MENTORED PATIENT-ORIENTED RESEARCH CAREER DEVELOPMENT AWARD

描述(由申请人提供)： 拉美裔是美国最大的少数民族群体，马萨诸塞州几乎占加州拉美裔人口的80%。MA有较高的2型糖尿病患病率和较高的糖尿病肾病(DN)风险。矛盾的是，包括我们自己的数据表明，马萨诸塞州的心血管疾病负担可能比非西班牙裔白人(NHW)低。我们试图定义糖尿病肾病(125 MA，125 nhw)高危人群的心血管负荷(冠状动脉钙化，CAC)及其决定因素，以检验三个假设：1)在糖尿病肾病患者中，MA患者的CAC评分低于NHW患者，且进展缓慢；2)MA患者的社会经济状况(SES)显著低于NHW患者；以及3)在糖尿病肾病患者中，MA患者的全因和心血管疾病死亡率较低。将在基线、12个月和24个月时确定10个常规测量、两个额外的心血管疾病危险因素(同型半胱氨酸、瘦素)和三个SES变量，这些变量是为初步分析预先指定的。在基线和24个月时，通过电子束计算机断层扫描确定CAC。将测试心血管疾病风险因素和不同种族的SES变量之间的关系，以确定它们对CAC种族差异的贡献。整个队列将从登记到赠款期限结束进行跟踪，以确定各种原因和心血管疾病死亡率的种族差异；这一人群的高事件发生率提供了检验所提出的假设的力量。提出了一套严密的完整随访计划。因此，这项研究将首次确定MA和NHW与糖尿病肾病患者的动脉粥样硬化负担的比较，以及几个心血管疾病危险因素的潜在作用。它将检验新的假设，即尽管医学和SES因素可能增加MA的心血管死亡风险，但相反的情况可能是正确的。查明卫生保健方面的差距将使我们能够设计有针对性的干预措施，以改善少数民族的健康。认识到MA患者心血管疾病风险较低或NHW患者心血管疾病风险较高的相关因素，可能有助于开发可能减轻糖尿病肾病患者心血管疾病负担的治疗方法。申请人拥有机构支持和职业发展计划，包括获得临床调查硕士学位，以实现其职业目标。

DESCRIPTION (provided by applicant): Hispanics are the largest ethnic minority group in the country and MA constitute almost 80% of Hispanics in California. MA have a high prevalence of type 2 diabetes and a higher risk for diabetic nephropathy (DN). Paradoxically, data including our own suggest that CVD burden may be lower in MA than non-Hispanic Whites (NHW). We seek to define the CVD burden (coronary artery calcification, CAC) and its determinants in a high-risk sub-group of non-dialyzed diabetics with DN (125 MA, 125 NHW), in order to test three hypotheses: 1) Among individuals with DN, the CAC scores in MA are lower and progress more slowly, than among NHW; 2) The socioeconomic status (SES) of MA individuals with DN is significantly lower than of NHW; and 3) Among individuals with DN, MA have a lower all-cause and CVD mortality. Ten routinely measured, two additional CVD risk factors (homocysteine, leptin) and three SES variables, pre-specified for primary analyses, will be ascertained at baseline, 12 and 24 months. CAC will be ascertained by electron beam computerized tomography at baseline and 24 months. The relationship of CVD risk factors and SES variables that vary by ethnicity will be tested for their contribution to ethnic differences in CAC. The entire cohort will be followed from enrollment till the end of the grant period to ascertain ethnic differences in all-cause and CVD mortality; a high event rate in this population provides power to test the hypotheses thus proposed. A rigorous plan for complete follow-up is proposed. Thus, this study will define for the first time the comparative atherosclerotic burden in MA and NHW with DN and the potential role of several CVD risk factors. It will test the novel hypothesis that despite medical and SES factors that might increase the risk for CVD mortality in MA, the opposite may be true. Identifying health-care disparities will permit us to design targeted interventions to improve the health of ethnic minorities. Recognition of factors associated with the lower CVD risk among MA or the higher risk among NHW may help develop therapies that may potentially reduce the CVD burden among patients with DN. The applicant has institutional support and a career development plan including obtaining a Masters in Clinical Investigation, to achieve his career goals.