Clinically Meaningful PTSD Improvement: Reducing Risk for Adverse Outcomes in Comorbid Cardiometabolic Disease

具有临床意义的 PTSD 改善：降低共病心脏代谢疾病不良后果的风险

• 批准号: 10683312
• 负责人: Jeffrey F. Scherrer
• 金额: $ 41.43万
• 依托单位: SAINT LOUIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-15 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10683312
• 关键词: Accounting; Address; Adverse event; African American; Age; Arousal; Cardiac rehabilitation; Cardiometabolic Disease; Cardiovascular Diseases; Cessation of life; Characteristics; Chronic Disease; Clinical; Clinical Trials; Cognition; Complications of Diabetes Mellitus; Confounding Factors (Epidemiology); DSM-V; Data; Data Collection; Data Sources; Diabetes Mellitus; Diagnosis; Disease; Disease Management; Disease Outcome; Disparity; Funding; Future; Gender; Goals; Grant; Guidelines; Health behavior; High Prevalence; Hospitalization; Hypertension; Individual; Knowledge; Laboratories; Link; Literature; Measures; Mediating; Mediator; Medical Records; Mental Depression; Mental disorders; Minority; Moods; Myocardial Infarction; National Heart, Lung, and Blood Institute; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Patients; Persons; Pharmaceutical Preparations; Phenotype; Post-Traumatic Stress Disorders; Premature Mortality; Provider; Psychotherapy; Race; Recurrence; Reduce health disparities; Research; Residual state; Risk; Risk Factors; Risk Reduction; Sampling; Self Care; Severities; Stroke; Symptoms; Testing; Time; Treatment outcome; Underrepresented Populations; United States; United States Department of Veterans Affairs; Veterans Health Administration; Work; adverse outcome; age group; associated symptom; blood pressure control; burden of illness; cardiometabolism; comorbidity; design; disparities in morbidity; disparity reduction; experience; glycemic control; health disparity; improved; improved outcome; indexing; medication compliance; modifiable risk; mortality; public health priorities; racial population; reduce symptoms; treatment guidelines

Posttraumatic stress disorder (PTSD) is the 4th most common, non-substance related, psychiatric disorder in the United States. Patients with PTSD vs. those without have a significantly greater risk for type 2 diabetes (T2D) and cardiovascular disease (CVD) and mortality. Determining if PTSD improvement is associated with addresses NHLBI priorities and informs efforts to reduce health disparities related to psychiatric disorders. But even in patients who experience improvement, residual PTSD symptoms may contribute to adverse T2D/CVD outcomes. Thus, it is important to determine which PTSD symptoms or combination of symptoms are most strongly associated with adverse T2D/CVD outcomes in patients with comorbid PTSD and T2D or CVD. better T2D/CVD outcomes and lower mortality This proposal builds on our past 4-years of funded research We now move our focus away from incident T2D/CVD to outcomes in comorbid PTSD and T2D/CVD. There are no studies that have determined if patients with comorbid PTSD and T2D or CVD who do vs. do not have clinically meaningful PTSD improvement are at lower risk for adverse T2D/CVD outcomes and death. There are no studies which have determined if specific PTSD symptoms (e.g., hyperarousal) or combination of symptoms are associated with adverse T2D/CVD outcomes and mortality. Our design determines if PTSD improvement is followed by better T2D/CVD outcomes and whether this is mediated by disease management variables such as medication adherence. focused on PTSD treatment and improved health behaviors, and incident T2D and CVD. We do not study a specific type of PTSD therapy because we want to demonstrate whether PTSD is a modifiable risk factor for T2D/CVD adverse outcomes and mortality. As in the prior funding period, we use Department of Veterans Affairs’ medical record data. This is an ideal ‘laboratory’ to test our hypotheses. In a 10 year observation period (2012-2022) we will sample 15,193 patients with PTSD and comorbid T2D and 17,442 patients with PTSD and comorbid CVD. Our aims are 1) determine if separate PTSD phenotypes (derived from latent class analysis of PTSD symptoms), and symptom change, in patients with comorbid PTSD- T2D/CVD, are differentially associated with an increased risk for adverse T2D and CVD outcomes, including disease related and all-cause mortality, 2) determine whether risks for adverse T2D and CVD outcomes, all- cause and cause specific mortality are lower in patients with vs. without a clinically meaningful PTSD improvement ; 3) determine if measures of T2D/CVD management, such as good glycemic control, statin medication adherence and improved depression, mediate the association between clinically meaningful PTSD improvement and T2D/ CVD outcomes. and 4) conduct planned age, gender, and race sub-group comparisons. Decades of research on depression and T2D/CVD led to guidelines that acknowledge depression as a risk factor for poor CVD outcomes. Positive results and confirmatory studies may eventually lead to similar guidelines that advise providers to screen and treat PTSD to improve T2D/CVD outcomes.

创伤后应激障碍（PTSD）是美国第四大常见的非物质相关精神疾病， 美国的患有PTSD的患者与没有PTSD的患者相比，患2型糖尿病的风险明显更高 (T2D)心血管疾病（CVD）和死亡率。确定PTSD的改善是否与 解决NHLBI的优先事项，并为减少健康 与精神疾病有关的差异。但即使在经历了改善的患者中， 这些症状可能导致不良的T2D/CVD结局。因此，重要的是要确定哪些PTSD 症状或症状组合与T2D/CVD不良结局的相关性最强， 患有PTSD和T2D或CVD的患者。 更好的T2D/CVD结局和更低的死亡率 这项提案建立在我们过去4年的资助研究基础上 我们现在把我们的 将注意力从T2D/CVD事件转移到PTSD和T2D/CVD共病的结果。没有研究 我已经确定了患有PTSD和T2D或CVD共病的患者是否具有临床意义， PTSD改善对不良T2D/CVD结局和死亡的风险较低。没有研究表明， 已经确定是否有特定的创伤后应激障碍症状（例如，过度觉醒）或症状组合相关 T2D/CVD的不良结局和死亡率。我们的设计决定了PTSD的改善是否会伴随着 更好的T2D/CVD结局，以及这是否由疾病管理变量（如药物）介导 坚持。 专注于PTSD治疗和改善健康行为，以及T2D和CVD事件。 我们不研究特定类型的PTSD治疗，因为我们想证明PTSD是否 是T2D/CVD不良结局和死亡率的可改变风险因素。与上一个融资期一样，我们使用 退伍军人事务部的医疗记录数据。这是一个理想的“实验室”来测试我们的假设。中 10年观察期（2012 - 2022年），我们将对15，193例PTSD和共病T2D患者进行抽样， 17，442例PTSD和共病CVD患者。我们的目标是1）确定是否单独的PTSD表型 （来自PTSD症状的潜在类别分析）和症状变化，在共病PTSD患者中， T2D/CVD与不良T2D和CVD结局的风险增加差异相关，包括 疾病相关死亡率和全因死亡率，2）确定T2D和CVD不良结局的风险，所有- 与没有临床意义的PTSD患者相比，PTSD患者的病因和病因特异性死亡率较低 改进 3）确定T2D/CVD管理的措施，如良好的血糖控制、他汀类药物 药物依从性和改善抑郁，介导临床意义的PTSD之间的关联 改善和T2D/CVD结局。 和4）进行计划的年龄、性别和种族分组 比较。数十年来对抑郁症和T2D/CVD的研究导致了承认 抑郁症是CVD不良结局的危险因素。积极的结果和验证性研究可能最终 导致类似的指导方针，建议提供者筛选和治疗PTSD，以改善T2D/CVD的结果。