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Assessing Syndemics of Cardiovascular Disease in People with and without HIV

评估感染者和未感染者的心血管疾病综合征

基本信息

批准号：
10683388
负责人：
Derek D Satre
金额：
$ 72.99万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-08-15 至 2027-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10683388
关键词：
Address Age Alcohols Anti-Retroviral Agents Atrial Fibrillation Biological Biological Factors Biological Markers Biological Specimen Banks Body Weight Cardiovascular Diseases Cardiovascular system Cessation of life Communities Coronary Data Data Sources Development Discrimination Disease Disease Outcome Disease Progression Disparity Dyslipidemias Economic Conditions Economic Factors Elderly Electronic Health Record Emotional Enrollment Evaluation Event Functional disorder Future GDF15 gene General Population Geography Goals HIV HIV Infections Health Health Services Accessibility Health system Healthcare Systems Heart failure High Prevalence Homelessness Immunologic Deficiency Syndromes Inflammation Insurance Benefits Integrase Intervention Interview Joints Knowledge Link Measures Mental Depression Mental Health Modeling Morbidity - disease rate Myocardial Infarction Neighborhoods Obesity Patients Peripheral arterial disease Persons Population Public Health Recording of previous events Research Resources Risk Risk Factors Sampling Smoking Social Conditions Social isolation Stigmatization Stroke Substance Use Disorder Surveys Toxic effect Trauma Vascularization Vulnerable Populations Woman antiretroviral therapy burden of illness cardiovascular disorder prevention cardiovascular disorder risk care systems cohort comparison group deprivation design follow-up health care availability health care disparity high risk housing instability inhibitor marginalized population men mortality preventive intervention pro-brain natriuretic peptide (1-76)recruit response social social factors social relationships social stigma substance use syndemic synergism treatment disparity

项目摘要

PROJECT SUMMARY/ABSTRACT Combination antiretroviral therapy (ART) has led to dramatic declines in morbidity and mortality for people with HIV (PWH). However, as PWH age, the risk of cardiovascular disease (CVD) has increased, with a projected lifetime burden among PWH of 65% for men and 44% for women. The higher observed risk of CVD in PWH compared with the general population is a result of the higher prevalence of established CVD risk factors (smoking, alcohol, dyslipidemia), and direct effects of HIV infection, including immunodeficiency and inflammation. Recent studies have also implicated integrase strand inhibitors and other ART with increases in body weight, which may further increase risk of CVD. There are also many understudied social and economic conditions that may contribute to the high CVD risk in PWH, including disparities in healthcare access and treatment, social isolation, history of trauma, and HIV stigma. While most studies have considered the impact of CVD risk factors in isolation, it is well known that many frequently co-occur, such as smoking, alcohol, obesity and depression. Furthermore, the ways in which social factors exacerbate the effect of biomedical CVD risk factors among PWH is not well understood. Using a syndemics framework, which is uniquely suited for the evaluation of the clustering of social and biological conditions in vulnerable populations, we will investigate reasons for the persistently high risk of CVD among PWH. With the team’s interdisciplinary expertise in HIV, CVD and syndemics, our study is designed to understand how social, economic and biological factors combine in PWH, contributing to their high CVD risk. We will leverage comprehensive electronic health record (EHR) data from Kaiser Permanente (KP) and detailed existing survey and biospecimen from the KP Research Bank (KPRB). In Aim 1, we will examine synergistic relationships with major adverse cardiovascular events (MACE) among 29,000 PWH and 1:20 matched people without HIV (PWoH) enrolled in KP from 2000-2021. We will evaluate clusters of social and biological factors available in EHRs such as mental health, substance use disorders (SUD), neighborhood deprivation, and insurance benefits. For Aim 2, we will perform a complementary study within the KPRB to identify synergistic relationships with subclinical CVD among 1,969 PWH (709 with biospecimens) and 1:1 matched PWoH. We will consider additional social factors from surveys that may impact CVD risk, including discrimination and stigma, social isolation, emotional and practical health support, and economic factors. Finally, Aim 3 will involve recruitment of 60 PWH from high-risk clusters identified in Aims 1 and 2 for in-depth qualitative interviews to explore how the syndemic conditions contribute to the high CVD risk. The interviews will inform a follow-up survey of 350 PWH recruited from the same high- risk clusters, to confirm syndemic conditions in a larger sample that could be addressed in future CVD prevention efforts. Integrating quantitative and qualitative data sources, this study has great potential to inform future comprehensive community- and health system-level interventions to reduce the CVD burden in PWH.

项目总结/文摘