We propose a 5-year research and training program for Dr. Neil A. Zakai (a junior faculty member at the University of Vermont) to develop an independent career in vascular epidemiology by investigating the impact hemostatic biomarker levels have on regional and racial differences in stroke and coronary heart disease (CHD) in the 30,228 black and white individuals in the REasons for Geographic and Racial Differences in Stroke study (REGARDS). Dr. Mary Cushman, an internationally recognized investigator in cardiovascular epidemiology, will serve as the principle mentor for this project. Though the period of this study, Dr. Cushman will support the educational and research aspects of this project. The advisory committee was selected from experts in epidemiology, neurology, and hematology to provide the best opportunities for networking and future collaborations. Dr. Zakai will meet with the advisory committee both in person and through teleconferences on a monthly basis. To achieve a future independent research career for Dr. Zakai, we propose specific coursework in epidemiology and biostatistics at the University of Vermont and the Johns Hopkins Bloomberg School of Public Health. The project will be a case-cohort study focusing on the impact of multiple hemostatic biomarkers (both individually and in groups) on the regional and racial differences in stroke and CHD incidence in the United States.
The specific aims will 1) create the nested case-cohort study within REGARDS, 2) use multivariable modeling and factor analysis to elucidate mechanisms for stroke and CHD and 3) integrate hemostatic biomarkers and traditional CVD risk factors into a model for stroke and CHD risk that can account for racial and/or regional differences in CVD. The Laboratory for Clinical and Biochemical Research at the University of Vermont serves as an ideal setting to conduct this research by bringing together the laboratory aspects and the epidemiological expertise to ensure a rich translational research experience.

Public Health Relevance

There are regional and racial differences in coronary heart disease and stroke not explained by conventional cardiovascular risk factors. We hypothesize that regional and racial differences in hemostasis underlie some of these disparities.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Clinical Investigator Award (CIA) (K08)
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Special Emphasis Panel (ZHL1-CSR-U (F1))
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Wang, Wayne C
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University of Vermont & St Agric College
Internal Medicine/Medicine
Schools of Medicine
United States
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Akinyemiju, Tomi; Moore, Justin Xavier; Judd, Suzanne et al. (2017) Metabolic dysregulation and cancer mortality in a national cohort of blacks and whites. BMC Cancer 17:856
Naik, Rakhi P; Irvin, Marguerite R; Judd, Suzanne et al. (2017) Sickle Cell Trait and the Risk of ESRD in Blacks. J Am Soc Nephrol 28:2180-2187
Landry, K K; Alexander, K S; Zakai, N A et al. (2017) Association of stroke risk biomarkers with stroke symptoms: the Reasons for Geographic and Racial Differences in Stroke cohort. J Thromb Haemost 15:21-27
Akinyemiju, Tomi; Moore, Justin Xavier; Pisu, Maria et al. (2016) A prospective study of dietary patterns and cancer mortality among Blacks and Whites in the REGARDS cohort. Int J Cancer 139:2221-31
Moore, J X; Zakai, N A; Mahalingam, M et al. (2016) Hemostasis biomarkers and risk of sepsis: the REGARDS cohort. J Thromb Haemost 14:2169-2176
O'Neal, Wesley T; Soliman, Elsayed Z; Howard, George et al. (2015) Inflammation and hemostasis in atrial fibrillation and coronary heart disease: The REasons for Geographic And Racial Differences in Stroke study. Atherosclerosis 243:192-7
Alexander, Kristine S; Zakai, Neil A; Gillett, Sarah et al. (2014) ABO blood type, factor VIII, and incident cognitive impairment in the REGARDS cohort. Neurology 83:1271-6
Zakai, N A; Judd, S E; Alexander, K et al. (2014) ABO blood type and stroke risk: the REasons for Geographic And Racial Differences in Stroke Study. J Thromb Haemost 12:564-70
Gillett, Sarah R; Boyle, Rebekah H; Zakai, Neil A et al. (2014) Validating laboratory results in a national observational cohort study without field centers: the Reasons for Geographic and Racial Differences in Stroke cohort. Clin Biochem 47:243-6