Development of New Point-of-Care Tools to Assess Cardiovascular Disease Risk for Women Within the Primary Healthcare Setting
Abstract
The proposed study addresses the FY21 PRMRP Topic Area of Women’s Heart Disease with a primary focus on an area of Identification of sex-specific approaches to either develop novel diagnostics and treatments or increase the effectiveness of current practice to improve clinical care of women. Representation of women in the U.S. military population has been rapidly growing and as of 2021, over 230,000 women serve as active duty in the military service. Concurrent with this trend of active-duty women military Service Members, the number of women Veteran population seeking care at Veterans Affairs (VA) health care has been growing rapidly. Heart disease is the leading cause of death for women population, and women in military are at higher risk in number of traditional cardiovascular risk factors than their civilian counterparts. Furthermore, women Veterans are at a significantly higher risk of stroke than civilians and male Veterans. However, there is a lack of adequate point-of-care tools to assist clinicians in decision-making of optimal cardiovascular care for women Veterans, particularly young and minority groups. The current widely used American Cardiology/American Heart Association (ACC/AHA) Atherosclerosis Cardiovascular Disease (ASCVD) risk score does not perform well in assessing ASCVD risk for women Veterans, and particularly is not adequate for young women under 40 or with Hispanic background. On the contrary, there is a new VA women CVD risk score available, which performs better than the current ACC/AHA ASCVD risk score when applied to women Veterans and is acceptable for young women and women with Hispanic background. Sex-specific conditions such as early menopause, preeclampsia, and certain types of birth control methods were found positively associated with increased risk of CVD event among women. However, these positive associations varied by race, age, and other comorbid complications. This makes the female population more heterogeneous in spectrum of CVD risk than males and presents an additional challenge in predicting CVD risk in women accurately with traditional CVD risk factors alone. The prognostic model including sex-specific nontraditional risk factors and biomarkers as independent factors is warranted. The current study proposes to address this challenge by employing a precision medicine approach and applying state-of-art statistical methods such as Latent Class Joint Model and Finite Mixture Model to the large, representative data sets including women’s health records and biomarkers. The goal of the study is to develop a next-generation female specific personalized cardiovascular risk score and cardiovascular point-of-care tools tailored for women Veterans of all ages and background by capitalizing on available large-scale, representative data sets. The data sets are Dallas Heart Study (DHS, phases I and II, 7-year follow-up), Department of Defense Veterans Affairs Infrastructure for Clinical Intelligence (DaVINCI) Direct care data at Military Health System Data Repository (MDR), VA, national Corporate Data Warehouse (CDW), and Million Veteran Program (MVP) data. This study’s findings will contribute to a better management and treatment of CVD for active-duty women military Service Members and Veterans at military and VA healthcare systems. Specific aims of the study are: Aim 1: Externally validate and recalibrate the VA women CVD risk score to non-VA women. The study will externally validate and recalibrate the VA women CVD risk score using data from non-VA women including women veterans seeking care outside of VA, as well as the general population. Aim 2: Develop and internally validate a new personalized women CVD risk score stratified by subtypes of non-CVD risk factors. The new personalized CVD risk score will be built on recalibrated VA women CVD risk scores (from Aim 1) stratified by subtype of non-traditional CVD factors including sex-specific conditions and
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 28, 2022
- Source ID
- W81XWH2211018
Entities
People
- Haekyung Jeon-slaughter
Organizations
- Dallas VA Medical Center
- United States Army