Gender Race and Ethnic Disparities Research in Cardiovascular Disease Prevention

描述(由申请人提供)：在过去十年的研究中，心血管疾病(CVD)中的性别和种族/民族差异已被很好地记录下来。职业生涯中期研究奖的续展申请者Lori Mosca博士和她的许多学员，由于最初的K24奖，为我们在这一领域的知识进步做出了巨大贡献，在此期间，Mosca博士被提升为哥伦比亚大学医学中心的医学教授。关于护理和结果不一致的原因仍然存在大量问题，这是一个严重的科学差距，可以为旨在减少预防和治疗心血管疾病方面的性别和种族/差异的干预措施提供参考。该奖项的目的是为申请者提供受保护的时间，以增加高质量的以患者为导向的研究人员队伍，致力于a)了解性别和种族/民族对心血管疾病结果的独立贡献，以及b)针对可能减少差异的可改变因素开发新的干预措施。该奖项还将支持申请者有时间与其他对心血管疾病差异研究感兴趣的高级调查人员进行互动和学习，这对她的职业发展阶段来说是一个适当和重要的承诺。申请者和她的指导者提供的大量初步数据表明，在心血管疾病意识、风险因素控制和预防障碍方面存在差异。拟议的研究提供了一个及时的科学机会，可以从现有的和正在进行的研究中获得数据，这些研究非常适合评估差异的独立贡献者，并为旨在减少心血管差异的未来临床试验和干预措施的设计提供信息。这项研究的具体目的包括：1)检验种族/民族与a)冠心病是女性死亡的主要原因的认识之间的联系；b)了解心脏病发作症状和遇到心脏病症状时应采取的行动；c)在1997-2009年三年一次的具有全国代表性的女性样本中，了解降低冠心病风险的预防性/替代疗法的认知；2)确定针对住院的心血管疾病患者家属的筛查和教育计划的有效性是否因种族/民族而异，并检查适应、基线风险、和心理社会因素作为计划有效性的潜在混杂因素/效果修饰者，以及3)确定在连续进入大型医疗中心心血管疾病服务专线的患者中，心血管疾病危险因素的控制是否与种族/民族独立相关，并确定是否与服药依从性以及住院前有付费或无偿(家人/朋友)照顾者的关系。这项研究的意义和影响是，它将扩大我们对健康差距的了解，并将解决不同结果的病因，目标是开发有效的干预措施，以优化心血管疾病风险负担过重的人群的心血管健康。 公共卫生相关性：这项研究的目的是通过研究健康差异的原因的创新方法，为减少心血管疾病预防中的性别、种族和民族差异做出贡献，并利用所获得的知识为有针对性的教育计划提供信息，并设计未来的临床研究，旨在减少差异，改善所有人的心血管健康。

DESCRIPTION (provided by applicant): Gender and racial/ethnic disparities in cardiovascular disease (CVD) have been well documented over the past decade of research. The applicant for renewal of a Midcareer Research Award, Dr. Lori Mosca, and many of her mentees, have contributed substantially to advancement of our knowledge in this field as a result of the initial K24 award, during which time Dr. Mosca was promoted to Professor of Medicine at Columbia University Medical Center. Substantial questions remain regarding the reasons for discrepancies in care and outcomes, a critical scientific gap that could inform interventions designed to reduce gender and racial/disparities in the prevention and treatment of CVD. The goal of this award is to provide the applicant with protected time to increase the pool of high quality multidisciplinary patient oriented researchers dedicated to a) understanding the independent contributions of gender and race/ethnicity to CVD outcomes and b) developing novel interventions targeted to modifiable factors that may reduce disparities. The award will also support the applicant's time to interact with and learn from other senior investigators with an interest in CVD disparities research, an appropriate and important commitment for her stage of career development. Extensive preliminary data by the applicant and her mentees has documented disparities in CVD awareness, risk factor control, and barriers to prevention. The proposed research provides a timely scientific opportunity to garner data from existing and ongoing studies uniquely suited to evaluate independent contributors to disparities and inform the design of future clinical trials and interventions aimed to reduce CVD disparities. The specific aims of the research include: 1) To examine the association between race/ethnic group and a) awareness of coronary heart disease as the leading cause of death in women, b) knowledge of heart attack symptoms and actions to take when experiencing heart attack symptoms, and c) perceptions of preventive/alternative therapies for coronary heart disease risk reduction, among nationally representative samples of women surveyed triennially from 1997-2009, 2) To determine whether the effectiveness of a screening and education program for family members of patients hospitalized with CVD to improve lifestyle factors over one year varies by race/ethnic group and to examine acculturation, baseline risk, and psychosocial factors as potential confounders/effect modifiers of program effectiveness and 3) To ascertain whether control of CVD risk factors is independently associated with race/ethnic group among consecutive patients admitted to the cardiovascular disease service line of a major medical center, and to determine whether the association with medication adherence and having a paid or non-paid (family member/friend) caregiver prior to hospitalization. The significance and impact of this research is that it will extend our knowledge about health disparities and will address the etiology of differential outcomes with the goal of developing effective interventions to optimize cardiovascular health among populations that bear a disproportionate burden of CVD risk. PUBLIC HEALTH RELEVANCE: This purpose of this research is to contribute to a reduction in gender, racial, and ethnic disparities in cardiovascular disease prevention through innovative approaches to study the causes of health disparities and to use the knowledge gained to inform targeted educational programs and to design future clinical studies aimed to reduce disparities and improve cardiovascular health for all.