Cerebrovascular Disease and its Consequences in the Strong Study Cohort

强研究队列中的脑血管疾病及其后果

• 批准号: 7915643
• 负责人: DEDRA S BUCHWALD
• 金额: $ 170.22万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-15 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7915643
• 关键词: Acculturation; Address; Adult; African American; Age; Age-Years; Aging; Alcohol consumption; American; American Indian and Alaska Native; American Indians; Arizona; Atherosclerosis; Atrial Fibrillation; Benign; Blood Pressure; Blood Vessels; Brain; Brain Diseases; Brain imaging; Brain scan; Cardiac; Cardiovascular Diseases; Cardiovascular system; Centers for Disease Control and Prevention (U.S.); Cerebrovascular Disorders; Cessation of life; Clinical; Clinical assessments; Cognition; Cognitive; Cohort Studies; Communities; Data; Dementia; Diabetes Mellitus; Disabled Persons; Disease; Dyslipidemias; Echocardiography; Elderly; Employee Strikes; Epidemic; Ethnic group; Exercise; Expenditure; Follow-Up Studies; Future; Gender; General Population; Glucose; Health; Health care facility; Healthcare; Heart; Heart Atrium; Hemorrhage; High Prevalence; Hippocampus (Brain); Hypertension; Image; Image Analysis; Impaired cognition; Incidence; Infarction; Inflammatory; Intervention; Ischemic Stroke; Knowledge; Laboratories; Left; Lesion; Life Expectancy; Life Style; Link; Location; Magnetic Resonance Imaging; Measurement; Measures; Medical Records; Mental Depression; Metabolic syndrome; Morality; Morbidity - disease rate; Motor; Myocardial Infarction; Myocardial Ischemia; National Heart, Lung, and Blood Institute; Neuropsychological Tests; Obesity; Oklahoma; Overweight; Participant; Patient Self-Report; Patients; Performance; Peripheral Vascular Diseases; Persons; Physical Examination; Population; Positioning Attribute; Prevalence; Prevention; Prospective Studies; Public Health; Race; Randomized Controlled Trials; Recording of previous events; Risk; Risk Factors; Sampling; Screening procedure; Severities; Sex Distribution; Signs and Symptoms; Smoking; Societies; South Dakota; Stroke; Testing; Time; Transient Ischemic Attack; Tribes; Ultrasonography; Videotape; Weight; Woman; World Health Organization; base; blood lipid; blood pressure regulation; caucasian American; cerebral atrophy; cognitive function; cohort; cost; depressive symptoms; disability; disability leave; disorder risk; experience; indexing; life time cost; member; men; mortality; motor deficit; motor impairment; novel; population based; pre-clinical; public health relevance; racial and ethnic; research clinical testing; sex; white matter

DESCRIPTION (provided by applicant): Cerebrovascular disease (CBVD), a leading cause of morbidity and mortality, is linked to cognitive and motor impairment, and depression. Magnetic resonance imaging (MRI) has redefined CBVD in large cohort studies, such as the Cardiovascular Health Study (CHS) and Atherosclerosis Risk in Communities (ARIC). In CHS and ARIC, MRI revealed high prevalences of brain abnormalities, specifically white matter hyperintensities, infarcts, and hemorrhages, in populations without known stroke or transient ischemic attack. Further, overt CBVD, such as stroke, was strikingly less common than covert MRI-defined brain disease. The covert findings were not, however, benign accompaniments of aging as they were associated with impaired motor function and cognition, depression, and a striking increase in the risk of subsequent stroke and death. These studies have convincingly demonstrated that clinically-defined CBVD dramatically underestimates the true population burden of CBVD. Much of what we know about cardiovascular disease in American Indians (AIs) comes from the Strong Heart Study (SHS), a prospective study of 4,549 older adults from 13 tribes followed over 18 years. It conducted physical exams, laboratory and cardiac studies, and chart reviews to describe risk factors, prevalence, and incidence of cardiovascular disease morbidity and mortality. Recent analyses estimated the age- and gender- adjusted stroke incidence in the SHS as 679/100,000 persons, adjusted to the age and sex distribution of the U.S. adult population. This incidence is over twice that observed in the general population indicating AIs are experiencing an epidemic of CBVD. AIs, however, were not included in CHS or ARIC or the other community- based studies of CBVD, and the SHS did not perform MRIs. We will complete a clinical and MRI evaluation to re- assess risk and protective factors and describe MRI-defined CBVD in the SHS. With these data from surviving cohort members, we will address our Specific Aims which are to: 1) estimate the prevalence and quantify the extent of CBVD defined by brain MRI findings, specifically white matter hyperintensities, infarcts, hemorrhages, and cerebral atrophy; 2) assess the relationship of risk factors with prevalent MRI-defined CBVD such as demographic, lifestyle, clinical, laboratory, echocardiographic, and ultrasound measures, and the unique influence of acculturation and degree of Indian heritage; and 3) document the strength of associations of MRI- defined CBVD with motor deficits, cognitive impairment, and depressive symptoms, and establish if they are independent of demographic, lifestyle, and laboratory measures. The elevated stroke rates suggest that AIs may be suffering from a large burden of covert CBVD. As an AI sample in which CVD has been rigorously assessed, the SHS cohort is ideal for investigating CBVD and its manifestations. Of the original cohort of 4,549 members, only ~1,950 members will be alive and able to participate; 283 have died since the last submission. Other opportunities to gain knowledge on CBVD among AIs are not forthcoming. There is an urgent need to initiate this study now since as every year passes, fewer members of the original cohort survive. PUBLIC HEALTH RELEVANCE: Cerebrovascular Disease and its Consequences in the Strong Heart Study Cohort The American Indian population is one of the fastest growing segments of our society. Recent information has shown that American Indians have strokes at least 2-3 times more often as White Americans. The damage created by strokes, and other cerebrovascular diseases, can be seen on an MRI (or brain) scan. MRIs also reveal many "silent" strokes that are never apparent to the person or their doctor. This study will examine American Indians for damage to the brain caused by both apparent and "silent" strokes. The American Indian population is experiencing an epidemic of cerebrovascular disease, which given the cost and disability caused by strokes, promises to be a staggering public health issues in the years to come.

描述（由申请人提供）：脑血管疾病（CBVD）是发病和死亡的主要原因，与认知和运动障碍以及抑郁症有关。磁共振成像 (MRI) 在心血管健康研究 (CHS) 和社区动脉粥样硬化风险 (ARIC) 等大型队列研究中重新定义了 CBVD。在 CHS 和 ARIC 中，MRI 显示在没有已知中风或短暂性脑缺血发作的人群中，大脑异常的患病率很高，特别是白质高信号、梗死和出血。此外，明显的 CBVD（例如中风）比隐性 MRI 定义的脑部疾病要少见得多。然而，这些秘密发现并不是衰老的良性伴随物，因为它们与运动功能和认知受损、抑郁以及随后中风和死亡风险显着增加有关。这些研究令人信服地证明，临床定义的 CBVD 大大低估了 CBVD 的真实人群负担。我们对美洲印第安人 (AI) 心血管疾病的了解大部分来自强心研究 (SHS)，这是一项对来自 13 个部落的 4,549 名老年人进行了超过 18 年跟踪的前瞻性研究。它进行了体检、实验室和心脏研究以及图表审查，以描述心血管疾病发病率和死亡率的危险因素、患病率和发生率。最近的分析估计，根据美国成年人口的年龄和性别分布进行调整后，SHS 中经年龄和性别调整的中风发病率为 679/100,000 人。这一发病率是普通人群中观察到的发病率的两倍多，表明人工智能正在经历 CBVD 的流行。然而，AI 并未包含在 CHS 或 ARIC 或其他基于社区的 CBVD 研究中，并且 SHS 也没有进行 MRI。我们将完成临床和 MRI 评估，以重新评估风险和保护因素，并在 SHS 中描述 MRI 定义的 CBVD。利用幸存队列成员的这些数据，我们将实现我们的具体目标，即：1）估计脑部 MRI 结果定义的 CBVD 患病率并量化其程度，特别是白质高信号、梗塞、出血和脑萎缩； 2) 评估风险因素与流行的 MRI 定义的 CBVD 的关系，如人口、生活方式、临床、实验室、超声心动图和超声测量，以及文化适应和印度传统程度的独特影响； 3) 记录 MRI 定义的 CBVD 与运动缺陷、认知障碍和抑郁症状之间的关联强度，并确定它们是否独立于人口统计学、生活方式和实验室测量。中风率升高表明人工智能可能承受着巨大的隐性 CBVD 负担。作为经过严格评估 CVD 的 AI 样本，SHS 队列非常适合研究 CBVD 及其表现。在最初的 4,549 名成员中，只有约 1,950 名成员还活着并且能够参加；自上次提交以来已有 283 人死亡。人工智能中尚未有其他获得 CBD 知识的机会。现在迫切需要启动这项研究，因为随着时间的推移，原始队列中存活下来的成员越来越少。公共卫生相关性：强心脏研究队列中的脑血管疾病及其后果 美洲印第安人人口是我们社会中增长最快的群体之一。最近的信息显示，美国印第安人中风的几率至少是美国白人的 2-3 倍。中风和其他脑血管疾病造成的损害可以通过 MRI（或大脑）扫描看到。核磁共振成像还可以揭示许多“无声”的中风，这些中风对于患者或他们的医生来说是不明显的。这项研究将检查美洲印第安人因明显中风和“无症状”中风造成的大脑损伤。美洲印第安人正在经历脑血管疾病的流行，考虑到中风造成的成本和残疾，这种疾病有望在未来几年成为一个令人震惊的公共卫生问题。