Evaluation of Racial Differences in Cardiorespiratory Fitness Decline with Aging & Underlying Biological Mechanisms

心肺健康随年龄下降的种族差异评估

• 批准号: 10027042
• 负责人: Ambarish Pandey
• 金额: $ 16.35万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10027042
• 关键词: Adipose tissue; Adult; African American; Age; Age Factors; Age-Years; Aging; Attenuated; Biological; Blood Pressure; Body Composition; Cardiac; Cardiac Output; Cardiovascular system; Communities; Conflict (Psychology); Cross-Sectional Studies; Data; Development; Diabetes Mellitus; Disease; EFRAC; Echocardiography; Elderly; Ethics; Evaluation; Exercise; Exercise Test; Future; Goals; Health Care Costs; Heart; Heart Rate; Heart failure; High Prevalence; Hypertension; Impaired cognition; Impairment; Individual; Intervention; Left Ventricular Hypertrophy; Low Prevalence; Magnetic Resonance Imaging; Measures; Mentors; Morbidity - disease rate; Muscle; Myocardial; Myocardial Infarction; Myocardial perfusion; Nested Case-Control Study; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Oxygen; Participant; Pathway interactions; Performance; Peripheral; Phenotype; Prevalence; Prevention approach; Race; Reporting; Reproducibility; Research Design; Research Personnel; Risk; Risk Factors; Series; Sex Factors; Skeletal Muscle; Stress; Stress Tests; Stroke Volume; Structure; Testing; Time; Training Programs; Visit; Work; age related; base; cardiorespiratory fitness; chronotropic; cohort; cost; design; epidemiology study; ethnic difference; exercise training; fitness; fitness test; follow-up; functional status; hemodynamics; high risk; improved; insight; middle age; mortality; muscle form; myocardial injury; novel; novel strategies; phase 2 study; phase 3 study; preservation; prevent; racial and ethnic; racial difference; racial disparity; sex; sex risk; uptake

Project Abstract: Heart failure (HF) with preserved ejection fraction (HFpEF) is common in older adults and increasing in prevalence. Furthermore, there are substantial racial disparities in the burden of HF, including HFpEF, such that African American (AA) have much higher prevalence of HF than other races. In a series of epidemiological studies, we have demonstrated that low cardiorespiratory fitness (CRF), measured as peak oxygen uptake (peak VO2) on a maximal stress test, is a strong independent predictor of higher risk of HF, particularly HFpEF, in older adults. Furthermore, CRF levels among AA are consistently lower as compared with other races. Taken together, low CRF and accelerated age-related decline in CRF may be key contributors to the racial differences in the burden of HF. A better understanding of the mechanisms underlying the racial disparities in prevalence of low CRF and age-related CRF decline is key to developing novel, effective approaches to prevention of HF in older AA adults. Accordingly, in this study, we aim to evaluate the racial differences in age-related decline in CRF and their underlying biological mechanisms. To this end, we will perform a nested case-control study within the Dallas Heart Study (DHS), a multi-ethnic cohort of community- dwelling individuals, including older AA and white adults matched for age, sex, and risk factors (BMI, systolic blood pressure, diabetes status) who underwent CRF testing in middle-age (mean age 50-55) as part of the DHS phase 2 visit (2007-09) and are participating in the DHS phase 3 10-years later (2019-2022). Participants will undergo repeat CRF assessment and comprehensive state-of-the-art phenotyping to comprehensively evaluate the potential mechanisms of racial differences in CRF, including the following: stroke volume reserve by echocardiogram, heart rate reserve, myocardial perfusion, myocardial energetics by cardiac MRI, skeletal muscle energetics assessment by 7T MRI, and regional adipose tissue by whole body MRI. Peak VO2 combined with its central and peripheral determinants will be compared among matched AA and white participants in the DHS phase 3. Successful completion of these two aims will quantify the CRF decline in AA versus white older individuals for the first time and elucidate specific mechanisms, thereby, providing critical insight into the underlying pathophysiologic mechanisms of low CRF.

项目摘要： 射血分数保留 (HFpEF) 的心力衰竭 (HF) 在老年人中很常见，并且这种情况有所增加 流行率。此外，心力衰竭（包括 HFpEF）的负担存在显着的种族差异，例如 非裔美国人 (AA) 的心衰患病率比其他种族高得多。在一系列的流行病学调查中 研究表明，心肺健康 (CRF) 较低（以峰值摄氧量衡量） 最大压力测试中的（峰值摄氧量）是心力衰竭风险较高的强有力的独立预测因子，特别是 HFpEF，发生于老年人。此外，与其他群体相比，AA 中的 CRF 水平始终较低 比赛。总而言之，低 CRF 和与年龄相关的 CRF 加速下降可能是导致 CRF 下降的关键因素。 心力衰竭负担的种族差异。更好地理解种族歧视背后的机制 低 CRF 和与年龄相关的 CRF 下降的患病率差异是开发新的、有效的关键 预防老年 AA 成人心力衰竭的方法。因此，在本研究中，我们旨在评估种族 与年龄相关的 CRF 下降的差异及其潜在的生物学机制。为此，我们将 在达拉斯心脏研究 (DHS) 中进行巢式病例对照研究，该研究是一个多种族社区队列 居住个体，包括年龄、性别和风险因素（BMI、收缩压）相匹配的老年 AA 和白人成年人 作为研究的一部分，在中年（平均年龄 50-55 岁）接受 CRF 测试的人 国土安全部第 2 阶段访问（2007-09），并在 10 年后（2019-2022）参加国土安全部第 3 阶段。参加者 将接受重复的 CRF 评估和全面的最先进的表型分析，以全面 评估 CRF 种族差异的潜在机制，包括以下内容： 每搏输出量储备 通过超声心动图、心率储备、心肌灌注、通过心脏 MRI 进行的心肌能量学、骨骼 通过 7T MRI 评估肌肉能量，通过全身 MRI 评估区域脂肪组织。峰值摄氧量 结合其中央和外围决定因素，将在匹配的 AA 和白色之间进行比较 DHS 第 3 阶段的参与者。成功完成这两个目标将量化 AA 中 CRF 的下降 首次与白人老年人进行比较并阐明具体机制，从而提供关键的 深入了解低 CRF 的潜在病理生理机制。