Coronary Heart Disease Risk Factors and Outcomes in the Twenty-First Century: Findings from the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study
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Abstract
REasons for Geographic and Racial Differences in Stroke (REGARDS) is a longitudinal
study supported by the National Institutes of Health to determine the disparities
in stroke-related mortality across USA. REGARDS has published a body of work designed
to understand the disparities in prevalence, awareness, treatment, and control of
coronary heart disease (CHD) and its risk factors in a biracial national cohort. REGARDS
has focused on racial and geographical disparities in the quality and access to health
care, the influence of lack of medical insurance, and has attempted to contrast current
guidelines in lipid lowering for secondary prevention in a nationwide cohort. It has
described CHD risk from nontraditional risk factors such as chronic kidney disease,
atrial fibrillation, and inflammation (i.e., high-sensitivity C-reactive protein)
and has also assessed the role of depression, psychosocial, environmental, and lifestyle
factors in CHD risk with emphasis on risk factor modification and ideal lifestyle
factors. REGARDS has examined the utility of various methodologies, e.g., the process
of medical record adjudication, proxy-based cause of death, and use of claim-based
algorithms to determine CHD risk. Some valuable insight into less well-studied concepts
such as the reliability of current troponin assays to identify "microsize infarcts,"
caregiving stress, and CHD, heart failure, and cognitive decline have also emerged.
In this review, we discuss some of the most important findings from REGARDS in the
context of the existing literature in an effort to identify gaps and directions for
further research.