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

创伤后应激障碍(PTSD)是世界上第四大最常见的非物质相关精神障碍 美国。患有创伤后应激障碍的患者与没有创伤后应激障碍的患者相比，患2型糖尿病的风险要大得多。 (T2D)和心血管疾病(CVD)和死亡率。确定创伤后应激障碍的改善是否与 解决NHLBI的优先事项并告知减少健康的努力 与精神障碍有关的差异。但即使在经历了改善的患者中，残余的创伤后应激障碍 症状可能导致T2D/CVD的不良结局。因此，重要的是要确定哪个创伤后应激障碍 症状或症状组合与T2D/CVD不良结局的相关性最强 合并PTSD和T2D或CVD的患者。 更好的T2D/CVD结局和更低的死亡率 这项建议建立在我们过去4年资助研究的基础上。 我们现在把我们的 将注意力从T2D/CVD事件转移到并发PTSD和T2D/CVD的结果上。没有研究表明 我已经确定了患有PTSD和T2D或CVD的患者是否没有临床意义 PTSD的改善降低了T2D/CVD不良结局和死亡的风险。没有研究表明 已确定是否与特定的PTSD症状(例如，高度唤醒)或症状组合相关 有不良的T2D/CVD结局和死亡率。我们的设计决定了创伤后应激障碍的改善是否 更好的T2D/CVD结果，以及这是否受药物等疾病管理变量的影响 坚持不懈。 重点关注创伤后应激障碍的治疗和健康行为的改善，以及T2D和CVD的发生。 我们不研究特定类型的创伤后应激障碍治疗，因为我们想要证明创伤后应激障碍 是T2D/CVD不良结局和死亡率的可改变的危险因素。与前一个资助期一样，我们使用 退伍军人事务部的病历数据。这是检验我们假设的理想“实验室”。在一个 10年观察期(2012-2022年)我们将对15,193名PTSD患者进行抽样调查，并合并T2D和 17,442例创伤后应激障碍合并心血管疾病患者。我们的目标是1)确定单独的创伤后应激障碍表型 (源自创伤后应激障碍症状的潜伏期分析)，以及合并创伤后应激障碍患者的症状变化。 T2D/CVD与T2D和CVD不良结局的风险增加有不同的相关性，包括 疾病相关和全因死亡率，2)确定T2D和CVD不良结局的风险，所有- 与没有临床意义的创伤后应激障碍患者相比，患有创伤后应激障碍的患者的原因和原因特定死亡率更低 改进 3)确定T2D/CVD管理措施，如良好的血糖控制、他汀类药物 服药依从性和改善的抑郁，在有临床意义的创伤后应激障碍之间的联系中起中介作用 改善和T2D/CVD结果。 4)进行有计划的年龄、性别和种族分组 比较。几十年来对抑郁症和T2D/CVD的研究导致了指南，该指南承认 抑郁是心血管疾病预后不良的危险因素。积极的结果和验证性研究最终可能 导致类似的指南，建议提供者筛查和治疗创伤后应激障碍，以改善T2D/CVD结果。

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.