Cardiovascular Diseases Clinical Trial
To investigate the contribution of genetic and environmental factors to vascular inflammation, and to define the extent to which inflammatory phenotypes and genotypes predict subclinical and clinical cardiovascular disease (CVD).
BACKGROUND:
Recent experimental and clinical studies support the concept that vascular inflammation is
central to the development of atherosclerosis, and that systemic inflammatory markers
predict a wide array of cardiovascular disease (CVD) events. There is increasing interest in
the role of genetic variation in inflammation contributing to the susceptibility for CVD. To
date mostly small case-control studies have suggested that polymorphisms in inflammatory
genes are associated with subclinical and clinical CVD, but the studies have differed with
regard to which genes are central. The investigators have previously measured systemic
markers of vascular inflammation (e.g. CRP, sICAM-1, MCP-1, IL-6) and oxidative stress
(isoprostanes), in a population-based sample of 3800 middle-aged and elderly men and women
of the Framingham Heart Study offspring cohort. They now propose to genotype inflammatory
candidate genes in the Framingham offspring cohort which have been phenotyped for CVD risk
factors, subclinical CVD.They also propose to measure systemic inflammatory markers in the
Framingham Study Generation III cohort, who are the children of the offspring cohort.
DESIGN NARRATIVE:
Dr. Benjamin and colleagues will genotype inflammatory candidate genes in the Framingham
offspring cohort which have been phenotyped for CVD risk factors, subclinical CVD. They also
will measure systemic inflammatory markers in the Framingham Study Generation III cohort,
who are the children of the offspring cohort. The central hypothesis of this study is that
systemic vascular inflammation represents a complex phenotype that evolves over a lifetime
and is influenced by both environmental and genetic factors. They further postulate that
variations in the inflammatory phenotype (marker levels) and genotype predispose to the
development of CVD. The purpose of this study is to determine the contribution of genetic
and environmental factors to vascular inflammation, and to define the extent to which
inflammatory phenotypes and genotypes predict subclinical and clinical CVD, and enhance risk
prediction models. The specific aims are: Aim 1. To examine the environmental determinants
of systemic inflammation in the community. Aim 2. To investigate the genetic determinants of
systemic inflammation. Aim 3. To identify the inflammatory phenotypic and genetic
determinants of subclinical CVD. Aim 4. To determine the contribution of inflammatory
phenotype versus genotype to prevalent and incident CVD and to incident hypertension. The
investigation will increase understanding as to whether inflammation is a core risk factor
for CVD or is merely a marker of presence and burden of other CVD risk factors. These
insights will fundamentally contribute to knowledge about the pathophysiology of CVD and may
lead to improved prevention, risk stratification and management of CVD.
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