INVESTIGATING RACIAL DISPARITIES IN OUTCOMES AFTER AMI

据信，美国黑人因心血管疾病而死亡和残疾的比例不成比例。《2010年健康人议程》的一个主要目标是消除这种差距。然而，到目前为止，对急性心肌梗死(AMI)预后的种族差异的研究仅限于对死亡率的检查，而没有对健康状况结果(症状、功能和生活质量)进行系统评估。此外，修改因素，如共病(如糖尿病)，代谢差异，或潜在的遗传决定因素对急性心肌梗死预后的种族差异的贡献还没有被探索。我们的初步数据表明，在急性心肌梗死6个月后，黑人患者的健康状况结果(症状、功能和生活质量)明显比白人差。以此为基础 我们计划在3年内从15个中心招募4,500名患者，以检验黑人急性心肌梗死患者在急性心肌梗死后1年的健康状况预后比白人患者差的基本假设。我们还计划评估糖尿病与种族背景对这一队列结果的交互作用。每个同意的患者都将接受基线访谈，提取他们的医疗记录，捐赠空腹血液样本进行血脂和基因分析，并在急性心肌梗死后6个月和12个月进行详细的随访访谈。该SCCOR项目的具体目标包括：1)描述一年内健康状况结果的种族差异；2)描述急性心肌梗死护理中的种族差异，并测试这些差异是否可以解释 这些研究包括：1)观察糖尿病和非糖尿病急性心肌梗死患者1年健康状况预后的差异；3)描述糖尿病和非糖尿病急性心肌梗死患者血清甘油三酯脂体的种族差异，并测试这些差异是否可以解释1年预后的差异；以及4)确定糖尿病和非糖尿病急性心肌梗死患者PPAR调节复合体基因变异的种族差异是否可以解释观察到的1年预后的种族差异。通过对预后的种族差异的严格描述，以及对多种潜在的社会经济、治疗、代谢和遗传中介的检查，我们将确定消除急性心肌梗死后预后的种族差异的机会。

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.