Weight in Secondary Prevention (WISP)

描述（由申请人提供）：冠状动脉疾病（CAD）或2型糖尿病（DM）患者承受着巨大的心血管发病率、死亡率和医疗费用负担。国家数据显示，这些患者约占成年人口的10%，占肥胖相关医疗费用的大部分。80%的冠心病患者和90%的糖尿病患者超重或肥胖。将体重作为这些患者不良事件二级预防的风险因素，正如本研究所做的那样，是有吸引力的，因为体重优化已被证明可以改善患者的预后。本研究建议使用来自两个基于人口的CAD或DM患者登记的独特数据集来描述体重指数（BMI）轨迹，与这些轨迹相关的患者特征，以及这些轨迹对医疗保健成本的影响。

DESCRIPTION (provided by applicant): Patients with coronary artery disease (CAD) or type-2 diabetes mellitus (DM) sustain large burdens of excess cardiovascular morbidity, mortality, and health care costs. National data reveal that these patients make up about 10% of the adult population and account for the majority of obesity related health care costs. Eighty percent of CAD patients and 90% of DM patients are overweight or obese. Focusing on weight as a risk factor in the secondary prevention of adverse events in these patients, as this study does, is attractive because weight optimization has been shown to improve patient outcomes. This study proposes to use a unique dataset from two large population-based registries of patients with CAD or DM to describe body mass index (BMI) trajectories, patient characteristics associated with those trajectories, and the effect of the trajectories on health care costs. This study addresses the NIH goal of systematic observations of obesity-related behaviors in real world settings. It also addresses the broader long-term goal of designing improved energy balance programs targeted at the most appropriate patients in an effort to reduce future cardiovascular events and other BMI-related complications. Specific aims are, in adult patients with a new diagnosis of CAD or type 2 DM and who meet other study- defined eligibility criteria (n=10,000): 1) to estimate their BMI trajectories 1, 3, and 5 years post-diagnosis; 2) to determine which patient demographic and disease-related characteristics are significantly associated with their 1-, 3-, and 5-year post-diagnosis BMI trajectories; and 3) to examine the association of the 1-, 3-, and 5-year post-diagnosis BMI trajectories with total health care costs. All analyses will be conducted separately for those with newly diagnosed coronary artery disease and those with newly diagnosed type 2 diabetes mellitus. This study will use electronic data from Kaiser Permanente Northwest disease registries, electronic medical record, and other databases. The use of existing data from linked databases will allow conducting a low-cost evaluation of BMI trajectories using growth curve analysis techniques. This evaluation will provide community-based background information useful for determining how to most effectively apply weight management programs. Relevance: This study focuses on patients at highest risk for future health problems related to obesity or overweight-those with coronary artery disease and type 2 diabetes mellitus. Understanding which patients will need the most support to manage weight will allow us to design the most cost-effective future programs.