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Treatment for TIA to manage cardiovascular disease and diabetes in older adults

TIA 治疗可控制老年人的心血管疾病和糖尿病

基本信息

批准号：
9750234
负责人：
WILLIAM H HERMAN
金额：
$ 23.4万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-01 至 2021-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9750234
关键词：
Adult Age Age-Years Aging Antihypertensive Agents Biological Markers Cardiovascular Diseases Cardiovascular Models Caring Carotid Endarterectomy Carotid stent Cessation of life Clinical Clinical Trials Communities Comorbidity Complement Complication Coronary heart disease Cost Analysis Cost Effectiveness Analysis Data Data Set Descriptor Development Diabetes Mellitus Diagnosis Disease Progression Disease model Effectiveness Elderly Equation Evaluation Funding Glucose Goals Health Expenditures Health Promotion Healthcare Systems Heart Diseases High Prevalence Hypertension Incidence Individual Intervention Ischemic Stroke Longevity Longitudinal Studies Medical Medicare Methods Michigan Modeling Modern Medicine Modernization Morbidity - disease rate Myocardial Infarction Natural History Neuropathy Non-Insulin-Dependent Diabetes Mellitus Operative Surgical Procedures Outcome Patients Persons Pharmaceutical Preparations Population Practice Guidelines Prevention Preventive treatment Procedures Process Quality of life Randomized Clinical Trials Recommendation Recording of previous events Recurrence Research Personnel Risk Risk Factors Risk stratification Smoking Cessation Intervention Smoking Prevention Stroke System Testing Time Transient Ischemic Attack Treatment outcome United States Update atherosclerosis risk base beneficiary cardiovascular disorder prevention cardiovascular health cost cost effective cost effectiveness design diabetic patient disability effective therapy evidence base improved macrovascular disease models and simulation mortality prevent response stroke model stroke therapy

项目摘要

Abstract: Type 2 diabetes (T2DM) and cardiovascular disease (CVD) are important causes of morbidity and mortality in the elderly population in the United States, costing over $104 billion annually to the Medicare system. The average monthly cost for Medicare beneficiaries with T2DM is 2.2 times higher than that for a Medicare beneficiary without T2DM. Costs of CVD for a Medicare beneficiary with T2DM account for 50% of total costs to Medicare from CVD. Because of 1) the high prevalence of T2DM and CVD, 2) their high costs, 3) increasing longevity, and 4) the increasing number of Medicare-eligible individuals, understanding the trajectory of cardiovascular health in persons with diabetes is becoming increasingly important. However, many modern treatment paradigms, including carotid endarterectomy (CE) and carotid artery stenting (CAS), are based on studies performed before the widespread use of high-potency anti-platelet medications, statins, antihypertensive and glucose lowering medications to prevent CVD, and prior to recent smoking prevention and cessation interventions. We propose to develop a detailed model of cardiovascular disease in persons with diabetes, and to use it to update treatment paradigms for CE and CAS in individuals with TIA. Combining the Cardiovascular Health Study (CHS) and Atherosclerotic Risk in Communities (ARIC) data sets, we will develop risk equations for incident TIA and ischemic stroke following TIA in people with T2DM. The risk equations will depend on demographic descriptors, biomarkers, treatment history, and clinical history. We will calibrate and validate the equations to modern standards of care. The final risk equations will be integrated into the Michigan Model for Diabetes, providing a unified model of CVD (TIA, stroke, and heart disease). Using our CVD model, we will perform cost-effectiveness analysis of CE plus modern medical management (MMM) vs CAS plus MMM vs MMM without surgery and we will develop age-specific recommendations for treatment of TIA in older adults based on best-available evidence.

摘要： 2型糖尿病（T2DM）和心血管疾病（CVD）是发病的重要原因，美国老年人口的死亡率，每年花费超过1040亿美元的医疗保险系统患有T2DM的医疗保险受益人的平均每月费用是患有T2DM的医疗保险受益人的2.2倍。无T2DM的Medicare受益人。患有T2DM的医疗保险受益人的CVD费用占50%，从CVD到Medicare的总成本。由于1）T2DM和CVD的高患病率，2）其高成本，3）增加寿命，以及4）越来越多的医疗保险合格的个人，了解轨迹糖尿病患者的心血管健康变得越来越重要。然而，许多现代治疗范例，包括颈动脉内膜切除术（CE）和颈动脉支架植入术（CAS），是基于在广泛使用高效抗血小板药物、他汀类药物、抗高血压药物之前进行的研究和降糖药物，以预防心血管疾病，并在最近的吸烟预防和戒烟之前干预措施。我们建议开发糖尿病患者心血管疾病的详细模型，用它来更新TIA患者CE和CAS的治疗模式。结合心血管健康研究（CHS）和社区动脉粥样硬化风险（ARIC）数据我们将开发T2DM患者TIA事件和TIA后缺血性卒中的风险方程。的风险方程将取决于人口统计学描述符、生物标志物、治疗史和临床史。我们将根据现代护理标准校准和验证方程式。最终的风险方程将被整合密歇根糖尿病模型，提供了一个统一的CVD模型（TIA，中风和心脏病）。使用我们的CVD模型，我们将进行CE+现代医疗管理（MMM）与 CAS加MMM与不手术的MMM相比，我们将制定针对年龄的治疗建议，基于现有最佳证据的老年人TIA。