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Addressing the Racial Disparity of Angiotensin Inhibitor Benefit in HFrEF Hospitalizations: Distinguishing Genomic and Social Factors

Award Number: F31HL167561
ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: FELLOWSHIP/SCHOLARSHIP/STUDENT LOANS
PERIOD OF PERFORMANCE START DATE: 05/15/2023
PERIOD OF PERFORMANCE END DATE: 07/28/2025

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Addressing the Racial Disparity of Angiotensin Inhibitor Benefit in HFrEF Hospitalizations: Distinguishing Genomic and Social Factors - Project Summary / Abstract Heart failure (HF) affects ~6.2 million Americans and is one of the leading causes of hospitalization in the U.S. Hospitalizations for heart failure (HHF) account for 80% of HF costs since 83% of HF patients are hospitalized at least once and 43% at least four times. About 30% of HF patients die within one year of being hospitalized. Black HF patients experience higher hospitalization rates over time compared to White HF patients. Angiotensin Inhibitors prevent HHF. Although these drugs are most effective in patients with reduced ejection fraction (HFrEF), HHF patients remain high, suggesting that drug response differs between individuals. Race seems to be a critical factor in angiotensin inhibitor response because White HF patients experienced a 44% reduction in the risk of HHF on these drugs, while this effect was not seen in Black HF patients. Although this difference in responsiveness to angiotensin inhibitors is not yet fully understood, these drugs are guideline- recommended for all HFrEF patients. Given the increasing frequency, costs, and grave outcomes, there is a critical need to understand the factors underlying racial disparity in the angiotensin inhibitor-associated reduction of HFrEF hospitalizations. Race is a complex construct of social and genomic variables, and both may play a role in this racial disparity. Our central hypothesis is social variables better explain this racial disparity. Therefore, the overall objective is to understand the effects of self-identified race, genomics, and social variables in the racial disparity of angiotensin inhibitor-associated reductions in HFrEF hospitalizations. Pharmacogenomic (PGx) studies often rely on self-identified race instead of genomic ancestry, and findings of genetic variants responsible for differences in HF treatment outcomes are inconsistent. Aim 1 overcomes this limitation with a diverse cohort of HFrEF patients (N=575 Black, N=547 White) in the Henry Ford Heart Failure PGx registry (HFPGR) with whole-genome data, allowing for ancestral quantification and access to electronic medical records. Many studies investigating racial disparities in HHF are outdated, given current knowledge on access to care that can influence HHF. Aim 2 overcomes this limitation with access to a more contemporary dataset where patients have similar health care access and quality. Studies investigating the effects of social determinants of health (SDoH) on HHF found cumulative increases of specific social variables were associated with an increased risk of HHF but did not investigate drug-specific social variables. Aim 3 overcomes this limitation by testing for interactions using self-identified race, genomic ancestry, and social variables specifically related to angiotensin inhibitor benefit in HFrEF hospitalizations. The overall approach is to analyze an existing clinical and genomics dataset (HFPGR) with HHF as the primary outcome. This research is feasible by leveraging an existing dataset, the expertise of my sponsors, resources at the University of Michigan and Henry Ford Health System, and established methods. In completing this project, I will learn critical research skills in PGx and social services that will prepare me for more advanced, post-doctoral training.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2024 ( Subtotal = $41,817 )
2024	2024	REGENTS OF THE UNIVERSITY OF MICHIGAN	1109 GEDDES AVE, SUITE 3300	ANN ARBOR	MI	48109	WASHTENAW	USA	Cardiovascular Diseases Research	000	2	7/12/2024	NON-COMPETING CONTINUATION	$41,817
2024	2024	REGENTS OF THE UNIVERSITY OF MICHIGAN	1109 GEDDES AVE, SUITE 3300	ANN ARBOR	MI	48109	WASHTENAW	USA	Cardiovascular Diseases Research	001	2	8/21/2024	NON-COMPETING CONTINUATION	$0
														Subtotal = $41,817

Issue Date FY: 2023 ( Subtotal = $40,537 )
2023	2023	REGENTS OF THE UNIVERSITY OF MICHIGAN	503 THOMPSON STREET	ANN ARBOR	MI	48109	WASHTENAW	USA	Cardiovascular Diseases Research	001	1	5/15/2023	NEW	$0
2023	2023	REGENTS OF THE UNIVERSITY OF MICHIGAN	503 THOMPSON STREET	ANN ARBOR	MI	48109	WASHTENAW	USA	Cardiovascular Diseases Research	000	1	5/15/2023	NEW	$40,537
														Subtotal = $40,537

Grand Total All Awards = $82,354

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Addressing the Racial Disparity of Angiotensin Inhibitor Benefit in HFrEF Hospitalizations: Distinguishing Genomic and Social Factors

Award Number: F31HL167561

ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: FELLOWSHIP/SCHOLARSHIP/STUDENT LOANS

PERIOD OF PERFORMANCE START DATE: 05/15/2023

PERIOD OF PERFORMANCE END DATE: 07/28/2025

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