PAcific Islander, Native Hawaiian and Asian American Cardiovascular Health Epidemiology (PANACHE) Study - ABSTRACT In 2020, there were nearly 24 million Asian Americans and 1.6 million Native Hawaiians and other Pacific Islanders in the U.S., representing 8% of the total U.S. population, and these groups represent the fastest growing U.S. population group over the past decade. Yet, few data exist about the contemporary epidemiology of major cardiovascular diseases and explanatory variables between different Asian American, Native Hawaiian and Pacific Islander (AANHPI) subgroups in large, representative U.S. populations and compared with non-Hispanic Whites. As highlighted in NOT-HL-23-001 (Epidemiologic studies in Asian Americans, Native Hawaiians, and Pacific Islanders), there is a pressing need to fill these key knowledge gaps given the substantial heterogeneity between these different subpopulations in a variety of exposures that may potentially contribute to differential rates of cardiovascular diseases and reflect opportunities to improve care and outcomes. We propose to address many of these knowledge gaps through the PAcific Islander, Native Hawaiian and Asian American Cardiovascular Health Epidemiology (PANACHE) Study which will leverage collaborations between the Kaiser Permanente Northern California and Kaiser Permanente Hawaii integrated healthcare delivery systems whose collective AANHPI adult population is >800,000 and non-Hispanic white population of >1.7 million between 2012 and 2021. The specific aims of the PANACHE Study are (1) to delineate the contemporary incidences of heart failure (HF), atrial fibrillation (AF) and myocardial infarction (MI) among different AANHPI subpopulations compared with non-Hispanic Whites; (2) to develop and validate novel predictive models for incident HF, AF and MI within AANHPI subpopulations; and (3) to characterize self- reported sociocultural, behavioral, dietary and environmental factors across AANHPI subpopulations and their association with clinical cardiovascular risk factors and overall predicted risks of incident HF, AF and MI, along with establishing a linked data and specimen biorepository using remote blood collection methods. Overall, the PANACHE Study brings together a highly experienced multidisciplinary team with complimentary expertise in cardiovascular disease and evaluating ethnic differences, use of electronic health records and other data sources, and advanced predictive analytics; as well as access to and success in engaging large populations of AANHPI adults in Hawaii and Northern California. The PANACHE Study will increase our understanding of the epidemiology and contributing factors to major cardiovascular diseases in support of the goal to improve the quality of care and outcomes for these understudied patient subgroups.