Treatment for TIA to manage cardiovascular disease and diabetes in older adults

摘要： 2型糖尿病(T2 DM)和心血管疾病(CVD)是发病率和 美国老年人口死亡率，医疗保险每年花费超过1040亿美元 系统。患有T2 DM的联邦医疗保险受益人的平均每月费用是 没有T2 DM的医疗保险受益人。患有T2 DM的医疗保险受益人的心血管疾病费用占50% 从心血管疾病到联邦医疗保险的总费用。由于1)T2 DM和心血管疾病的高患病率，2)其高昂的成本，3) 长寿，以及4)符合医疗保险条件的个人数量不断增加，了解其发展轨迹 糖尿病患者的心血管健康状况正变得越来越重要。然而，许多现代人 包括颈动脉内膜切除术(CE)和颈动脉支架植入术(CAS)在内的治疗模式是基于 在高效抗血小板药物、他汀类药物、抗高血压药物广泛使用之前进行的研究 和降糖药物预防心血管疾病，在最近的戒烟和戒烟之前 干预措施。我们建议开发一个糖尿病患者心血管疾病的详细模型，并 使用它更新患有TIA的患者的CE和CAS的治疗范例。 结合心血管健康研究(CHS)和社区动脉粥样硬化风险(ARIC)数据 集合，我们将建立T2 DM患者短暂性脑缺血发作和短暂性脑缺血发作后的危险方程。这个 风险方程式将取决于人口统计学描述、生物标志物、治疗史和临床史。我们 将根据现代护理标准校准和验证方程式。最终的风险方程将被积分 纳入密歇根糖尿病模型，提供了心血管疾病(短暂性脑缺血发作、中风和心脏病)的统一模型。vbl.使用 在我们的CVD模型中，我们将对CE加现代医疗管理(MMM)与 CAS加MMM与非手术的MMM比较，我们将制定针对年龄的治疗建议 根据最佳可用证据，TIA在老年人中的应用。

Abstract: Type 2 diabetes (T2DM) and cardiovascular disease (CVD) are important causes of morbidity and mortality in the elderly population in the United States, costing over $104 billion annually to the Medicare system. The average monthly cost for Medicare beneficiaries with T2DM is 2.2 times higher than that for a Medicare beneficiary without T2DM. Costs of CVD for a Medicare beneficiary with T2DM account for 50% of total costs to Medicare from CVD. Because of 1) the high prevalence of T2DM and CVD, 2) their high costs, 3) increasing longevity, and 4) the increasing number of Medicare-eligible individuals, understanding the trajectory of cardiovascular health in persons with diabetes is becoming increasingly important. However, many modern treatment paradigms, including carotid endarterectomy (CE) and carotid artery stenting (CAS), are based on studies performed before the widespread use of high-potency anti-platelet medications, statins, antihypertensive and glucose lowering medications to prevent CVD, and prior to recent smoking prevention and cessation interventions. We propose to develop a detailed model of cardiovascular disease in persons with diabetes, and to use it to update treatment paradigms for CE and CAS in individuals with TIA. Combining the Cardiovascular Health Study (CHS) and Atherosclerotic Risk in Communities (ARIC) data sets, we will develop risk equations for incident TIA and ischemic stroke following TIA in people with T2DM. The risk equations will depend on demographic descriptors, biomarkers, treatment history, and clinical history. We will calibrate and validate the equations to modern standards of care. The final risk equations will be integrated into the Michigan Model for Diabetes, providing a unified model of CVD (TIA, stroke, and heart disease). Using our CVD model, we will perform cost-effectiveness analysis of CE plus modern medical management (MMM) vs CAS plus MMM vs MMM without surgery and we will develop age-specific recommendations for treatment of TIA in older adults based on best-available evidence.