The purpose of this K-23 grant proposal is to develop a didactic training and research program that will enable Dr. Adams to become an independent investigator in the epidemiology of cardiovascular disease. Dr. Adams is particularly interested in the epidemiology of cardiovascular disease in survivors of childhood cancer and would like to expand his knowledge and skill in order to look at the precursors of cardiovascular disease in general.
The specific aims of this proposal are: 1) To establish a comprehensive training program in field techniques of epidemiology, follow-up study design and advanced statistical techniques including mathematical model building and survival analysis; 2) To analyze data from an ongoing study at the University of Rochester evaluating cardiovascular functioning in childhood cancer survivors treated with high-dose mediastinal irradiation; 3) To design a non-concurrent prospective study to assess the association between chest irradiation during infancy and coronary artery disease in adulthood; 4) To design and carry out a pilot study to assess the association between chest irradiation during infancy and subclinical cardiovascular disease. This program takes advantage of expertise in preventive cardiology, pediatrics, and radiation-associated heart disease found within the University of Rochester Medical Center. Additionally, a previously well followed cohort in the Rochester area of nearly 2800 individuals exposed to low-dose irradiation to the thymus as infants and 4800 of their siblings provides a unique opportunity to assess the potential association between low-dose chest irradiation during infancy and cardiovascular disease later in life. The major project of this proposal evaluating this cohort is in fact two studies: 1) the follow-up of the entire cohort evaluating the risk of clinical coronary artery disease events associated with radiotherapy and 2) a pilot study clinically evaluating CAD risk factors and cardiac function. At the end of the training program, Dr. Adams will be an independent investigator in the field of preventive cardiology with experience in several study designs. The clinical and public health significance of this proposal is based on the fact that much remains unknown about the epidemiology and pathophysiology of atherosclerosis in special subpopulations such as those exposed to irradiation during childhood. This group of individuals, if shown to be at high risk, constitutes a potentially huge number of persons who may benefit from additional preventive measures.
