Cardiovascular Risk among Transgender Persons in a Regional Electronic Health Record Registry

区域电子健康记录登记中跨性别者的心血管风险

• 批准号: 10092599
• 负责人: JARROD DALTON
• 金额: $ 9.89万
• 依托单位: CLEVELAND CLINIC LERNER COM-CWRU
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-15 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10092599
• 关键词: Accounting; Administrative Supplement; Adult; Affect; Age; American; American Heart Association; Antihypertensive Agents; Assessment tool; Atherosclerosis; Cardiology; Cardiovascular Diseases; Cardiovascular Models; Cardiovascular system; Caring; Cessation of life; Clinic; Clinical; Communities; Community Developments; Data; Decision Making; Dimensions; Discipline of Nursing; Economics; Effectiveness; Electronic Health Record; Endocrinology; Environment; Equation; Event; Foundations; Gonadal Steroid Hormones; Guidelines; Health Sciences; Health system; Healthcare Systems; Heterogeneity; Hormone use; Immunology; Internal Medicine; Lead; Measures; Methods; Modeling; Morbidity - disease rate; Myocardial Infarction; Nature; Neighborhoods; Ohio; Outcome; Patients; Performance; Persons; Pharmaceutical Preparations; Population; Prevention; Preventive therapy; Primary Health Care; Primary Prevention; Psychiatry; Quality of life; Registries; Research; Research Personnel; Risk; Risk Assessment; Risk Factors; Sampling; Science; Sexual and Gender Minorities; Social Work; Socioeconomic Status; Stroke; Subgroup; System; Time; United States; Variant; Work; atherosclerosis risk; base; cardiovascular disorder prevention; cardiovascular disorder risk; cardiovascular risk factor; clinical decision support; clinical decision-making; cohort; college; contextual factors; cost; ethnic minority population; gender minority; health data; heart disease risk; hormone therapy; human very old age (85+); improved; insight; interest; low socioeconomic status; mortality; population health; predictive modeling; prevention service; racial minority; response; spatial epidemiology; tool; transgender; transgender women; translational scientist; urban poverty

PROJECT SUMMARY/ABSTRACT Cardiovascular disease limits the activity and quality of life of millions of adults every year, costing the United States billions of dollars, and accounting for more than 40% of all deaths among those 65-74 and 60% of all deaths for those aged 85 and older.1 Accurate assessment of atherosclerotic cardiovascular disease (ASCVD) risk is needed for effective primary prevention. More research on how SEP affects atherosclerotic risk is needed, particularly among gender minorities. Guidelines from the American College of Cardiology and American Heart Association (ACC/AHA) for prevention of ASCVD now uniformly include the assessment of risk of heart attack and stroke using risk calculators (the AHA/ACC Pooled Cohort Equations (PCE)) to determine the appropriateness of statin and anti-hypertensive medications, preventive therapies which are known to substantially reduce the burden of serious cardiovascular events and cardiovascular death. However, too little is known about the performance of standard cardiovascular risk factors in transgender persons. For several decades, researchers have been interested in better understanding cardiovascular risk among transgender persons, and among those receiving cross-sex hormone therapy in particular. Review studies have found some indication of increased ASCVD morbidity and mortality among transgender persons, particular transgender women, but these reviews also concluded that prior studies were of low quality, had small samples, a constrained number of measured ASCVD risk factors and too few cardiovascular events to enable robust conclusions about cardiovascular risk. This supplemental study, “Cardiovascular Risk among Transgender Persons in a Regional Electronic Health Record Registry” is proposed in response to “NOT-OD-20-032: Notice of Special Interest: Administrative Supplements for Research on Sexual and Gender Minority (SGM) Populations”. Our prior work indicates a significant degree of neighborhood-level variability in major ASCVD events (myocardial infarction, stroke or cardiovascular death), with low-SEP neighborhoods associated with event rates over three times that of high-SEP neighborhoods. Moreover, neighborhood SEP explained four times the amount of neighborhood-level variation in ASCVD event rates than that explained by the ACCF/AHA Pooled Cohort Equations Risk Model. The focus of this study is on examining and decomposing cardiovascular risk and underlying cardiovascular risk factors among transgender adults in a 20-year regional electronic health record registry. This work will provide (i) an understanding of ASCVD risk in transgender persons and (ii) support for clinical decision making for primary prevention of adverse cardiovascular events. This supplemental applications proposes to conduct our analysis in a transdisciplinary team-based environment, in a newly-established, cutting-edge regional research registry, based on electronic health data from Northeast Ohio’s two largest health systems, Cleveland Clinic and MetroHealth.

项目概要/摘要 心血管疾病每年限制数百万成年人的活动和生活质量，给美国造成巨大损失 国家数十亿美元，占 65-74 岁死亡人数的 40% 以上，占所有死亡人数的 60% 85 岁及以上老年人的死亡情况。1 动脉粥样硬化性心血管疾病 (ASCVD) 的准确评估 有效的一级预防需要风险。 需要更多关于 SEP 如何影响动脉粥样硬化风险的研究，特别是在性别少数群体中。 美国心脏病学会和美国心脏协会 (ACC/AHA) 的指南 ASCVD 的预防现在统一包括使用风险评估心脏病发作和中风的风险 计算器（AHA/ACC 队列方程 (PCE)）来确定他汀类药物和药物的适当性 已知可显着减轻血压负担的抗高血压药物、预防性疗法 然而，人们对严重心血管事件和心血管死亡的表现知之甚少。 几十年来，研究人员一直在研究跨性别者的标准心血管危险因素。 有兴趣更好地了解跨性别者和接受治疗的人的心血管风险 特别是跨性别激素疗法的回顾研究发现了一些增加 ASCVD 的迹象。 跨性别者，特别是跨性别女性的发病率和死亡率，但这些审查也 得出的结论是，先前的研究质量低、样本小、测量的数量有限 ASCVD 危险因素和心血管事件太少，无法得出关于心血管风险的可靠结论。 这项补充研究“区域电子健康中跨性别者的心血管风险” 记录登记处”是为了回应“NOT-OD-20-032：特别关注通知：行政 性和性别少数群体（SGM）研究补充”。 我们之前的工作表明，主要 ASCVD 事件存在显着的邻里层面变异性 （心肌梗塞、中风或心血管死亡），具有与事件相关的低 SEP 社区 其比率是高 SEP 社区的三倍以上，而且，社区 SEP 的解释是高 SEP 社区的四倍。 ASCVD 事件发生率的邻里水平变化量比 ACCF/AHA 汇总解释的变化量 队列方程风险模型本研究的重点是检查和分解心血管风险。 20 年区域电子健康调查中跨性别成年人的潜在心血管危险因素 这项工作将提供 (i) 对跨性别者 ASCVD 风险的了解，以及 (ii) 支持不良心血管事件一级预防的临床决策。 该补充申请建议以跨学科团队为基础进行分析 环境，在一个新建立的、基于电子健康数据的尖端区域研究登记册中 来自俄亥俄州东北部两个最大的卫生系统克利夫兰诊所和 MetroHealth。