Among patients with COVID19, there is a high prevalence of cardiovascular disease, and >7% of patients experience myocardial injury as a result of the infection (22% of critically ill patients). COVID19 may disproportionately affect people with cardiovascular disease. Previous observations suggest that underlying cardiovascular disease is associated with an increased risk of in-hospital death among patients hospitalized with COVID19. Furthermore, coagulopathy and vascular endothelial dysfunction have also been proposed as complications of COVID19. We propose a supplement to ?Adopting a Precision Medicine Paradigm in Puerto Rico: leveraging ancestral diversity to identify predictors of clopidogrel response in Caribbean Hispanics? to describe and better understand how the COVID19 pandemic is affecting our established cohort of Caribbean Hispanics with cardiovascular disease. Our cohort is currently made up of 549 patients with coronary artery disease (CAD), peripheral artery disease (PAD), and/or a history of stroke (CVA) who are currently receiving treatment with the antithrombotic medication clopidogrel (with or without aspirin). Building on the personalized medicine approach we are already developing for this population, we will combine serologic testing to measure individual exposure to the SARS-CoV-2 virus with their health (symptoms, clinical outcomes, medical comorbidities), access to care (including SARS-CoV-2 testing), and household status during the COVID19 pandemic. This will allow us to evaluate the true prevalence of SARS-CoV-2 exposure in our cohort, as well as understand the phenotypic effects of the virus in our population. These data will shed light on the underlying biological pathways involved in COVID-19 pathogenesis. We will then combine data from our cohort with patients hospitalized for acute COVID19 to perform a targeted and untargeted exploratory genome-wide association study of poor clinical outcomes (e.g., hospitalizations, ICU admission, need of mechanical ventilators) in order to identify potential risk markers or protective genes among Caribbean Hispanics suffering from the disease.
The majority of clinical studies lack the racial/ethnic diversity of the US population, particularly our under- represented minority populations of Latinos (i.e., ~1% of participants in clinical trials). This proposal is aligned with the consensus report of the Institute of Medicine that recommends identifying patient characteristics and treatments that vary by ethnicity so that personalized interventions can be developed in Caribbean Hispanics to minimize differences in care and disparities in outcomes. It is also consistent with Healthy People 2020, which seeks to eliminate health disparities in Hispanics, as well as prevent harm through valid and useful genomic tools in clinical practices. OMB No. 0925-0001/0002 (Rev. 03/2020 Approved Through 02/28/2023) Page Continuation Format Page
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