Sex Disparities in Cardiovascular Disease and Optimal Coronary Revascularization in Dialysis Patients

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PROJECT SUMMARY The overall goal of this K23 Career Development proposal is to provide me with the essential mentorship and career development necessary to become an independent investigator with expertise in women’s cardiovascular health and kidney disease. Ischemic and non-ischemic cardiovascular disease remains the leading cause of death among patients initiating dialysis, and the burden of cardiovascular events increases with the progression of kidney disease. The central hypothesis is that among patients with end-stage kidney disease (ESKD), women as compared to men, have a higher frequency of cardiovascular events and receive suboptimal revascularization treatment strategies, which results in higher cardiovascular mortality. The goals for the proposed study are to examine the sex differences in ischemic and non-ischemic cardiovascular events, coronary revascularization strategies, and clinical outcomes in dialysis patients. I will develop a decision model to determine the optimal coronary revascularization strategy for dialysis patients with coronary artery disease and perform a focus group study to explore patients’ attitudes and barriers to coronary revascularization. My preliminary data show a higher frequency of cardiovascular events in women versus men among the ESKD population. The proposed cohort study leverages the infrastructure of the largest prospectively maintained cohort of dialysis patients in the United States, with over 6 million enrollees. My study is significant because it will fill the current knowledge gap in the interplay between sex, kidney disease, and cardiovascular disease in patients undergoing dialysis. The proposal is innovative since it will be the first study to examine differences in women as compared to men in cardiovascular events and revascularization strategies among dialysis patients. I will develop a novel sex-specific decision tool to determine the optimal revascularization strategy in patients with ESKD. This study aims to improve our knowledge so that clinicians can better counsel their patients and modify their risk for adverse cardiovascular outcomes. New knowledge from this proposal will lead to future studies with targeted interventions directed at reducing health disparities in patients with kidney disease to improve cardiovascular care, especially in women. I anticipate that my findings will lead to new policy decisions and actionable initiatives to reduce health disparities and foster more sex-inclusive cardiovascular health planning. I propose a career development plan that combines advanced biostatistical coursework, and didactic training in translational research methods and health equity related to understanding sex differences in cardiovascular health among patients with ESKD. I will receive mentorship by a team of expert investigators from disciplines in clinical epidemiology, mixed-methods research, and decision analysis research. Through the K23 Career Development Award Program, I will generate data, and enhance knowledge and skills in patient-oriented clinical research to submit an R01 application, and then transition to become an independent investigator.