Weight in Secondary Prevention (WISP)

描述(由申请人提供)：冠心病(CAD)或2型糖尿病(DM)患者承受着心血管疾病发病率、死亡率和医疗费用过高的沉重负担。国家数据显示，这些患者约占成年人口的10%，占与肥胖相关的医疗费用的大部分。80%的CAD患者和90%的DM患者超重或肥胖。正如这项研究所做的那样，将体重作为二级预防这些患者不良事件的风险因素是有吸引力的，因为体重优化已被证明可以改善患者的预后。这项研究建议使用来自两个大型基于人群的冠心病或糖尿病患者登记的独特数据集来描述身体质量指数(BMI)轨迹、与这些轨迹相关的患者特征以及这些轨迹对医疗费用的影响。 这项研究针对的是美国国立卫生研究院在现实世界中系统观察肥胖相关行为的目标。它还解决了更广泛的长期目标，即针对最合适的患者设计改进的能量平衡计划，以努力减少未来的心血管事件和其他与BMI相关的并发症。 具体目标是，对于新诊断为冠心病或2型糖尿病并符合其他研究定义的资格标准的成年患者(n=10,000)：1)估计他们在诊断后1、3和5年的BMI轨迹；2)确定哪些患者的人口统计和疾病相关特征与他们诊断后1、3和5年的BMI轨迹显著相关；以及3)检查诊断后1、3和5年的BMI轨迹与总医疗费用的关系。所有分析将分别针对新诊断的冠状动脉疾病患者和新诊断的2型糖尿病患者进行。 这项研究将使用来自Kaiser Permanente西北疾病登记处的电子数据、电子医疗记录和其他数据库。利用相关数据库中的现有数据，将能够使用增长曲线分析技术对体重指数轨迹进行低成本评估。这项评估将提供基于社区的背景信息，有助于确定如何最有效地应用体重管理计划。 相关性：这项研究重点关注与肥胖或超重相关的未来健康问题风险最高的患者--那些患有冠状动脉疾病和2型糖尿病的患者。了解哪些患者需要最多的支持来控制体重，将使我们能够设计出最具成本效益的未来计划。

DESCRIPTION (provided by applicant): Patients with coronary artery disease (CAD) or type-2 diabetes mellitus (DM) sustain large burdens of excess cardiovascular morbidity, mortality, and health care costs. National data reveal that these patients make up about 10% of the adult population and account for the majority of obesity related health care costs. Eighty percent of CAD patients and 90% of DM patients are overweight or obese. Focusing on weight as a risk factor in the secondary prevention of adverse events in these patients, as this study does, is attractive because weight optimization has been shown to improve patient outcomes. This study proposes to use a unique dataset from two large population-based registries of patients with CAD or DM to describe body mass index (BMI) trajectories, patient characteristics associated with those trajectories, and the effect of the trajectories on health care costs. This study addresses the NIH goal of systematic observations of obesity-related behaviors in real world settings. It also addresses the broader long-term goal of designing improved energy balance programs targeted at the most appropriate patients in an effort to reduce future cardiovascular events and other BMI-related complications. Specific aims are, in adult patients with a new diagnosis of CAD or type 2 DM and who meet other study- defined eligibility criteria (n=10,000): 1) to estimate their BMI trajectories 1, 3, and 5 years post-diagnosis; 2) to determine which patient demographic and disease-related characteristics are significantly associated with their 1-, 3-, and 5-year post-diagnosis BMI trajectories; and 3) to examine the association of the 1-, 3-, and 5-year post-diagnosis BMI trajectories with total health care costs. All analyses will be conducted separately for those with newly diagnosed coronary artery disease and those with newly diagnosed type 2 diabetes mellitus. This study will use electronic data from Kaiser Permanente Northwest disease registries, electronic medical record, and other databases. The use of existing data from linked databases will allow conducting a low-cost evaluation of BMI trajectories using growth curve analysis techniques. This evaluation will provide community-based background information useful for determining how to most effectively apply weight management programs. Relevance: This study focuses on patients at highest risk for future health problems related to obesity or overweight-those with coronary artery disease and type 2 diabetes mellitus. Understanding which patients will need the most support to manage weight will allow us to design the most cost-effective future programs.