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.

项目摘要/摘要 心血管疾病限制每年数百万成年人的活动和生活质量 州数十亿美元，占65-74岁和60％的所有死亡人数的40％以上 对85岁及以上的人的死亡。1精确评估动脉粥样硬化心血管疾病（ASCVD） 有效的初级预防需要风险。 需要对SEP如何影响动脉粥样硬化风险的更多研究，尤其是在性别少数群体中。 美国心脏病学和美国心脏协会（ACC/AHA）的指南 现在，防止ASCVD统一包括使用风险评估心脏病和中风的风险 计算器（AHA/ACC合并队列方程（PCE））确定他汀类药物的适当性 抗高血压药物，预防疗法已知可大大减少燃烧 严重的心血管事件和心血管死亡。但是，关于表现的知之甚少 跨性别者的标准心血管危险因素。几十年来，研究人员一直 有兴趣更好地了解跨性别者的心血管风险 尤其是跨性别疗法。综述研究发现ASCVD增加了 跨性别者，特定跨性别妇女的发病率和死亡率，但这些评论也 得出结论，先前的研究质量低，样品很少，测量的数量有限。 ASCVD危险因素和太少的心血管事件，无法就心血管风险得出强大的结论。 这项补充研究：“区域电子健康中跨性别者的心血管风险 提出了记录注册表”，以回应“非OD-20-032：特殊兴趣通知：行政 性别和性别少数民族（SGM）人口的补充”。 我们先前的工作表明大型ASCVD事件中的邻居级别可变性很大 （心肌梗塞，中风或心血管死亡），与事件相关的低sep邻居 比率超过高层社区的三倍。此外，邻里Sep解释了四倍 ASCVD事件率的邻居级别变化量比ACCF/AHA所解释的量 队列方程风险模型。这项研究的重点是检查和分解心血管风险 以及在20年的区域电子健康中，跨性别成年人中的基本心血管危险因素 记录注册表。这项工作将（i）了解跨性别者的ASCVD风险和（ii） 支持主要预防不良心血管事件的临床决策。 这项补充申请提案，以在基于跨学科的团队中进行分析 基于电子健康数据的新建立的尖端区域研究注册表中的环境 来自俄亥俄州东北部的两个最大的卫生系统，分别是克利夫兰诊所和MetroHealth。