INVESTIGATING RACIAL DISPARITIES IN OUTCOMES AFTER AMI

据信，美国黑人在心血管疾病造成的死亡和残疾中所占的比例不成比例。《2010年健康人议程》的一个主要目标是消除这种差距。然而，迄今为止，急性心肌梗死（AMI）结局的种族差异研究仅限于死亡率检查，而没有系统评价健康状况结局（症状、功能和生活质量）。此外，还没有探讨诸如合并症（如糖尿病）、代谢差异或潜在遗传决定因素等修正因素对AMI结局种族差异的影响。我们的初步数据表明，AMI后6个月，黑人患者的健康状况（症状、功能和生活质量）明显差于白人。在此基础上 我们计划在3年内从15个中心招募4，500名患者，以检验黑人AMI患者在AMI后1年的健康状况结果比白色患者更差的基本假设。我们还计划在该队列中评估糖尿病与种族背景对结局的相互作用。每位知情同意的患者将接受基线访谈，提取其病历，捐赠空腹血液样本进行脂质和遗传分析，并在AMI后6个月和12个月进行详细的随访访谈。本SCCOR项目的具体目标包括：1）描述1年健康状况结局的种族差异; 2）描述AMI护理中的种族差异，并测试这些差异是否解释了 观察1年健康状况结果的差异; 3）描述糖尿病和非糖尿病AMI患者血清甘油三酯脂质组的种族差异，并测试这些差异是否可以解释1年结果的差异;和4）确定糖尿病和非糖尿病AMI患者中PPAR调节复合物的遗传变体的种族差异是否解释了观察到的1-年成果。通过对结果种族差异的严格描述，以及对多种潜在的社会经济、治疗、代谢和遗传介质的检查，我们将确定消除AMI后结果种族差异的机会。

Black Americans are believed to bear a disproportionate share of death and disability from cardiovascular disease. A principal goal of the Healthy People 2010 agenda is to eliminate such disparities. To date, however, studies of racial differences in acute myocardial infarction (AMI) outcomes have been limited to an examination of mortality without systematic evaluation of health status outcomes (symptoms, function and quality of life). In addition, the contribution of modifying factors such as co-morbidities (e.g. diabetes), differences in metabolism, or potential genetic determinants to racial difference in AMI outcomes have not been explored. Our preliminary data suggest that the health status outcomes (the symptoms, function and quality of life) of black patients are significantly worse than whites 6 months after AMI. Building upon this insight, we plan to enroll 4,500 patients over 3 years from 15 centers to test the fundamental hypothesis that black AMI patients have worse health status outcomes 1 year after an AMI than white patients. We also plan to evaluate the interaction of diabetes with racial background on outcomes in this cohort. Each consenting patient will undergo a baseline interview, abstraction of their medical record, donation of a fasting blood specimen for lipid and genetic analyses and detailed follow-up interviews at 6- and 12-months after their AMI. The specific aims of this SCCOR project include: 1) to describe racial differences in 1-year health status outcomes; 2) to describe racial differences in AMI care and test whether these differences account for observed disparities in 1-year health status outcomes; 3) to describe racial differences in the serum triglyceride lipidome among diabetic and non-diabetic AMI patients and test whether these differences account for disparities in 1-year outcomes; and 4) to determine whether racial differences in genetic variants of the PPAR regulatory complex among diabetic and non-diabetic AMI patients account for observed racial differences in 1-year outcomes. Through the rigorous description of racial differences in outcome, and the examination of multiple potential socio-economic, treatment, metabolic and genetic mediators, we will identify opportunities to eliminate racial disparities in outcomes after AMI.