CVD Risk and Outcome Heterogeneity in Older Adults with Diabetes

项目摘要 拟议研究的总体目标是为老年人的个性化护理提供证据， 糖尿病前期（PD）和糖尿病（DM），通过调查他们的风险和心血管疾病和残疾的发展。 患有PD和DM的老年人患有糖尿病发病率，特别是CVD， 残疾，这对病人来说是很重要的我们的研究将使用纵向数据来观察CVD， PD/DM患者随时间的残疾发展。这些分析将导致基于人口的实际 根据糖尿病患者心血管疾病和残疾的个体风险对他们进行分层的方法，有助于个性化护理。 我们的研究将测试PD/DM患者的CVD和残疾发展是否遵循几个不同的轨迹 不同的预测因素和风险会因年龄而异。我们假设心血管疾病可以解释 PD/DM < 75的患者比老年人残疾更多，我们可以开发风险模型， 指导临床决策。具体目标是：1）研究发展风险的异质性 CVD在中老年PD/DM患者中; 2）研究他们发生CVD风险的异质性， 残疾;和3）指定患有PD/DM的老年人中CVD和残疾的风险模型， 不同的种族和最老的老人。 为了实现我们的目标，我们将对健康和退休调查（HRS）a进行二级数据分析。 全国代表性的健康访谈调查已经收集了20多年的数据。除了 广泛的健康访谈信息，HRS还具有生物标志物（HBA 1c，总胆固醇和HDL胆固醇， CRP、胱抑素）、身体评估信息（血压、体重、腰围、步行速度）， 参与者子样本的处方药和医疗保险索赔联系。HRS允许我们 纵向评价关键变量，以解释PD/DM老年人的种族和队列变化， 并考虑多年来的管理及其变化。HRS已经招募了近6,000人， 51岁至100岁的糖尿病患者。我们会采用先进的统计分析作为重要工具，以测试我们的 关于动态过程、时间依赖性风险和年龄组差异的想法。我们相信这项工作将 为老年患者提供指导个体化DM护理的证据，并将导致以下风险模型： 结果包括老年人，不同种族和复杂的健康状况。

Project Summary The overall goal of the proposed research is to provide evidence for individualizing care for older adults with prediabetes (PD) and diabetes (DM) by investigating their risks and development of CVD and disability. Older adults with PD and DM suffer disproportionality from diabetes morbidity, particularly CVD and also disability, an outcome that really matters to patients. Our study will use longitudinal data to observe CVD and disability development in PD/DM patients over time. These analyses will lead to practical population based methods to stratify people with DM for their individual risks of CVD and disability, helping to individualize care. Our research will test whether CVD and disability development in PD/DM follows several distinct trajectories with different predictors and risks that will differ by age. We hypothesize that CVD explains the risk of disability more in people with PD/DM < 75 than in those older, and that we can develop risk models to better guide clinical decision-making. The specific aims are to: 1), investigate heterogeneity in the risk of developing CVD In adults from middle to old age aging with PD/DM; 2) investigate heterogeneity in their risk of developing disability; and 3) specify risk models for CVD and disability in people aging with PD/DM, including people with diverse ethnicities and the oldest old. To accomplish our goal we will perform secondary data analysis of the Health and Retirement Survey (HRS) a nationally representative health interview survey that has been collecting data for over 20 years. Besides extensive health interview information, the HRS also features biomarkers (HBA1c, total and HDL cholesterol, CRP, cystatin), physical assessment information (blood pressure, weight, waist circumference, walking speed), prescription medications for a subsample of participants, and Medicare claims linkages. The HRS allows us to evaluate key variables longitudinally, to account for ethnicity and cohort changes in people aging with PD/DM, and to consider management and its changes over many years. The HRS has enrolled nearly 6,000 people with diabetes aged 51 to over 100. We will employ sophisticated statistical analyses as important tools to test our ideas about dynamic processes, time-dependent risks and age-cohort differences. We believe this work will provide evidence to guide individualized DM care for older patients and will will lead to risk models for outcomes that include people of advanced age, diverse ethnicities and complex health status.