Sex Disparities in Cardiovascular Disease and Optimal Coronary Revascularization in Dialysis Patients

心血管疾病的性别差异和透析患者的最佳冠状动脉血运重建

• 批准号: 10214933
• 负责人: Silvi Shah
• 金额: $ 19.88万
• 依托单位: UNIVERSITY OF CINCINNATI
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-07 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10214933
• 关键词: Accounting; Address; Attitude; Biometry; Cardiovascular Diseases; Cardiovascular system; Caring; Cause of Death; Cessation of life; Clinical; Clinical Research; Clinical Trials; Cohort Studies; Congestive Heart Failure; Coronary; Coronary Arteriosclerosis; Coronary Artery Bypass; Counseling; Data; Decision Analysis; Decision Making; Decision Modeling; Development Plans; Dialysis patients; Dialysis procedure; Discipline; Disease Outcome; End stage renal failure; Equilibrium; Event; Exclusion; Focus Groups; Fostering; Frequencies; Funding; Future; General Population; Goals; Health Benefit; Health Planning; Health Status; Incidence; Information Systems; Infrastructure; Intervention; K-Series Research Career Programs; Kidney; Kidney Diseases; Knowledge; Link; Medicare claim; Mentors; Mentorship; Methodology; Methods; Modeling; Myocardial Infarction; Observational epidemiology; Outcome; Patients; Performance; Policies; Population; Prevalence; Process; Qualitative Methods; Quality of life; Reporting; Research; Research Methodology; Research Personnel; Risk; Sex Differences; Stroke; Structure; Time; Training; Translational Research; Treatment outcome; United States; Universities; Unstable angina; Woman; Women' s Health; Work; acute coronary syndrome; base; cardiovascular health; career; career development; clinical epidemiology; cohort; design; experience; health disparity; health equity; improved; improved outcome; innovation; men; mortality; mortality risk; novel; patient oriented; percutaneous coronary intervention; prospective; recruit; sex; sex disparity; skills; support tools; surgical risk; tool; treatment strategy

PROJECT SUMMARY The overall goal of this K23 Career Development proposal is to provide me with the essential mentorship and career development necessary to become an independent investigator with expertise in women’s cardiovascular health and kidney disease. Ischemic and non-ischemic cardiovascular disease remains the leading cause of death among patients initiating dialysis, and the burden of cardiovascular events increases with the progression of kidney disease. The central hypothesis is that among patients with end-stage kidney disease (ESKD), women as compared to men, have a higher frequency of cardiovascular events and receive suboptimal revascularization treatment strategies, which results in higher cardiovascular mortality. The goals for the proposed study are to examine the sex differences in ischemic and non-ischemic cardiovascular events, coronary revascularization strategies, and clinical outcomes in dialysis patients. I will develop a decision model to determine the optimal coronary revascularization strategy for dialysis patients with coronary artery disease and perform a focus group study to explore patients’ attitudes and barriers to coronary revascularization. My preliminary data show a higher frequency of cardiovascular events in women versus men among the ESKD population. The proposed cohort study leverages the infrastructure of the largest prospectively maintained cohort of dialysis patients in the United States, with over 6 million enrollees. My study is significant because it will fill the current knowledge gap in the interplay between sex, kidney disease, and cardiovascular disease in patients undergoing dialysis. The proposal is innovative since it will be the first study to examine differences in women as compared to men in cardiovascular events and revascularization strategies among dialysis patients. I will develop a novel sex-specific decision tool to determine the optimal revascularization strategy in patients with ESKD. This study aims to improve our knowledge so that clinicians can better counsel their patients and modify their risk for adverse cardiovascular outcomes. New knowledge from this proposal will lead to future studies with targeted interventions directed at reducing health disparities in patients with kidney disease to improve cardiovascular care, especially in women. I anticipate that my findings will lead to new policy decisions and actionable initiatives to reduce health disparities and foster more sex-inclusive cardiovascular health planning. I propose a career development plan that combines advanced biostatistical coursework, and didactic training in translational research methods and health equity related to understanding sex differences in cardiovascular health among patients with ESKD. I will receive mentorship by a team of expert investigators from disciplines in clinical epidemiology, mixed-methods research, and decision analysis research. Through the K23 Career Development Award Program, I will generate data, and enhance knowledge and skills in patient-oriented clinical research to submit an R01 application, and then transition to become an independent investigator.

项目摘要 这项K23职业发展建议的总体目标是为我提供基本的概念和 成为具有妇女专业知识的独立调查员所必需的职业发展 心血管健康和肾脏疾病。缺血性和非缺血性心血管疾病仍然是 患者的主要死亡原因引发了透析，心血管事件的燃烧增加了 随着肾脏疾病的进展。中心假设是终末期肾脏的患者 疾病（ESKD），与男性相比，女性的心血管事件频率更高，并且接受 次级血运重建治疗策略，导致心血管死亡率更高。目标 拟议的研究是检查缺血性和非缺血性心血管事件的性别差异， 冠状动脉血运重建策略和透析患者的临床结果。我将开发一个决策模型 确定透析冠状动脉疾病患者的最佳冠状动脉血运重建策略 并进行焦点小组研究，以探索患者的与会者和冠状动脉血运重建障碍。我的 初步数据显示，女性与男性的心血管事件的频率更高 人口。拟议的队列研究利用了前瞻性维护的最大的基础设施 在美国，透析患者的队列有超过600万。我的研究很重要，因为它 将填补性，肾脏疾病和心血管疾病之间相互作用的当前知识差距 接受透析的患者。该提案具有创新性，因为它将是第一个研究的研究 与男性在心血管事件中的男性相比，透析患者中​​的女性和血运重建策略相比。 我将开发一种新颖的性别决策工具，以确定患者的最佳血运重建策略 与ESKD。这项研究旨在提高我们的知识，以便临床医生能够更好地造成患者的造成 修改其不良心血管结局的风险。该提议的新知识将导致未来 针对有针对性干预措施的研究旨在将肾脏疾病患者的健康差异降低到 改善心血管护理，尤其是在女性中。我预计我的发现将导致新的政策决定 以及可行的举措，以减少健康差异并促进更多的性别性心血管健康 规划。我提出了一项职业发展计划，将高级生物统计学课程结合在一起 翻译研究方法和健康公平的培训与了解性别差异有关 ESKD患者的心血管健康。我将获得一组专家调查员团队 来自临床流行病学，混合方法研究和决策分析研究的学科。通过 K23职业发展奖计划，我将生成数据，并增强知识和技能 面向患者的临床研究以提交R01应用，然后过渡成为独立的 研究者。