Cardiovascular Disease and Diabetic Nephropathy

描述（由申请人提供）： 西班牙裔是美国最大的少数民族群体，在加州，MA占西班牙裔的近80%。 MA是2型糖尿病的高发人群，糖尿病肾病（DN）的发病风险较高。 奇怪的是，包括我们自己的数据表明，MA的CVD负担可能低于非西班牙裔白人（NHW）。 我们试图定义CVD负担非透析糖尿病肾病高危亚组中冠状动脉钙化及其决定因素（125 MA，125 NHW），以检验三个假设：1）DN患者中MA组CAC评分较NHW组低，进展缓慢; 2）MA DN患者的社会经济地位（SES）显著低于NHW患者; 3）在DN患者中，MA患者的全因死亡率和CVD死亡率较低。 将在基线、12个月和24个月时确定10个常规测量的、2个额外的CVD风险因素（同型半胱氨酸、瘦素）和3个SES变量（预先指定用于主要分析）。 CAC将在基线和24个月时通过电子束计算机断层扫描确定。 CVD危险因素和SES变量之间的关系因种族而异，将测试其对CAC种族差异的贡献。 从入组到资助期结束，将对整个队列进行随访，以确定全因和CVD死亡率的种族差异;该人群的高事件发生率为检验由此提出的假设提供了动力。 提出了一个严格的计划，以完成后续行动。 因此，本研究将首次确定MA和NHW与DN的比较动脉粥样硬化负荷以及几种CVD危险因素的潜在作用。 它将测试新的假设，尽管医疗和社会经济地位的因素，可能会增加心血管疾病的死亡率在MA的风险，相反的可能是真的。 查明保健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。 识别与MA中较低CVD风险或NHW中较高风险相关的因素可能有助于开发可能降低DN患者CVD负担的治疗方法。 申请人有机构的支持和职业发展计划，包括获得临床研究硕士学位，以实现他的职业目标。

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.