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

项目摘要 本K23职业发展建议书的总体目标是为我提供必要的指导， 职业发展是成为一名具有妇女问题专门知识的独立调查员所必需的。 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 开始透析患者的主要死亡原因，心血管事件的负担增加 与肾脏疾病的进展有关。中心假设是，在终末期肾病患者中， 在患有ESKD的女性中，与男性相比，女性的心血管事件发生率更高， 次优的血运重建治疗策略，导致更高的心血管死亡率。的目标 这项研究的目的是检查缺血性和非缺血性心血管事件的性别差异， 透析患者的冠状动脉血运重建策略和临床结局。我会建立一个决策模型 确定冠心病透析患者的最佳冠脉血运重建策略 并进行焦点小组研究，以探讨患者对冠状动脉血运重建的态度和障碍。我 初步数据显示ESKD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， 在美国的透析患者队列中，有超过600万的登记者。我的研究意义重大，因为它 将填补目前在性别、肾脏疾病和心血管疾病之间相互作用方面的知识空白， 接受透析的患者。这项建议是创新的，因为它将是第一项研究，以审查不同的， 女性与男性相比，在透析患者中心血管事件和血运重建策略。 我将开发一种新的性别特异性决策工具，以确定患者的最佳血运重建策略 关于ESKD这项研究旨在提高我们的知识，使临床医生可以更好地咨询他们的病人， 降低心血管不良结局的风险。这项提案的新知识将导致未来 针对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 和可行的举措，以减少健康差距，促进更多的性别包容性心血管健康 规划我提出了一个职业发展计划，结合先进的生物统计学课程，和教学 与理解性别差异有关的转化研究方法和健康公平培训， ESKD患者的心血管健康状况。我将接受一组专家调查员的指导 来自临床流行病学、混合方法研究和决策分析研究的学科。通过 K23职业发展奖励计划，我将生成数据，并提高知识和技能， 以患者为导向的临床研究提交R 01申请，然后过渡为独立研究 调查员

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.