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deGoma EM, Ahmad ZS, O'Brien EC, Kindt I, Shrader P, Newman CB, Pokharel Y, Baum SJ, Hemphill LC, Hudgins LC, Ahmed CD, Gidding SS, Duffy D, Neal W, Wilemon K, Roe MT, Rader DJ, Ballantyne CM, Linton MF, Duell PB, Shapiro MD, Moriarty PM, Knowles JW. Treatment Gaps in Adults With Heterozygous Familial Hypercholesterolemia in the United States: Data From the CASCADE-FH Registry. ACTA ACUST UNITED AC 2016; 9:240-9. [PMID: 27013694 DOI: 10.1161/circgenetics.116.001381] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/18/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiovascular disease burden and treatment patterns among patients with familial hypercholesterolemia (FH) in the United States remain poorly described. In 2013, the FH Foundation launched the Cascade Screening for Awareness and Detection (CASCADE) of FH Registry to address this knowledge gap. METHODS AND RESULTS We conducted a cross-sectional analysis of 1295 adults with heterozygous FH enrolled in the CASCADE-FH Registry from 11 US lipid clinics. Median age at initiation of lipid-lowering therapy was 39 years, and median age at FH diagnosis was 47 years. Prevalent coronary heart disease was reported in 36% of patients, and 61% exhibited 1 or more modifiable risk factors. Median untreated low-density lipoprotein cholesterol (LDL-C) was 239 mg/dL. At enrollment, median LDL-C was 141 mg/dL; 42% of patients were taking high-intensity statin therapy and 45% received >1 LDL-lowering medication. Among FH patients receiving LDL-lowering medication(s), 25% achieved an LDL-C <100 mg/dL and 41% achieved a ≥50% LDL-C reduction. Factors associated with prevalent coronary heart disease included diabetes mellitus (adjusted odds ratio 1.74; 95% confidence interval 1.08-2.82) and hypertension (2.48; 1.92-3.21). Factors associated with a ≥50% LDL-C reduction from untreated levels included high-intensity statin use (7.33; 1.86-28.86) and use of >1 LDL-lowering medication (1.80; 1.34-2.41). CONCLUSIONS FH patients in the CASCADE-FH Registry are diagnosed late in life and often do not achieve adequate LDL-C lowering, despite a high prevalence of coronary heart disease and risk factors. These findings highlight the need for earlier diagnosis of FH and initiation of lipid-lowering therapy, more consistent use of guideline-recommended LDL-lowering therapy, and comprehensive management of traditional coronary heart disease risk factors.
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Affiliation(s)
- Emil M deGoma
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Zahid S Ahmad
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Emily C O'Brien
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Iris Kindt
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Peter Shrader
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Connie B Newman
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Yashashwi Pokharel
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Seth J Baum
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Linda C Hemphill
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Lisa C Hudgins
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Catherine D Ahmed
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Samuel S Gidding
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Danielle Duffy
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - William Neal
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Katherine Wilemon
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Matthew T Roe
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Daniel J Rader
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Christie M Ballantyne
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - MacRae F Linton
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - P Barton Duell
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Michael D Shapiro
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Patrick M Moriarty
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.)
| | - Joshua W Knowles
- From the University of Pennsylvania, Philadelphia (E.M.d., D.J.R.); University of Texas Southwestern, Dallas (Z.S.A.); Duke Clinical Research Institute, Durham, NC (E.C.O., P.S., M.T.R.); The FH Foundation, South Pasadena, CA (I.K., C.D.A., K.W.); New York University School of Medicine (C.B.N.); Mid America Heart Institute, Kansas City, MO (Y.P.); Preventive Cardiology Inc, Boca Raton, FL (S.J.B.); Massachusetts General Hospital, Boston (L.C. Hemphill); The Rogosin Institute, New York, NY (L.C. Hudgins); Nemours Cardiac Center, Wilmington, DE (S.S.G.); Thomas Jefferson University Hospital, Philadelphia, PA (D.D.); West Virginia University, Morgantown (W.N.); Baylor College of Medicine, Houston, TX (C.M.B.); Vanderbilt University School of Medicine, Nashville, TN (M.F.L.); Oregon Health and Science University, Portland, OR (P.B.D., M.D.S.); University of Kansas Medical Center (P.M.M.); and Stanford University, CA (J.W.K.).
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