Clinically Meaningful PTSD Improvement: Reducing Risk for Adverse Outcomes in Comorbid Cardiometabolic Disease

具有临床意义的 PTSD 改善：降低共病心脏代谢疾病不良后果的风险

• 批准号: 10510354
• 负责人: Jeffrey F. Scherrer
• 金额: $ 45.14万
• 依托单位: SAINT LOUIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-15 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10510354
• 关键词: Accounting; Address; Adverse event; African American; Age; Arousal; Cardiac rehabilitation; Cardiometabolic Disease; Cardiovascular Diseases; Cessation of life; Characteristics; Chronic Disease; Clinical; Clinical Trials; Cognition; Complications of Diabetes Mellitus; Confounding Factors (Epidemiology); DSM-V; Data; Data Collection; Data Sources; Diabetes Mellitus; Diagnosis; Disease; Disease Management; Disease Outcome; Funding; Future; Gender; Goals; Grant; Guidelines; Health behavior; High Prevalence; Hospitalization; Hypertension; Individual; Knowledge; Laboratories; Lead; Link; Literature; Measures; Mediating; Mediator of activation protein; Medical Records; Mental Depression; Mental disorders; Minority; Moods; Myocardial Infarction; National Heart, Lung, and Blood Institute; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Patients; Persons; Pharmaceutical Preparations; Phenotype; Post-Traumatic Stress Disorders; Premature Mortality; Provider; Psychotherapy; Race; Recurrence; Reduce health disparities; Research; Residual state; Risk; Risk Factors; Sampling; Self Care; Severities; Stroke; Subgroup; Symptoms; Testing; Time; Treatment outcome; Underrepresented Populations; United States; United States Department of Veterans Affairs; Veterans Health Administration; Work; adverse outcome; age group; associated symptom; blood pressure control; burden of illness; cardiometabolism; comorbidity; design; disparities in morbidity; disparity reduction; experience; glycemic control; health disparity; improved; indexing; medication compliance; modifiable risk; mortality; public health priorities; reduce symptoms; treatment guidelines

Posttraumatic stress disorder (PTSD) is the 4th most common, non-substance related, psychiatric disorder in the United States. Patients with PTSD vs. those without have a significantly greater risk for type 2 diabetes (T2D) and cardiovascular disease (CVD) and mortality. Determining if PTSD improvement is associated with addresses NHLBI priorities and informs efforts to reduce health disparities related to psychiatric disorders. But even in patients who experience improvement, residual PTSD symptoms may contribute to adverse T2D/CVD outcomes. Thus, it is important to determine which PTSD symptoms or combination of symptoms are most strongly associated with adverse T2D/CVD outcomes in patients with comorbid PTSD and T2D or CVD. better T2D/CVD outcomes and lower mortality This proposal builds on our past 4-years of funded research We now move our focus away from incident T2D/CVD to outcomes in comorbid PTSD and T2D/CVD. There are no studies that have determined if patients with comorbid PTSD and T2D or CVD who do vs. do not have clinically meaningful PTSD improvement are at lower risk for adverse T2D/CVD outcomes and death. There are no studies which have determined if specific PTSD symptoms (e.g., hyperarousal) or combination of symptoms are associated with adverse T2D/CVD outcomes and mortality. Our design determines if PTSD improvement is followed by better T2D/CVD outcomes and whether this is mediated by disease management variables such as medication adherence. focused on PTSD treatment and improved health behaviors, and incident T2D and CVD. We do not study a specific type of PTSD therapy because we want to demonstrate whether PTSD is a modifiable risk factor for T2D/CVD adverse outcomes and mortality. As in the prior funding period, we use Department of Veterans Affairs’ medical record data. This is an ideal ‘laboratory’ to test our hypotheses. In a 10 year observation period (2012-2022) we will sample 15,193 patients with PTSD and comorbid T2D and 17,442 patients with PTSD and comorbid CVD. Our aims are 1) determine if separate PTSD phenotypes (derived from latent class analysis of PTSD symptoms), and symptom change, in patients with comorbid PTSD- T2D/CVD, are differentially associated with an increased risk for adverse T2D and CVD outcomes, including disease related and all-cause mortality, 2) determine whether risks for adverse T2D and CVD outcomes, all- cause and cause specific mortality are lower in patients with vs. without a clinically meaningful PTSD improvement ; 3) determine if measures of T2D/CVD management, such as good glycemic control, statin medication adherence and improved depression, mediate the association between clinically meaningful PTSD improvement and T2D/ CVD outcomes. and 4) conduct planned age, gender, and race sub-group comparisons. Decades of research on depression and T2D/CVD led to guidelines that acknowledge depression as a risk factor for poor CVD outcomes. Positive results and confirmatory studies may eventually lead to similar guidelines that advise providers to screen and treat PTSD to improve T2D/CVD outcomes.

创伤后应激障碍（PTSD）是第四最常见的，非固定性相关的，精神疾病 美国。 PTSD与没有PTSD的患者患有2型糖尿病的风险明显更大 （T2D）和心血管疾病（CVD）和死亡率。确定PTSD改善是否与 解决NHLBI的优先事项并告知减少健康的努力 与精神疾病有关的差异。但是即使在有改善的患者中，残留的PTSD 症状可能导致不良T2D/CVD结果。那很重要的是确定哪个PTSD 症状或症状的组合与不良T2D/CVD结局最密切相关 合并症PTSD和T2D或CVD的患者。 更好的T2D/CVD结果和较低的死亡率 该提案建立在我们过去4年的资助研究的基础上 我们现在移动我们的 从事件T2D/CVD聚焦到合并症PTSD和T2D/CVD的结果。没有研究 已经确定合并症PTSD和T2D或CVD的患者是否具有临床意义 PTSD改善的不良T2D/CVD结局和死亡的风险较低。没有研究 已经确定特定的PTSD症状（例如，高伴侣）或症状的组合是否相关 具有不良T2D/CVD的结果和死亡率。我们的设计确定了PTSD的改进是否后面 更好的T2D/CVD结果以及这是否是由疾病管理变量（例如药物）介导的 坚持。 专注于PTSD治疗和改善的健康行为，以及事件T2D和CVD。 我们不研究特定类型的PTSD疗法，因为我们要证明PTSD是否是PTSD 是T2D/CVD广告结果和死亡率的可修改风险因素。与以前的资金期一样，我们使用 退伍军人事务部的病历数据。这是检验我们的假设的理想“实验室”。在 10年观察期（2012-2022）我们将采样15,193例PTSD和合并症T2D患者 17,442例PTSD和合并症CVD患者。我们的目标是1）确定是否单独 （源自PTSD症状的潜在类别分析）和症状的变化，患有PTSD-患者 T2D/CVD与不良T2D和CVD结果的风险增加不同，包括 与疾病相关和全因死亡率，2）确定是否有不良T2D和CVD结果的风险 与没有临床有意义的PTSD的患者的原因和导致特定死亡率较低 改进 ; 3）确定T2D/CVD管理的测量是否是否（例如良好的血糖控制），他汀类药物 药物依从性和改善抑郁症，介导临床上有意义的PTSD之间的关联 改进和T2D/ CVD结果。 4）进行计划的年龄，性别和种族子群 比较。数十年的抑郁症研究和T2D/CVD导致了确认的准则 抑郁是CVD结果不良的危险因素。积极的结果和确认研究可能最终 导致类似的准则，建议提供者筛查和治疗PTSD以改善T2D/CVD结果。