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Predicting CHD Events in Black and White Women

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Coronary Heart Disease (CHD) is currently the number one cause of death in women. The increasing number of CHD deaths in younger women plus the projected increase in the incidence and prevalence of CHD in older women paints a bleak picture of their future CHD rates. To reverse this trend, early detection of CHD in women is essential, but diagnosing CHD in women is challenging since they often experience ischemia differently than men do. Our previous findings revealed that 97% of women with acute coronary syndrome (ACS) retrospectively reported experiencing prodromal symptoms (PS) not commonly associated with CHD for more than a month prior to ACS, indicating time to intervene. We also found significant racial differences in PS. However, no clinically tested instrument describes the full range of PS that racially diverse women report. We developed and tested the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS) with approximately 1000 racially diverse women to retrospectively assess their PS and acute symptoms associated with ACS. However, we do not know if PS identified retrospectively will prove useful in predicting CHD events in women. Therefore, we propose to conduct a longitudinal observational study to determine if the MAPMISS will differentiate prospectively between women who will and will not experience a CHD event in a 2-year period. Confirmation of this hypothesis through survival and longitudinal analysis, in conjunction with identifying the most sensitive and specific symptoms, would provide the evidence-base needed to assist clinicians in deciding whether to refer a woman for cardiovascular diagnostic testing. We will use standard psychometric techniques to develop a MAPMISS screening instrument. We will compare the area under receiver operator curves to identify the most accurate, efficient, and parsimonious measure for screening. We also will explore the correspondence between the MAPMISS screen scores and CHD diagnostic test results.

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