SURPASS: (Statin Use and Risk Prediction of Atherosclerotic Cardiovascular Disease in minority Subgroups)

项目总结 尽管技术进步，心血管疾病(CVD)仍然是导致死亡、残疾、 和医疗费用。然而，在准确的心血管风险预测和 预防，特别是在种族/少数民族方面。此外，心血管疾病风险存在显著的异质性。 以及西班牙裔和亚裔亚裔分组的分类结果。目前的心血管风险评估 这些工具在这些不同的人群中还没有得到很好的验证，而且在很大程度上仍然不清楚为什么少数民族 患者更不可能开始和更有可能停止挽救生命的治疗。罗德里格斯博士的总体目标是 K01的应用是为了解决未被研究的心血管疾病预测和治疗方面的知识空白 种族/少数民族人口。拟议的研究将利用电子健康记录(EHR)数据 建立了由NHLBI资助的队列，其中丰富了分类的西班牙裔和亚洲患者。使用这个 罗德里格斯博士将首先测试ACC/AHA集合队列方程在分类的亚洲和 使用来自两家大型医疗保健公司的1,234,751名患者的大型不同混合支付者队列的西班牙裔亚群 北加州和夏威夷的系统。其次，她将为不同的公司建立新的心血管疾病风险预测模型 使用机器学习技术的患者分组。最后，她将确定他汀类药物使用不足的原因，并 停止在电子病历中使用自然语言处理。这项研究将评估现有数据 来自稳定人群的真实世界临床实践，将为未来的风险预测模型和胆固醇提供信息 针对不同种族/民族群体的治疗指南。该提案与NHBLI的战略目标一致 通过利用流行病学和数据科学来了解和 解决复杂的健康问题。这项提议还将使罗德里格斯博士做好准备，以实现她的长期目标 成为心血管疾病预防和少数群体健康领域的国家领导者和独立调查者。建议数 教学和应用数据科学经验，包括高级流行病学方法和 机器学习，将使罗德里格斯博士准备将她的研究应用于心血管疾病预防和治疗的其他领域 人口。这一培训计划建立在斯坦福大学在卫生服务研究方面的优势之上， 流行病学和生物医学信息学。她的导师团队由Latha Palaniappan博士领导，包括 心血管预防和健康服务研究的专家(共同导师海登瑞克博士)应用 统计分析(Robert Tibshiani博士，顾问)，电子病历中的机器学习(Nigam Shah博士，顾问)， 以及慢性病预测和医疗决策(顾问Michael Pignone博士)。罗德里格斯医生的 团队致力于确保提案的成功，并监督她在他们的 各自的专业领域。这份K01申请中提出的研究和培训计划将发展Dr。 罗德里格斯成为一名独一无二的高技能临床医生研究员，准备竞争R级资金并推出 她的独立研究生涯。 好了！

PROJECT SUMMARY Despite advances in technology, cardiovascular disease (CVD) remains the leading cause of death, disability, and healthcare costs in the U.S. Yet, there is a tremendous gap in accurate cardiovascular risk prediction and prevention, particularly in racial/ethnic minorities. Furthermore, there is significant heterogeneity in CVD risks and outcomes for disaggregated Hispanic and Asian subgroups. The current cardiovascular risk assessment tools have not been well-validated in these diverse populations, and it remains largely unknown why minority patients are less likely to start and more likely to stop life-saving therapies. The overall goal of Dr. Rodriguez’s K01 application is to address gaps in knowledge about CVD prediction and treatment in understudied racial/ethnic minority populations. The proposed study will utilize the electronic health record (EHR) data from an established NHLBI-funded cohort enriched with disaggregated Hispanic and Asian patients. Using this cohort, Dr. Rodriguez will first test the ACC/AHA Pooled Cohort Equations in disaggregated Asian and Hispanic subgroups using a large diverse mixed-payer cohort of 1,234,751 patients from two large healthcare systems in Northern California and Hawaii. Secondly, she will build new CVD risk prediction models for diverse patient subgroups using machine learning techniques. Finally, she will identify reasons for statin underuse and discontinuation using natural language processing in the EHR. This study, which will evaluate existing data from real-world clinical practice in a stable population, will inform future risk prediction models and cholesterol treatment guidelines for diverse racial/ethnic groups. The proposal is aligned with the NHBLI’s strategic goals to eliminate health disparities and inequities by leveraging epidemiology and data science to understand and solve complex health problems. This proposal will also prepare Dr. Rodriguez to meet her long-term goal of becoming a national leader and independent investigator in CVD prevention and minority health. The proposed didactic and applied data science experiences, including training in advanced epidemiological methods and machine learning, will prepare Dr. Rodriguez to apply her research to other areas of CVD prevention and populations. This training program builds on the strengths of Stanford University in health services research, epidemiology, and biomedical informatics. Her mentorship team, led by Dr. Latha Palaniappan, includes experts in cardiovascular prevention and health services research (Dr. Heidenreich, co-mentor), applied statistical analyses (Dr. Robert Tibshirani, advisor), machine learning in the EHR (Dr. Nigam Shah, advisor), and chronic disease prediction and medical decision making (Dr. Michael Pignone, advisor). Dr. Rodriguez’s team is committed to ensuring the success of the proposal as well as overseeing her advanced training in their respective areas of expertise. The research and training plan proposed in this K01 application will develop Dr. Rodriguez into a unique and highly-skilled clinician researcher ready to compete for R-level funding and launch her independent research career. !