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

项目总结 这项K23职业发展计划的总体目标是为我提供必要的指导和 成为一名具有妇女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 开始透析的患者的主要死亡原因，心血管事件的负担增加 随着肾脏疾病的发展。中心假设是，在终末期肾病患者中 疾病(ESKD)，女性比男性有更高的心血管事件和接受 次优的血运重建治疗策略，导致更高的心血管死亡率。目标 这项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， 透析患者的冠状动脉血运重建策略和临床结果。我将开发一个决策模型 冠心病透析患者最佳冠状动脉血运重建策略的探讨 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。我的 初步数据显示，在ESKD中，女性发生心血管事件的频率高于男性 人口。拟议的队列研究利用了预期维护的最大规模的基础设施 美国的透析患者队列，注册人数超过600万。我的研究很有意义，因为它 将填补目前在性、肾脏疾病和心血管疾病之间相互作用的知识空白 正在接受透析的患者。这项提议是创新的，因为它将是第一项研究，以检查不同 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。 我将开发一种新的针对性别的决策工具，以确定患者最佳的血管重建策略 与ESKD合作。这项研究的目的是提高我们的认识，使临床医生能够更好地为他们的患者提供咨询和 修改他们心血管不良结局的风险。从这项建议中获得的新知识将带来未来 旨在减少肾病患者健康差距的有针对性的干预研究 改善心血管护理，特别是女性。我预计我的发现将导致新的政策决定 减少健康差距和促进更多性别包容的心血管健康的可行倡议 计划。我提出了一个职业发展计划，将高级生物统计学课程和教学相结合 与理解性别差异有关的转化性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人员的指导 来自临床流行病学、混合方法研究和决策分析研究的学科。穿过 K23职业发展奖励计划，我将生成数据，并在 以患者为导向的临床研究提交R01申请，然后过渡成为独立的 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.