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

心血管疾病的性别差异和透析患者的最佳冠状动脉血运重建

• 批准号: 10640075
• 负责人: Silvi Shah
• 金额: $ 19.56万
• 依托单位: UNIVERSITY OF CINCINNATI
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-07 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10640075
• 关键词: Accounting; Address; Attitude; Biometry; Cardiovascular Diseases; Cardiovascular system; Caring; Cause of Death; Cessation of life; Clinical; Clinical Research; Clinical Trials; Cohort Studies; Congestive Heart Failure; Coronary; Coronary Arteriosclerosis; Coronary Artery Bypass; Coronary Vessels; Counseling; Data; Decision Analysis; Decision Making; Decision Modeling; Dedications; Development Plans; Dialysis patients; Dialysis procedure; Discipline; Disease Outcome; Disparity; End stage renal failure; Equilibrium; Event; Exclusion; Focus Groups; Fostering; Frequencies; Funding; Future; General Population; Goals; Health Benefit; Health Planning; Health Status; Incidence; Information Systems; Infrastructure; Intervention; Ischemia; K-Series Research Career Programs; Kidney; Kidney Diseases; Knowledge; Link; Medicare claim; Mentors; Mentorship; Methodology; Methods; Modeling; Myocardial Infarction; Observational epidemiology; Outcome; Patients; Performance; Policies; Population; Prevalence; Process; Qualitative Methods; Quality of life; Reduce health disparities; Reporting; Research; Research Methodology; Research Personnel; Risk; Sex Differences; Stroke; Structure; Training; Translational Research; United States; Universities; Unstable angina; Vascularization; Woman; Women' s Health; Work; acute coronary syndrome; cardiovascular health; career; career development; clinical epidemiology; cohort; design; experience; health disparity; health equity; improved; improved outcome; innovation; men; mortality; mortality risk; novel; patient oriented; percutaneous coronary intervention; prospective; recruit; sex; sex disparity; skills; support tools; surgical risk; tool; treatment strategy

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.

项目概要 K23 职业发展提案的总体目标是为我提供必要的指导和帮助 成为具有女性专业知识的独立调查员所必需的职业发展 心血管健康和肾脏疾病。缺血性和非缺血性心血管疾病仍然是最常见的疾病 开始透析的患者死亡的主要原因，心血管事件的负担增加 随着肾脏疾病的进展。中心假设是，在终末期肾病患者中 疾病（ESKD），与男性相比，女性发生心血管事件的频率更高，并且接受 次优的血运重建治疗策略，导致更高的心血管死亡率。目标 拟议的研究旨在检查缺血性和非缺血性心血管事件的性别差异， 冠状动脉血运重建策略以及透析患者的临床结果。我将开发一个决策模型 确定冠状动脉疾病透析患者的最佳冠状动脉血运重建策略 并进行焦点小组研究，探讨患者对冠状动脉血运重建的态度和障碍。我的 初步数据显示，ESKD 患者中，女性心血管事件的发生率高于男性 人口。拟议的队列研究利用了最大的前瞻性维护的基础设施 美国的透析患者队列，有超过 600 万参与者。我的研究很重要，因为它 将填补目前关于性、肾脏疾病和心血管疾病之间相互作用的知识空白 接受透析的患者。该提案具有创新性，因为它将是第一项考察差异的研究 女性与男性在透析患者心血管事件和血运重建策略方面的比较。 我将开发一种新型的性别特异性决策工具来确定患者的最佳血运重建策略 与 ESKD。这项研究旨在提高我们的知识，以便临床医生能够更好地为患者提供咨询和 改变不良心血管结局的风险。该提案中的新知识将引导未来 旨在减少肾病患者健康差异的有针对性的干预措施的研究 改善心血管护理，尤其是女性。我预计我的发现将导致新的政策决定 以及可采取行动的举措，以减少健康差距并促进更具性别包容性的心血管健康 规划。我提出了一个职业发展计划，结合了先进的生物统计课程和教学 与理解性别差异相关的转化研究方法和健康公平方面的培训 ESKD 患者的心血管健康状况。我将接受专家调查团队的指导 来自临床流行病学、混合方法研究和决策分析研究等学科。通过 在 K23 职业发展奖励计划中，我将生成数据，并增强以下方面的知识和技能： 以患者为中心的临床研究提交R01申请，然后转型成为独立的 研究者。