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Andresen K, Hinojosa-Campos M, Podmore B, Drysdale M, Qizilbash N, Cunnington M. Validity of Routine Health Data To Identify Safety Outcomes of Interest For Covid-19 Vaccines and Therapeutics in the Context of the Emerging Pandemic: A Comprehensive Literature Review. Drug Healthc Patient Saf 2024; 16:1-17. [PMID: 38192299 PMCID: PMC10771726 DOI: 10.2147/dhps.s415292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/15/2023] [Indexed: 01/10/2024] Open
Abstract
Introduction Regulatory guidance encourages transparent reporting of information on the quality and validity of electronic health record data being used to generate real-world benefit-risk evidence for vaccines and therapeutics. We aimed to provide an overview of the availability of validated diagnostic algorithms for selected safety endpoints for Coronavirus disease 2019 (COVID-19) vaccines and therapeutics in the context of the emerging pandemic prior to December 2020. Methods We reviewed the literature up to December 2020 to identify validation studies for various safety events of interest, including myocardial infarction, arrhythmia, myocarditis, acute cardiac injury, vasculitis/vasculopathy, venous thromboembolism, stroke, respiratory distress syndrome (RDS), pneumonitis, cytokine release syndrome (CRS), multiple organ dysfunction syndrome, and renal failure. We included studies published between 2015 and 2020 that were considered high quality assessed with QUADAS and that reported positive predictive values (PPVs). Results Out of 43 identified studies, we found that diagnostic algorithms for cardiovascular outcomes were supported by the highest number of validation studies (n=17). Accurate algorithms are available for myocardial infarction (median PPV 80%; IQR 22%), arrhythmia (PPV range >70%), venous thromboembolism (median PPV: 73%) and ischaemic stroke (PPV range ≥85%). We found a lack of validation studies for less common respiratory and cardiac safety outcomes of interest (eg, pneumonitis and myocarditis), as well as for COVID-specific complications (CRS, RDS). Conclusion There is a need for better understanding of barriers to conducting validation studies, including data governance restrictions. Regulatory guidance should promote embedding validation within real-world EHR research used for decision-making.
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Affiliation(s)
- Kirsty Andresen
- OXON Epidemiology, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Bélène Podmore
- OXON Epidemiology, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
- OXON Epidemiology, Madrid, Spain
| | | | - Nawab Qizilbash
- OXON Epidemiology, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
- OXON Epidemiology, Madrid, Spain
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Khodneva Y, Ringel JB, Rajan M, Goyal P, Jackson EA, Sterling MR, Cherrington A, Oparil S, Durant R, Safford MM, Levitan EB. Depressive symptoms, cognitive impairment, and all-cause mortality among REGARDS participants with heart failure. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac064. [PMID: 36330357 PMCID: PMC9617474 DOI: 10.1093/ehjopen/oeac064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/06/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022]
Abstract
Aims To ascertain whether depressive symptoms and cognitive impairment (CI) are associated with mortality among patients with heart failure (HF), adjusting for sociodemographic, comorbidities, and biomarkers. Methods and results We utilized Medicare-linked data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, a biracial prospective ongoing cohort of 30 239 US community-dwelling adults, recruited in 2003-07. HF diagnosis was ascertained in claims analysis. Depressive symptoms were defined as a score ≥4 on the four-item Center for Epidemiological Studies-Depression scale. Cognitive impairment was defined as a score of ≤4 on the six-item screener that assessed three-item recall and orientation to year, month, and day of the week. Sequentially adjusted Cox proportional hazard models were used to estimate the risk of death. We analyzed 1059 REGARDS participants (mean age 73, 48%-African American) with HF; of those 146 (14%) reported depressive symptoms, 136 (13%) had CI and 31 (3%) had both. Over the median follow-up of 6.8 years (interquartile range, 3.4-10.3), 785 (74%) died. In the socio-demographics-adjusted model, CI was significantly associated with increased mortality, hazard ratio 1.24 (95% confidence interval 1.01-1.52), compared with persons with neither depressive symptoms nor CI, but this association was attenuated after further adjustment. Neither depressive symptoms alone nor their comorbidity with CI was associated with mortality. Risk factors of all-cause mortality included: low income, comorbidities, smoking, physical inactivity, and severity of HF. Conclusion Depressive symptoms, CI, or their comorbidity was not associated with mortality in HF in this study. Treatment of HF in elderly needs to be tailored to cognitive status and includes focus on medical comorbidities.
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Affiliation(s)
- Yulia Khodneva
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA
| | - Joanna Bryan Ringel
- Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
| | - Mangala Rajan
- Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
| | - Parag Goyal
- Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
- Division of Cardiology, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
| | - Elizabeth A Jackson
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA
| | - Madeline R Sterling
- Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
| | - Andrea Cherrington
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA
| | - Suzanne Oparil
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA
| | - Raegan Durant
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA
| | - Monika M Safford
- Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
| | - Emily B Levitan
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, Al 35294, USA
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Khan SS, Krefman AE, Zhao L, Liu L, Chorniy A, Daviglus ML, Schiman C, Liu K, Shih T, Garside D, Vu THT, Lloyd-Jones DM, Allen NB. Association of Body Mass Index in Midlife With Morbidity Burden in Older Adulthood and Longevity. JAMA Netw Open 2022; 5:e222318. [PMID: 35289856 PMCID: PMC8924714 DOI: 10.1001/jamanetworkopen.2022.2318] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/20/2022] [Indexed: 11/23/2022] Open
Abstract
Importance Abundant evidence links obesity with adverse health consequences. However, controversies persist regarding whether overweight status compared with normal body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) is associated with longer survival and whether this occurs at the expense of greater long-term morbidity and health care expenditures. Objective To examine the association of BMI in midlife with morbidity burden, longevity, and health care expenditures in adults 65 years and older. Design, Setting, and Participants Prospective cohort study at the Chicago Heart Association Detection Project in Industry, with baseline in-person examination between November 1967 and January 1973 linked with Medicare follow-up between January 1985 and December 2015. Participants included 29 621 adults who were at least age 65 years in follow-up and enrolled in Medicare. Data were analyzed from January 2020 to December 2021. Exposures Standard BMI categories. Main Outcomes and Measures (1) Morbidity burden at 65 years and older assessed with the Gagne combined comorbidity score (ranging from -2 to 26, with higher score associated with higher mortality), which is a well-validated index based on International Classification of Diseases, Ninth Revision codes for use in administrative data sets; (2) longevity (age at death); and (3) health care costs based on Medicare linkage in older adulthood (aged ≥65 years). Results Among 29 621 participants, mean (SD) age was 40 (12) years, 57.1% were men, and 9.1% were Black; 46.0% had normal BMI, 39.6% were overweight, and 11.9% had classes I and II obesity at baseline. Higher cumulative morbidity burden in older adulthood was observed among those who were overweight (7.22 morbidity-years) and those with classes I and II obesity (9.80) compared with those with a normal BMI (6.10) in midlife (P < .001). Mean age at death was similar between those who were overweight (82.1 years [95% CI, 81.9-82.2 years]) and those who had normal BMI (82.3 years [95% CI, 82.1-82.5 years]) but shorter in those who with classes I and II obesity (80.8 years [95% CI, 80.5-81.1 years]). The proportion (SE) of life-years lived in older adulthood with Gagne score of at least 1 was 0.38% (0.00%) in those with a normal BMI, 0.41% (0.00%) in those with overweight, and 0.43% (0.01%) in those with classes I and II obesity. Cumulative median per-person health care costs in older adulthood were significantly higher among overweight participants ($12 390 [95% CI, $10 427 to $14 354]) and those with classes I and II obesity ($23 396 [95% CI, $18 474 to $28 319]) participants compared with those with a normal BMI (P < .001). Conclusions and Relevance In this cohort study, overweight in midlife, compared with normal BMI, was associated with higher cumulative burden of morbidity and greater proportion of life lived with morbidity in the context of similar longevity. These findings translated to higher total health care expenditures in older adulthood for those who were overweight in midlife.
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Affiliation(s)
- Sadiya S. Khan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amy E. Krefman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lihui Zhao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lei Liu
- Division of Biostatistics, Washington University in St Louis, St Louis, Missouri
| | - Anna Chorniy
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Martha L. Daviglus
- Institute for Minority Health Research, College of Medicine, University of Illinois at Chicago, Chicago
| | - Cuiping Schiman
- Department of Economics, Georgia Southern University, Statesboro
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tina Shih
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniel Garside
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Thanh-Huyen T. Vu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Donald M. Lloyd-Jones
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Norrina B. Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Hubbard D, McKinley EC, Colantonio LD, Poudel B, Rosenson RS, Brown TM, Jackson EA, Huang L, Orroth KK, Mues KE, Dluzniewski PJ, Bittner V, Muntner P. Characteristics of patients with diabetes and a history of myocardial infarction initiating PCSK9 and SGLT2 inhibitors. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 13:100121. [PMID: 38560067 PMCID: PMC10978183 DOI: 10.1016/j.ahjo.2022.100121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/27/2022] [Accepted: 03/09/2022] [Indexed: 04/04/2024]
Abstract
Study objective Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) reduce the risk for atherosclerotic cardiovascular disease (ASCVD) events in patients with diabetes and ASCVD. We assessed factors associated with initiating either medication among patients with diabetes and a prior myocardial infarction (MI). Setting/participants US adults ≥19 years old with private health insurance (MarketScan) or government health insurance (Medicare) who had diabetes and a prior MI and initiated a PCSK9i or an SGLT2i in 2017 or 2018. Main outcome measures PCSK9i or SGLT2i initiation was identified using pharmacy claims. Results Overall, 8102 patients initiated a PCSK9i (n = 1501; 18.5%) or an SGLT2i (n = 6601; 81.5%). Patients with 2 and ≥3 versus 1 prior MI (risk ratio [RR]: 1.32 [95%CI: 1.17-1.48] and 1.68 [1.41-2.01], respectively), prior coronary revascularization (1.47 [1.31-1.64]), prior stroke (1.28 [1.06-1.56]), history of peripheral artery disease (1.27 [1.14-1.41]), receiving cardiologist care (1.51 [1.36-1.67]) or taking ezetimibe (2.57 [2.35-2.82]) were more likely to initiate a PCSK9i versus an SGLT2i. Patients with a history of short-term (RR 1.07 [95%CI 1.05-1.09]) or long-term (1.07 [1.04-1.09]) diabetes complications, and taking a low/moderate- and high-intensity statin dosage (1.61 [1.51-1.70] and 1.68 [1.58-1.77], respectively) were more likely to initiate an SGLT2i versus a PCSK9i. Among patients who initiated a PCSK9i, 2.9% subsequently initiated an SGLT2i; 0.8% who initiated an SGLT2i subsequently initiated a PCSK9i. Conclusion The decision to initiate PCSK9i or SGLT2i is explained by having very high cardiovascular disease risk for those initiating PCSK9i and diabetes complications for those initiating SGLT2i.
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Affiliation(s)
- Demetria Hubbard
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Emily C McKinley
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Lisandro D Colantonio
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Bharat Poudel
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Robert S Rosenson
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Todd M Brown
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Elizabeth A Jackson
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Lei Huang
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kate K Orroth
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, United States
| | - Katherine E Mues
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, United States
| | - Paul J Dluzniewski
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, United States
| | - Vera Bittner
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
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Muntner P, Orroth KK, Mues KE, Exter J, Shannon ED, Zaha R, Rosenson RS, Jackson EA. Evaluating a Simple Approach to Identify Adults Meeting the 2018 AHA/ACC Cholesterol Guideline Definition of Very High Risk for Atherosclerotic Cardiovascular Disease. Cardiovasc Drugs Ther 2021; 36:475-481. [PMID: 33661432 DOI: 10.1007/s10557-021-07167-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2021] [Indexed: 01/05/2023]
Abstract
PURPOSE The 2018 American Heart Association/American College of Cardiology (AHA/ACC) cholesterol guideline defines very high atherosclerotic cardiovascular disease (ASCVD) risk as a history of ≥ 2 major ASCVD events or 1 major ASCVD event and multiple high-risk conditions. We tested if a simplified approach, having a history of a major ASCVD event, would identify a high proportion of patients that meet the 2018 AHA/ACC cholesterol guideline criteria for very high risk. METHODS We analyzed data from US adults with health insurance in the MarketScan database who had experienced an acute coronary syndrome in the past year (recent ACS, n = 3626), a myocardial infarction (MI) other than a recent ACS (n = 7572), an ischemic stroke (n = 3551), or symptomatic peripheral artery disease (PAD, n = 5919). Patients were followed from January 1, 2016, through December 31, 2017, for recurrent ASCVD events. RESULTS Among 16,344 patients with a history of a major ASCVD event, 94.0% met the 2018 AHA/ACC cholesterol guideline definition for very high risk including 92.9%, 96.5%, 93.1%, and 96.2% with a recent ACS, history of MI, history of stroke, and symptomatic PAD, respectively. The incidence of ASCVD events per 1000 person-years was 50.4 (95% CI: 47.6-53.3) among all patients with a history of a major ASCVD event versus 53.1 (95% CI: 50.1-56.1) among patients who met the 2018 AHA/ACC cholesterol guideline definition of very high risk. CONCLUSION The vast majority of patients with a recent ACS, history of MI, ischemic stroke, or symptomatic PAD meet the 2018 AHA/ACC cholesterol guideline definition of very high risk.
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Affiliation(s)
- Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave South, RPHB 140J, Birmingham, AL, 35294-0013, USA.
| | - Kate K Orroth
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | | | | | - Erin D Shannon
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - Rebecca Zaha
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - Robert S Rosenson
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elizabeth A Jackson
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Hubbard D, Colantonio LD, Rosenson RS, Brown TM, Jackson EA, Huang L, Orroth KK, Reading S, Woodward M, Bittner V, Gutierrez OM, Safford MM, Farkouh ME, Muntner P. Risk for recurrent cardiovascular disease events among patients with diabetes and chronic kidney disease. Cardiovasc Diabetol 2021; 20:58. [PMID: 33648518 PMCID: PMC7923492 DOI: 10.1186/s12933-021-01247-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/15/2021] [Indexed: 02/08/2023] Open
Abstract
Background Adults who have experienced multiple cardiovascular disease (CVD) events have a very high risk for additional events. Diabetes and chronic kidney disease (CKD) are each associated with an increased risk for recurrent CVD events following a myocardial infarction (MI). Methods We compared the risk for recurrent CVD events among US adults with health insurance who were hospitalized for an MI between 2014 and 2017 and had (1) CVD prior to their MI but were free from diabetes or CKD (prior CVD), and those without CVD prior to their MI who had (2) diabetes only, (3) CKD only and (4) both diabetes and CKD. We followed patients from hospital discharge through December 31, 2018 for recurrent CVD events including coronary, stroke, and peripheral artery events. Results Among 162,730 patients, 55.2% had prior CVD, and 28.3%, 8.3%, and 8.2% had diabetes only, CKD only, and both diabetes and CKD, respectively. The rate for recurrent CVD events per 1000 person-years was 135 among patients with prior CVD and 110, 124 and 171 among those with diabetes only, CKD only and both diabetes and CKD, respectively. Compared to patients with prior CVD, the multivariable-adjusted hazard ratio for recurrent CVD events was 0.92 (95%CI 0.90–0.95), 0.89 (95%CI: 0.85–0.93), and 1.18 (95%CI: 1.14–1.22) among those with diabetes only, CKD only, and both diabetes and CKD, respectively. Conclusion Following MI, adults with both diabetes and CKD had a higher risk for recurrent CVD events compared to those with prior CVD without diabetes or CKD. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-021-01247-0.
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Affiliation(s)
- Demetria Hubbard
- Department of Epidemiology, University of Alabama At Birmingham, 1665 University Blvd, RPHB 140J, Birmingham, AL, 35233-0013, USA
| | - Lisandro D Colantonio
- Department of Epidemiology, University of Alabama At Birmingham, 1665 University Blvd, RPHB 140J, Birmingham, AL, 35233-0013, USA
| | - Robert S Rosenson
- Mount Sinai Heart, Icahn School of Medicine At Mount Sinai, New York, NY, USA
| | - Todd M Brown
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Elizabeth A Jackson
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Lei Huang
- Department of Epidemiology, University of Alabama At Birmingham, 1665 University Blvd, RPHB 140J, Birmingham, AL, 35233-0013, USA
| | - Kate K Orroth
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - Stephanie Reading
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - Mark Woodward
- The George Institute for Global Health, Imperial College, London, UK.,Department of Epidemiology and Biostatistics, School of Public Health, The George Institute for Global Health, University of New South Wales, Kensington, Australia.,Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Vera Bittner
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Orlando M Gutierrez
- Department of Epidemiology, University of Alabama At Birmingham, 1665 University Blvd, RPHB 140J, Birmingham, AL, 35233-0013, USA
| | - Monika M Safford
- Weill Cornell Medical College, Cornell University, Ithaca, NY, USA
| | - Michael E Farkouh
- Peter Munk Cardiac Centre, University of Toronto and Heart and Stroke Richard Lewar Centre of Excellence, Toronto, ON, Canada
| | - Paul Muntner
- Department of Epidemiology, University of Alabama At Birmingham, 1665 University Blvd, RPHB 140J, Birmingham, AL, 35233-0013, USA.
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7
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Peters SA, Colantonio LD, Chen L, Bittner V, Farkouh ME, Rosenson RS, Jackson EA, Dluzniewski P, Poudel B, Muntner P, Woodward M. Sex Differences in Incident and Recurrent Coronary Events and All-Cause Mortality. J Am Coll Cardiol 2020; 76:1751-1760. [DOI: 10.1016/j.jacc.2020.08.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/31/2020] [Accepted: 08/12/2020] [Indexed: 01/08/2023]
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Peters SAE, Colantonio LD, Dai Y, Zhao H, Bittner V, Farkouh ME, Dluzniewski P, Poudel B, Muntner P, Woodward M. Trends in Recurrent Coronary Heart Disease After Myocardial Infarction Among US Women and Men Between 2008 and 2017. Circulation 2020; 143:650-660. [PMID: 32951451 DOI: 10.1161/circulationaha.120.047065] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Rates for recurrent coronary heart disease (CHD) events have declined in the United States. However, few studies have assessed whether this decline has been similar among women and men. METHODS Data were used from 770 408 US women and 700 477 US men <65 years of age with commercial health insurance through MarketScan and ≥66 years of age with government health insurance through Medicare who had a myocardial infarction (MI) hospitalization between 2008 and 2017. Women and men were followed up for recurrent MI, recurrent CHD events (ie, recurrent MI or coronary revascularization), heart failure hospitalization, and all-cause mortality (Medicare only) in the 365 days after MI. RESULTS From 2008 to 2017, age-standardized recurrent MI rates per 1000 person-years decreased from 89.2 to 72.3 in women and from 94.2 to 81.3 in men (multivariable-adjusted P interaction by sex <0.001). Recurrent CHD event rates decreased from 166.3 to 133.3 in women and from 198.1 to 176.8 in men (P interaction <0.001). Heart failure hospitalization rates decreased from 177.4 to 158.1 in women and from 162.9 to 156.1 in men (P interaction=0.001). All-cause mortality rates decreased from 403.2 to 389.5 in women and from 436.1 to 417.9 in men (P interaction=0.82). In 2017, the multivariable-adjusted rate ratios comparing women with men were 0.90 (95% CI, 0.86-0.93) for recurrent MI, 0.80 (95% CI, 0.78-0.82) for recurrent CHD events, 0.99 (95% CI, 0.96-1.01) for heart failure hospitalization, and 0.82 (95% CI, 0.80-0.83) for all-cause mortality. CONCLUSIONS Rates of recurrent MI, recurrent CHD events, heart failure hospitalization, and mortality in the first year after an MI declined considerably between 2008 and 2017 in both men and women, with proportionally greater reductions for women than men. However, rates remain very high, and rates of recurrent MI, recurrent CHD events, and death continue to be higher among men than women.
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Affiliation(s)
- Sanne A E Peters
- The George Institute for Global Health, Imperial College London, UK (S.A.E.P., M.W.).,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands (S.A.E.P.).,The George Institute for Global Health, University of New South Wales, Sydney, Australia (S.A.E.P., M.W.)
| | - Lisandro D Colantonio
- Department of Epidemiology (L.D.C., Y.D., H.Z., B.P., P.M.), University of Alabama at Birmingham
| | - Yuling Dai
- Department of Epidemiology (L.D.C., Y.D., H.Z., B.P., P.M.), University of Alabama at Birmingham
| | - Hong Zhao
- Department of Epidemiology (L.D.C., Y.D., H.Z., B.P., P.M.), University of Alabama at Birmingham
| | - Vera Bittner
- Division of Cardiovascular Disease (V.B.), University of Alabama at Birmingham
| | - Michael E Farkouh
- Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, ON, Canada (M.E.F.)
| | - Paul Dluzniewski
- Center for Observational Research, Amgen Inc, Thousand Oaks, CA (P.D.)
| | - Bharat Poudel
- Department of Epidemiology (L.D.C., Y.D., H.Z., B.P., P.M.), University of Alabama at Birmingham
| | - Paul Muntner
- Department of Epidemiology (L.D.C., Y.D., H.Z., B.P., P.M.), University of Alabama at Birmingham
| | - Mark Woodward
- The George Institute for Global Health, Imperial College London, UK (S.A.E.P., M.W.).,The George Institute for Global Health, University of New South Wales, Sydney, Australia (S.A.E.P., M.W.).,Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.)
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9
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Rosenson RS, Hubbard D, Monda KL, Reading SR, Chen L, Dluzniewski PJ, Burkholder GA, Muntner P, Colantonio LD. Excess Risk for Atherosclerotic Cardiovascular Outcomes Among US Adults With HIV in the Current Era. J Am Heart Assoc 2020; 9:e013744. [PMID: 31880980 PMCID: PMC6988153 DOI: 10.1161/jaha.119.013744] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/07/2019] [Indexed: 01/15/2023]
Abstract
Background In the 2000s, adults with HIV had a higher risk for atherosclerotic cardiovascular disease (ASCVD) compared with those without HIV. There is uncertainty if this excess risk still exists in the United States given changes in antiretroviral therapies and increased statin use. Methods and Results We compared the risk for ASCVD events between US adults aged ≥19 years with and without HIV who had commercial or supplemental Medicare health insurance between January 1, 2011, and December 31, 2016. Beneficiaries with HIV (n=82 426) were frequency matched 1:4 on age, sex, and calendar year to those without HIV (n=329 704). Beneficiaries with and without HIV were followed up through December 31, 2016, for ASCVD events, including myocardial infarction, stroke, and lower extremity artery disease hospitalizations. Most beneficiaries were aged <55 years (79%) and men (84%). Over a median follow-up of 1.6 years (maximum, 6 years), there were 3287 ASCVD events, 2190 myocardial infarctions, 891 strokes, and 322 lower extremity artery disease events. The rate per 1000 person-years among beneficiaries with and without HIV was 5.53 and 3.49 for ASCVD, respectively, 3.58 and 2.34 for myocardial infarction, respectively, 1.49 and 0.94 for stroke, respectively, and 0.65 and 0.31 for lower extremity artery disease hospitalizations, respectively. The multivariable-adjusted hazard ratio (95% CI) for ASCVD, myocardial infarction, stroke, and lower extremity artery disease hospitalizations comparing beneficiaries with versus without HIV was 1.29 (1.18-1.40), 1.26 (1.13-1.39), 1.30 (1.11-1.52), and 1.46 (1.11-1.92), respectively. Conclusions Adults with HIV in the United States continue to have a higher ASCVD risk compared with their counterparts without HIV.
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Affiliation(s)
| | | | | | | | - Ligong Chen
- University of Alabama at BirminghamBirminghamAL
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10
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Colantonio LD, Rosenson RS, Deng L, Monda KL, Dai Y, Farkouh ME, Safford MM, Philip K, Mues KE, Muntner P. Adherence to Statin Therapy Among US Adults Between 2007 and 2014. J Am Heart Assoc 2020; 8:e010376. [PMID: 30616455 PMCID: PMC6405715 DOI: 10.1161/jaha.118.010376] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Prior studies suggest that persistence with and adherence to statin therapy is low. Interventions to improve statin persistence and adherence have been developed over the past decade. Methods and Results This was a retrospective cohort study of adults aged ≥21 y with commercial or government health insurance in the MarketScan (Truven Health Analytics) and Medicare databases who initiated statins in 2007–2014 and (1) started treatment after a myocardial infarction (n=201 573), (2) had diabetes mellitus but without coronary heart disease (CHD; n=610 049), or (3) did not have CHD or diabetes mellitus (n=2 244 868). Persistence with (ie, not discontinuing treatment) and high adherence to statin therapy were assessed using pharmacy fills in the year following treatment initiation. In 2007 and 2014, the proportions of patients persistent with statin therapy were 78.1% and 79.1%, respectively, among those initiating treatment following myocardial infarction; 66.5% and 67.3%, respectively, for those with diabetes mellitus but without CHD; and 64.3% and 63.9%, respectively, for those without CHD or diabetes mellitus. Between 2007 and 2014, high adherence to statin therapy increased from 57.9% to 63.8% among patients initiating treatment following myocardial infarction and from 34.9% to 37.6% among those with diabetes mellitus but without CHD (each Ptrend<0.001). Among patients without CHD or diabetes mellitus, high adherence did not improve between 2007 (35.7%) and 2014 (36.8%; Ptrend=0.14). In 2014, statin adherence was lower among younger, black, and Hispanic patients versus white patients and those initiating a high‐intensity statin dosage. Statin adherence was higher among men and patients with cardiologist care following treatment initiation. Conclusions Persistence with and adherence to statin therapy remain low, particularly among those without CHD.
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Affiliation(s)
- Lisandro D Colantonio
- 1 Department of Epidemiology School of Public Health University of Alabama at Birmingham AL
| | - Robert S Rosenson
- 2 Mount Sinai Heart Icahn School of Medicine at Mount Sinai New York NY
| | - Luqin Deng
- 1 Department of Epidemiology School of Public Health University of Alabama at Birmingham AL
| | - Keri L Monda
- 3 Center for Observational Research Amgen Inc. Thousand Oaks CA
| | - Yuling Dai
- 1 Department of Epidemiology School of Public Health University of Alabama at Birmingham AL
| | - Michael E Farkouh
- 4 Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre of Excellence University of Toronto Ontario Canada
| | - Monika M Safford
- 5 Department of Medicine Weill Cornell Medical College New York NY
| | | | | | - Paul Muntner
- 1 Department of Epidemiology School of Public Health University of Alabama at Birmingham AL
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11
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Lee DC, Feldman JM, Osorio M, Koziatek CA, Nguyen MV, Nagappan A, Shim CJ, Vinson AJ, Thorpe LE, McGraw NA. Improving the geographical precision of rural chronic disease surveillance by using emergency claims data: a cross-sectional comparison of survey versus claims data in Sullivan County, New York. BMJ Open 2019; 9:e033373. [PMID: 31740475 PMCID: PMC6887089 DOI: 10.1136/bmjopen-2019-033373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/31/2019] [Accepted: 10/31/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Some of the most pressing health problems are found in rural America. However, the surveillance needed to track and prevent disease in these regions is lacking. Our objective was to perform a comprehensive health survey of a single rural county to assess the validity of using emergency claims data to estimate rural disease prevalence at a sub-county level. DESIGN We performed a cross-sectional study of chronic disease prevalence estimates using emergency department (ED) claims data versus mailed health surveys designed to capture a substantial proportion of residents in New York's rural Sullivan County. SETTING Sullivan County, a rural county ranked second-to-last for health outcomes in New York State. PARTICIPANTS Adult residents of Sullivan County aged 25 years and older who responded to the health survey in 2017-2018 or had at least one ED visit in 2011-2015. OUTCOME MEASURES We compared age and gender-adjusted prevalence of hypertension, hyperlipidaemia, diabetes, cancer, asthma and chronic obstructive pulmonary disease/emphysema among nine sub-county areas. RESULTS Our county-wide mailed survey obtained 6675 completed responses for a response rate of 30.4%. This sample represented more than 12% of the estimated 53 020 adults in Sullivan County. Using emergency claims data, we identified 34 576 adults from Sullivan County who visited an ED at least once during 2011-2015. At a sub-county level, prevalence estimates from mailed surveys and emergency claims data correlated especially well for diabetes (r=0.90) and asthma (r=0.85). Other conditions were not well correlated (range: 0.23-0.46). Using emergency claims data, we created more geographically detailed maps of disease prevalence using geocoded addresses. CONCLUSIONS For select conditions, emergency claims data may be useful for tracking disease prevalence in rural areas and providing more geographically detailed estimates. For rural regions lacking robust health surveillance, emergency claims data can inform how to geographically target efforts to prevent chronic disease.
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Affiliation(s)
- David C Lee
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York City, New York, USA
- Department of Population Health, New York University School of Medicine, New York City, New York, USA
| | - Justin M Feldman
- Department of Population Health, New York University School of Medicine, New York City, New York, USA
| | - Marcela Osorio
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York City, New York, USA
| | - Christian A Koziatek
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York City, New York, USA
| | - Michael V Nguyen
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York City, New York, USA
| | - Ashwini Nagappan
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York City, New York, USA
| | - Christopher J Shim
- California Northstate University College of Medicine, Elk Grove, California, USA
| | - Andrew J Vinson
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York City, New York, USA
| | - Lorna E Thorpe
- Department of Population Health, New York University School of Medicine, New York City, New York, USA
| | - Nancy A McGraw
- Sullivan County Public Health Services, Liberty, New York, USA
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Colantonio LD, Shannon ED, Orroth KK, Zaha R, Jackson EA, Rosenson RS, Exter J, Mues KE, Muntner P. Ischemic Event Rates in Very-High-Risk Adults. J Am Coll Cardiol 2019; 74:2496-2507. [DOI: 10.1016/j.jacc.2019.09.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/21/2019] [Accepted: 09/04/2019] [Indexed: 11/27/2022]
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13
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Bittner V, Colantonio LD, Dai Y, Woodward M, Mefford MT, Rosenson RS, Muntner P, Monda KL, Kilgore ML, Jaeger BC, Levitan EB. Association of Region and Hospital and Patient Characteristics With Use of High-Intensity Statins After Myocardial Infarction Among Medicare Beneficiaries. JAMA Cardiol 2019; 4:865-872. [PMID: 31339519 PMCID: PMC6659160 DOI: 10.1001/jamacardio.2019.2481] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/31/2019] [Indexed: 01/14/2023]
Abstract
Importance High-intensity statin use after myocardial infarction (MI) varies by patient characteristics, but little is known about differences in use by hospital or region. Objective To explore the relative strength of associations of region and hospital and patient characteristics with high-intensity statin use after MI. Design, Setting, and Participants This retrospective cohort analysis used Medicare administrative claims and enrollment data to evaluate fee-for-service Medicare beneficiaries 66 years or older who were hospitalized for MI from January 1, 2011, through June 30, 2015, with a statin prescription claim within 30 days of discharge. Data were analyzed from January 4, 2017, through May 12, 2019. Exposures Beneficiary characteristics were abstracted from Medicare data. Hospital characteristics were obtained from the 2014 American Hospital Association Survey and Hospital Compare quality metrics. Nine regions were defined according to the US Census. Main Outcomes and Measures Intensity of the first statin claim after discharge characterized as high (atorvastatin calcium, 40-80 mg, or rosuvastatin calcium, 20-40 mg/d) vs low to moderate (all other statin types and doses). Trends in high-intensity statins were examined from 2011 through 2015. Associations of region and beneficiary and hospital characteristics with high-intensity statin use from January 1, 2014, to June 15, 2015, were examined using Poisson distribution mixed models. Results Among the 139 643 fee-for-service beneficiaries included (69 968 men [50.1%] and 69 675 women [49.9%]; mean [SD] age, 76.7 [7.5] years), high-intensity statin use overall increased from 23.4% in 2011 to 55.6% in 2015, but treatment gaps persisted across regions. In models considering region and beneficiary and hospital characteristics, region was the strongest correlate of high-intensity statin use, with 66% higher use in New England than in the West South Central region (risk ratio [RR], 1.66; 95% CI, 1.47-1.87). Hospital size of at least 500 beds (RR, 1.15; 95% CI, 1.07-1.23), medical school affiliation (RR, 1.11; 95% CI, 1.05-1.17), male sex (RR, 1.10; 95% CI, 1.07-1.13), and patient receipt of a stent (RR, 1.35; 95% CI, 1.31-1.39) were associated with greater high-intensity statin use. For-profit hospital ownership, patient age older than 75 years, prior coronary disease, and other comorbidities were associated with lower use. Conclusions and Relevance This study's findings suggest that geographic region is the strongest correlate of high-intensity statin use after MI, leading to large treatment disparities.
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Affiliation(s)
- Vera Bittner
- Division of Cardiovascular Disease, University of Alabama at Birmingham
| | | | - Yuling Dai
- Department of Epidemiology, University of Alabama at Birmingham
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
- Department of Epidemiology, The Johns Hopkins University, Baltimore, Maryland
| | | | | | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham
| | - Keri L. Monda
- Center for Observational Research, Amgen, Inc, Thousand Oaks, California
| | - Meredith L. Kilgore
- Department of Health Care Organization and Policy, University of Alabama at Birmingham
| | - Byron C. Jaeger
- Department of Biostatistics, University of Alabama at Birmingham
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Douce DR, Soliman EZ, Naik R, Hyacinth HI, Cushman M, Winkler CA, Howard G, Lange EM, Lange LA, Irvin MR, Zakai NA. Association of sickle cell trait with atrial fibrillation: The REGARDS cohort. J Electrocardiol 2019; 55:1-5. [PMID: 31028976 PMCID: PMC6639128 DOI: 10.1016/j.jelectrocard.2019.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/04/2019] [Accepted: 04/16/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Sickle cell trait (SCT), sickle cell disease's (SCD) carrier status, has been recently associated with worse cardiovascular and renal outcomes. An increased prevalence of atrial fibrillation (AF) is documented in SCD patients; however, studies in individuals with SCT are lacking. OBJECTIVES To determine the association of SCT with AF. METHODS Among African-American participants in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study we assessed the association of SCT (by ECG or medical history) with prevalent AF using logistic regression adjusting for age, sex, income, education, history of stroke, myocardial infarction, diabetes, hypertension, and chronic kidney disease. A second evaluation was performed a mean of 9.2 years later among available participants, and the same model was used to test the association of SCT with incident AF. RESULTS In 10,409 participants with baseline ECG data and genotyping, 778 (7.5%) had SCT and 811 (7.8%) had prevalent AF. After adjusting for age, sex, education and income, SCT was associated with AF, OR 1.32 (95% CI 1.03-1.70). The association with incident AF assessed at the second in-home visit with the same adjustments was similar; OR 1.25 (95% CI 0.77-2.03). CONCLUSIONS SCT was associated with a higher prevalence of AF and a non-significantly higher incident AF over a 9.2 year period independent of AF risk factors. SCT remained associated with prevalent AF after adjusting for potential factors on the causal pathway such as hypertension and chronic kidney disease suggesting alternate mechanisms for the increased risk.
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Affiliation(s)
- Daniel R Douce
- University of Vermont College of Medicine, Department of Hematology & Oncology, United States of America
| | - Elsayed Z Soliman
- Wake Forest University, Department of Epidemiology & Prevention, United States of America
| | - Rakhi Naik
- Johns Hopkins University School of Medicine, Department of Hematology & Oncology, United States of America
| | - Hyacinth I Hyacinth
- Aflac Cancer and Blood Disorder Center of Emory University, Department of Pediatrics and Children's Healthcare of Atlanta, United States of America
| | - Mary Cushman
- University of Vermont College of Medicine, Department of Hematology & Oncology, United States of America
| | - Cheryl A Winkler
- National Cancer Institute, Basic Research Laboratory, United States of America
| | - George Howard
- University of Alabama at Birmingham School of Public Health, Department of Biostatistics, United States of America
| | - Ethan M Lange
- Department of Medicine, University of Colorado Anschutz Medical Campus, United States of America
| | - Leslie A Lange
- Department of Medicine, University of Colorado Anschutz Medical Campus, United States of America
| | - Marguerite R Irvin
- University of Alabama at Birmingham School of Public Health, Department of Epidemiology, United States of America
| | - Neil A Zakai
- University of Vermont College of Medicine, Department of Hematology & Oncology, United States of America.
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Colantonio LD, Deng L, Chen L, Farkouh ME, Monda KL, Harrison DJ, Maya JF, Kilgore ML, Muntner P, Rosenson RS. Medical Expenditures Among Medicare Beneficiaries with Statin-Associated Adverse Effects Following Myocardial Infarction. Cardiovasc Drugs Ther 2018; 32:601-610. [DOI: 10.1007/s10557-018-6840-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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