Multi-Ethnic Study of Atherosclerosis (MESA)

Overview

The Multi-Ethnic Study of Atherosclerosis (MESA) is a study of the characteristics of subclinical cardiovascular disease and the risk factors that predict progression to clinically overt cardiovascular disease or progression of the subclinical disease (Bild DE et al., Am J Epidemiol 2002; 156(9):871-881). MESA consists of a diverse, community-based sample of an initial 6,814 men and women aged 45-84 years without known cardiovascular disease at baseline. Thirty-eight percent of the recruited participants were White, 28 percent African American, 22 percent Hispanic, and 12 percent of Chinese descent. Participants were recruited from six field centers across the United States: Baltimore City and Baltimore County, Maryland; Chicago, Illinois; Forsyth County, North Carolina; Los Angeles County, California; New York, New York; and St. Paul, Minnesota. Participants are being followed for identification and characterization of cardiovascular disease events, including acute myocardial infarction and other forms of coronary heart disease (CHD), stroke, and heart failure; for cardiovascular disease interventions; and for mortality. The first examination took place over two years, from July 2000 to July 2002, and has been followed by additional examinations. Participants have been contacted every 9 to 12 months throughout the study to assess and adjudicate clinical morbidity and mortality. The study was approved by the Institutional review boards at all participating institutions, and all participants gave written informed consent. In addition, informed consent was obtained for extensive data sharing (dbGaP) and genetic/omic studies, including candidate genes (NHLBI CARe), genome-wide scans (NHLBI SHARe), exome sequencing (NHLBI ESP) and, most recently, the NHLBI TOPMed program.

Background: MESA was derived from an NHLBI Task Force on Research in Epidemiology and Prevention in which investigation of subclinical disease and its progression to clinical disease was recommended as a major focus for future NHLBI population studies. This was followed by a Special Emphasis Panel on Longitudinal Cohort Studies in 1995, which strongly recommended studies based on subclinical disease measures, and the inclusion of underrepresented minorities in population-based research. A subsequent Special Emphasis Panel on Use of Cardiac EBCT and MRI in Epidemiologic Studies of Cardiovascular Disease in 1996 recommended inclusion of carotid and cardiac MRI and EBCT in elucidating the progression of subclinical to clinical disease and identifying subclinical disease characteristics most strongly associated with increased risk. Requests for Proposals were released in 1997 and awards were made in 1999. Design Narrative: Participants were examined at baseline for evidence of subclinical CVD using cardiac computed tomography (CT), cardiac MRI, carotid ultrasound, flow-mediated brachial artery dilation, radial artery tonometry, ankle-brachial index measurement; established and putative laboratory risk markers; and socioeconomic, psychological, behavioral, and environmental characteristics. Selected baseline components were repeated and additional components such as spirometry, retinal photography, genotyping, cognitive function assessment and, in subsets, abdominal aortic CT, carotid MRI, cardiac MRI tagging for measures of regional myocardial function, were introduced over five subsequent examinations through 2018. Stored blood samples have been assayed for putative biochemical risk factors and stored for case-control studies. DNA has been extracted for study of candidate genes, genome-wide scanning, expression, and other -omics investigations, and lymphocytes were cryopreserved for possible immortalization. MESA is unique in its composition of four ethnic groups, having a cohort free of clinical CVD at baseline, and having multiple - and in some cases unique - subclinical CVD measures over time in the same individuals. Data collected from a large number and variety of MESA ancillary studies, including major ancillary studies on air pollution, chronic lung disease, genetics, and sleep, further contribute to its uniqueness. For a list of all phenotypic data documentation and protocols, refer to the MESA website: www.mesa-nhlbi.org. The MESA data are available to qualifying investigators directly from the study and also through dbGaP (http://www.ncbi.nlm.nih.gov/gap) and BioLINCC (https://biolincc.nhlbi.nih.gov). A variety of stored biospecimens are also available from the study, including DNA, serum, plasma, and urine.