2 results
42956 Patterns and impact of long-term glucocorticoid use on RA patients at risk for major adverse cardiac events
- Beth I. Wallace, Yuqing Gao, Punyasha Roul, Shirley Cohen-Mekelberg, Bryant England, Ted Mikuls, Daniel J. Clauw, Rodney Hayward, Akbar K. Waljee
-
- Journal:
- Journal of Clinical and Translational Science / Volume 5 / Issue s1 / March 2021
- Published online by Cambridge University Press:
- 30 March 2021, p. 141
-
- Article
-
- You have access Access
- Open access
- Export citation
-
ABSTRACT IMPACT: Glucocorticoid steroids are commonly used despite known dose-dependent cardiovascular toxicity, yet little is known about a) how patients with other cardiovascular risk factors use glucocorticoids, and b) how risks of glucocorticoid treatment might vary depending on a patient’s baseline cardiovascular risk. OBJECTIVES/GOALS: Up to one-third of RA patients use long-term glucocorticoids (GCs) despite a known, dose-dependent association with increased risk of major adverse cardiovascular events (MACE). We aim to evaluate patterns of GC use among RA patients with other MACE risk factors (i.e. diabetes, smoking), and examine how GC use may potentiate these risk factors. METHODS/STUDY POPULATION: We used claims data from Veterans Health Administration to identify 6,090 RA patients with ≥1 rheumatology clinic visit during 2013-2017. We used logistic regression to evaluate associations between incident MACE between 2013-2018, recent long-term GC use, and 5 MACE risk factors: hypertension, diabetes, hyperlipidemia, smoking, and prior MACE. We included two-way interaction terms between GC use and each risk factor. We used a claims-based algorithm to define MACE as any of acute MI, ischemic stroke, TIA, sudden death, or coronary revascularization, between index date and 12/31/2018. We defined index date as first rheumatology visit after meeting RA diagnostic criteria, and recent long-term GC use as ≥90 days’ supply dispensed over 2 years prior to index date. RESULTS/ANTICIPATED RESULTS: Among 2,884 eligible patients,1,553 (54%) had MACE risk factors, and 97 (3%) had prior MACE (Table 1). Overall, 16% of patients recently used long-term GC, compared to 17% of patients with MACE risk factors, and 22% of patients with prior MACE. Incident MACE occurred in 308 (11%) patients, 24% of whom had recent long-term GC use. Recent long-term GC use was independently associated with increased incident MACE (Table 2). While no interaction term was statistically significant overall, differences in odds of incident MACE were seen across levels of recent GC use for several risk factors, particularly diabetes (OR 2.10, 95% CI [0.93-4.77]), tobacco use (OR 2.88, 95% CI [1.16-7.14]) and prior MACE (OR 2.41, 95% CI [0.73-7.95]). DISCUSSION/SIGNIFICANCE OF FINDINGS: Long-term GC use is common among RA patients with MACE risk factors. In this cohort, 25% of patients with incident MACE had recently used long-term GC. Long-term GC use may potentiate effects of comorbidities like diabetes and smoking, disproportionately increasing MACE risk in certain patients.
79512 The Great Plains IDeA CTR Research Scholar Program
- Ted Mikuls, Heather Braddock, Lani Zimmerman
-
- Journal:
- Journal of Clinical and Translational Science / Volume 5 / Issue s1 / March 2021
- Published online by Cambridge University Press:
- 30 March 2021, p. 146
-
- Article
-
- You have access Access
- Open access
- Export citation
-
ABSTRACT IMPACT: To date, our Scholars have been highly productive in the conduct of impactful research and have contributed to the literature through dissemination of their findings. OBJECTIVES/GOALS: The primary purpose of the Great Plains IDeA Research Scholars Program (RSP) is to support the development and retention of early-career faculty preparing to compete for external funding as clinical-translational research (CTR) investigators. We developed processes for RSP applications, prioritization, and selection criteria. METHODS/STUDY POPULATION: In year 1, we admitted 4 Scholars and have since added 5 additional Scholars. Scholars are retained in the program until they receive R- or K-level funding or if progress is deemed to be substandard on two consecutive 6-month reviews (no awards revoked to date). Each scholar was assigned a mentor(s) or mentoring team. Each participant developed 1-year goals and a 4-5-year plan that included a refined proposal to collect preliminary data, a timetable for grant submissions (with a focus on R01 applications or equivalent), and personal goals to enhance chances of success. Scholars composed an Individual Development Plan (IDP) with mentor(s) feedback to identify the skills needed to achieve goals. Each Scholar completed pilot work to generate the requisite preliminary data for an extramural grant application. RESULTS/ANTICIPATED RESULTS: Over four years, we have had 9 scholars from 4 sites with 51 total applications. All scholars completed required grant writing seminar courses, an 8-hour Responsible Conduct of Research course, and were given access to seminars and workshops sponsored by the Great Plains IDeA CTR. Scholars received 0.5 FTE in research support and $50,000 annual funding to support their research and/or career development activities. Seven of 9 scholars have completed the program to date, collectively receiving an R01 (1), a U01 (1), a K23 (1), a VA Career Development Award (1), or COBRE pilot projects leadership roles (3). All remain active faculty at their institution. Two remaining scholars are working towards independent funding: both have submitted extramural grant applications with anticipated funding this year. DISCUSSION/SIGNIFICANCE OF FINDINGS: To date, our Scholars have been highly productive in the conduct of impactful research. They have submitted 36 grants; culminating in 27 funded projects and >$7.5 million in total funding for 7 graduates. They have disseminated their findings through 121 publications and 48 invited regional/national presentations.