Hispanics are the largest ethnic minority group in the country and MA constitute almost 80% of Hispanics in California. MA have a high prevalence of type 2 diabetes and a higher risk for diabetic nephropathy (DN). Paradoxically, data including our own suggest that CVD burden may be lower in MA than non-Hispanic Whites (NHW). We seek to define the CVD burden (coronary artery calcification, CAC) and its determinants in a high-risk sub-group of non-dialyzed diabetics with DN (125 MA, 125 NHW), in order to test three hypotheses: 1) Among individuals with DN, the CAC scores in MA are lower and progress more slowly, than among NHW; 2) The socioeconomic status (SES) of MA individuals with DN is significantly lower than of NHW; and 3) Among individuals with DN, MA have a lower all-cause and CVD mortality. Ten routinely measured, two additional CVD risk factors (homocysteine, leptin) and three SES variables, pre-specified for primary analyses, will be ascertained at baseline, 12 and 24 months. CAC will be ascertained by electron beam computerized tomography at baseline and 24 months. The relationship of CVD risk factors and SES variables that vary by ethnicity will be tested for their contribution to ethnic differences in CAC. The entire cohort will be followed from enrollment till the end of the grant period to ascertain ethnic differences in all-cause and CVD mortality; a high event rate in this population provides power to test the hypotheses thus proposed. A rigorous plan for complete follow-up is proposed. Thus, this study will define for the first time the comparative atherosclerotic burden in MA and NHW with DN and the potential role of several CVD risk factors. It will test the novel hypothesis that despite medical and SES factors that might increase the risk for CVD mortality in MA, the opposite may be true. Identifying health-care disparities will permit us to design targeted interventions to improve the health of ethnic minorities. Recognition of factors associated with the lower CVD risk among MA or the higher risk among NHW may help develop therapies that may potentially reduce the CVD burden among patients with DN. The applicant has institutional support and a career development plan including obtaining a Masters in Clinical Investigation, to achieve his career goals.
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