart failure (HF), a more common CVD event in older individuals than myocardial infarction or stroke. Recent trials have demonstrated greater absolute CVD risk reduction in older high-risk participants, underscoring the need for improved risk assessment to inform treatment decisions and patient–physician discussions regarding therapy. Cardiac biomarkers have been shown to identify higher-risk individuals and to improve HF risk prediction beyond traditional risk factors in middle-aged adults in the Atherosclerosis Risk in Communities (ARIC) Study. In the proposed work, we will develop risk prediction tools for atherosclerotic CVD and HF tailored for very old adults, including cardiac biomarker measurements, to provide more comprehensive CVD risk assessment and to allow more precise assessment of potential benefits and risks of therapy as well as midlife lifestyle, demographic, and clinical factors that lead to healthy cardiovascular aging. In addition to data on traditional risk factors and CVD events from ARIC, we propose to measure biomarkers of cardiac injury, stress, fibrosis, and inflammation in all ARIC participants who attended the most recent visit (visit 5: 2011–2013; most aged ≥70 years) and the upcoming visits (visit 6: n=4,214, 2016–2017, most aged ≥75 years; visit 7: n=3,827, 2018–2019) to address our aims: 1: To assess the performance of the Pooled Cohort Equation risk calculator for atherosclerotic CVD in very old adults and to develop an improved risk calculator using the best circulating biomarkers and risk factor panel; 2: To quantify and compare risk of HF versus atherosclerotic CVD, develop risk prediction tools for incident HF in very old adults and a comprehensive tool for HF, myocardial infarction, and stroke for primary prevention; 3: To identify major midlife factors leading to “healthy cardiovascular aging,” defined as the absence of clinical CVD events and elevated cardiac biomarkers.

尽管老年人对心血管疾病（CVD）事件的绝对风险最高，但美国 胆固醇和血压指南建议在这种高强度，侵略性较低的治疗中 基于有限的临床试验数据和更多副作用的潜力的风险人群。当前的风险预测 等式不包括年龄> 79岁的个人，也不包括心力衰竭（HF），这是更常见的 与心肌梗塞或中风相比，年长的个体中的CVD事件。最近的试验表明更大 年龄较大的高风险参与者的绝对CVD风险降低，强调了改善风险的需求 评估以告知治疗决策和有关治疗的患者 - 医生讨论。心脏 已经证明生物标志物可以识别高风险的个体并改善HF风险预测 在社区（ARIC）研究中，中年成年人的传统危险因素。在 拟议的工作，我们将为动脉粥样硬化CVD和HF开发风险预测工具，适合非常老的成年人， 包括心脏生物标志物测量，提供更全面的CVD风险评估并允许 更精确评估潜在的益处和治疗风险以及中年生活方式，人群， 以及导致健康心血管衰老的临床因素。除了有关传统风险因素的数据和 CVD事件来自ARIC，我们建议测量心脏损伤，应激，纤维化和炎症的生物标志物 在所有参加最近访问的ARIC参与者中（访问5：2011–2013；年龄≥70岁）和 即将到来的访问（访问6：n = 4,214，2016–2017，最年龄≥75岁；访问7：n = 3,827，2018-2019） 我们的目标：1：评估动脉粥样硬化CVD的合并队列方程式风险计算器的性能 在非常老的成年人中，使用最佳循环生物标志物和风险开发改善的风险计算器 因子面板； 2：要量化和比较HF与动脉粥样硬化CVD的风险，请开发风险预测工具 对于非常老的成年人的事件HF，以及用于HF，心肌梗塞和中风的全面工具 预防; 3：确定导致“健康心血管老化”的主要中年因素，定义为 缺乏临床CVD事件和心脏生物标志物升高。