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Vyas N, Zaheer A, Wijeysundera HC. Untangling the Complex Multidimensionality of the Social Determinants of Cardiovascular Health: A Systematic Review. Can J Cardiol 2024; 40:1000-1006. [PMID: 38513932 DOI: 10.1016/j.cjca.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/21/2024] [Accepted: 03/09/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The cardiovascular literature is limited by the lack of consensus on what are the best metrics for reporting social determinants of health (SDH) or social deprivation, and if they should be reported as a single metric or separately by their domains. METHODS A systematic review of the literature on cardiovascular surgeries and procedures was conducted, identifying articles from January 1, 2010, to December 31, 2023, that studied the relationship between health outcomes after cardiovascular procedures or surgeries and SDH/social deprivation. The cardiovascular procedures/surgeries of interest were coronary and valve surgeries and procedures including coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), valve replacement or repair, and transcatheter aortic valve intervention. RESULTS After screening 638 articles, we identified 47 papers that met our inclusion and exclusion criteria. The most common procedure evaluated was CABG and PCI; 46 of the studies focused on these 2 procedures. Almost all of the articles reported a different metric for SDH/social deprivation (41 different metrics); despite this, all of the metrics showed a consistent relationship with worse outcomes associated with greater degrees of SDH/deprivation. Only 9 reported on the individual domains of SDH/social deprivation; 3 studies showed a discordant relationship. CONCLUSIONS Although our systematic review identified numerous articles evaluating the relationship between SDH/social deprivation in cardiovascular disease, there was substantial heterogeneity in which metric was used and how it was reported. This reinforces the need for standards as to the best metrics for SDH/social deprivation as well as best practices for reporting.
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Affiliation(s)
- Navya Vyas
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Aida Zaheer
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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2
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AlMajali AS, Richards T, Yusuf SW, Telgenkamp B. Vascular service provision during the COVID-19 pandemic worsened major amputation rates in socially deprived diabetic populations. Front Endocrinol (Lausanne) 2024; 15:1304436. [PMID: 38836223 PMCID: PMC11148210 DOI: 10.3389/fendo.2024.1304436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 04/30/2024] [Indexed: 06/06/2024] Open
Abstract
Introduction The Coronavirus Disease - 2019 (COVID-19) pandemic significantly impacted healthcare service provision and put diabetic patients at increased risk of adverse health outcomes. We aimed to assess the impact of the COVID-19 pandemic on the incidence and demographic shift of major lower-limb amputation in diabetic patients. Methods We performed a retrospective analysis of diabetic patient records undergoing major lower-limb amputation between 01/03/2019 and 01/03/2021 at the Royal Sussex County Hospital, the regional arterial hub for Sussex. Primary outcomes were amputation incidence rates and patient demographics compared between the prepandemic and pandemic cohorts. Results The incidence rate ratio of major lower-limb amputations shows a drop in amputations during the pandemic compared to pre-pandemic (IRR 0.82; 95% CI 0.57-1.18). Data suggests a shift in the social deprivation background of patients receiving amputations to disproportionately affect those in the more deprived 50% of the population (p=0.038). Younger patients received more amputations during the pandemic compared to prepandemic levels (p=0.001). Conclusion Results suggest that during the COVID-19 pandemic there was a paradoxical reduction in amputations compared to prepandemic levels. However, changes to the demographic makeup of patient's receiving amputations are alarming as younger, and more deprived patients have been disproportionately affected by the pandemic.
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Affiliation(s)
- Ali S AlMajali
- Department of Acute Internal Medicine at the Royal Free Hospital, Royal Free London NHS Foundation Trust, London, United Kingdom
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Thomas Richards
- University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom
| | - Syed Waquar Yusuf
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, United Kingdom
- University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom
| | - Bjorn Telgenkamp
- University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom
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3
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Swaminathan N, Awuah WA, Bharadwaj HR, Roy S, Ferreira T, Adebusoye FT, Ismail IFNB, Azeem S, Abdul-Rahman T, Papadakis M. Early intervention and care for Diabetic Foot Ulcers in Low and Middle Income Countries: Addressing challenges and exploring future strategies: A narrative review. Health Sci Rep 2024; 7:e2075. [PMID: 38690005 PMCID: PMC11058085 DOI: 10.1002/hsr2.2075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 12/13/2023] [Accepted: 04/11/2024] [Indexed: 05/02/2024] Open
Abstract
Background and Aims Diabetic Foot Ulcers (DFUs) are a significant health concern, particularly in Low- and Middle-Income Countries (LMICs). This review explores key strategies for managing DFUs in LMICs, including integrating podiatry, endocrinology, and wound care services, educating patients, promoting self-care, and preventive measures to reduce amputation rates. Methods A comprehensive literature review was conducted, focusing on studies conducted in Low and Middle Income Countries to facilitate a qualitative analysis. The review examined the aetiology and risk factors to developing DFUs, clinical presentation, multidisciplinary management and evidence based interventions, challenges to the provision of care and future directions, all pertaining to DFUs in low and middle income countries. Results The aetiology and risk factors contributing to the development of DFUs are complex and multifaceted. Factors such as limited access to health care, inadequate diabetes management, and socioeconomic disparities significantly influence the incidence of DFUs. Clinical presentation varies, with patients often presenting at advanced stages of the disease due to delayed or missed diagnoses. Multidisciplinary management, incorporating podiatry, endocrinology, and wound care services, has exhibited substantial promise in enhancing patient outcomes. Evidence-based interventions, including offloading techniques, wound debridement, and the use of advanced wound dressings, have proven effective in promoting ulcer healing. Conclusion The burden of DFUs in LMICs requires comprehensive strategies. Integrating podiatry, endocrinology, and wound care services, along with patient education and self-care practices, is essential for reducing amputations and improving patients' quality of life. Regular follow-up and early detection are vital for effective DFU management, emphasizing the need for ongoing research and investment in LMIC health care infrastructure. Embracing these multidisciplinary, patient-centered approaches can effectively address the challenge of DFUs in LMICs, leading to better patient outcomes and improved quality of life.
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Affiliation(s)
| | | | | | - Sakshi Roy
- School of Medicine Queen's University Belfast Belfast UK
| | - Tomas Ferreira
- School of Clinical Medicine University of Cambridge Cambridge UK
| | | | | | - Saleha Azeem
- Faculty of Medicine King Edward Medical University Lahore Pakistan
| | | | - Marios Papadakis
- Department of Surgery II, University Hospital Witten-Herdecke, Heusnerstrasse 40 University of Witten-Herdecke Wuppertal Germany
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Pártos K, Major D, Dósa N, Fazekas-Pongor V, Tabak AG, Ungvári Z, Horváth I, Barta I, Pozsgai É, Bodnár T, Fehér G, Lenkey Z, Fekete M, Springó Z. Diagnosis rates, therapeutic characteristics, lifestyle, and cancer screening habits of patients with diabetes mellitus in a highly deprived region in Hungary: a cross-sectional analysis. Front Endocrinol (Lausanne) 2024; 15:1299148. [PMID: 38752177 PMCID: PMC11094325 DOI: 10.3389/fendo.2024.1299148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 04/08/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction Low socioeconomic status affects not only diagnosis rates and therapy of patients with diabetes mellitus but also their health behavior. Our primary goal was to examine diagnosis rates and therapy of individuals with diabetes living in Ormánság, one of the most deprived areas in Hungary and Europe. Our secondary goal was to examine the differences in lifestyle factors and cancer screening participation of patients with diagnosed and undiagnosed diabetes compared to healthy participants. Methods Our study is a cross-sectional analysis using data from the "Ormánság Health Program". The "Ormánság Health Program" was launched to improve the health of individuals in a deprived region of Hungary. Participants in the program were coded as diagnosed diabetes based on diagnosis by a physician as a part of the program, self-reported diabetes status, and self-reported prescription of antidiabetic medication. Undiagnosed diabetes was defined as elevated blood glucose levels without self-reported diabetes and antidiabetic prescription. Diagnosis and therapeutic characteristics were presented descriptively. To examine lifestyle factors and screening participation, patients with diagnosed and undiagnosed diabetes were compared to healthy participants using linear regression or multinomial logistic regression models adjusted for sex and age. Results Our study population consisted of 246 individuals, and 17.9% had either diagnosed (n=33) or undiagnosed (n=11) diabetes. Metformin was prescribed in 75.8% (n=25) of diagnosed cases and sodium-glucose cotransporter-2 inhibitors (SGLT-2) in 12.1% (n=4) of diagnosed patients. After adjustment, participants with diagnosed diabetes had more comorbidities (adjusted [aOR]: 3.50, 95% confidence interval [95% CI]: 1.34-9.18, p<0.05), consumed vegetables more often (aOR: 2.49, 95% CI: 1.07-5.78, p<0.05), but desserts less often (aOR: 0.33, 95% CI: 0.15-0.75, p<0.01) than healthy individuals. Patients with undiagnosed diabetes were not different in this regard from healthy participants. No significant differences were observed for cancer screening participation between groups. Conclusions To increase recognition of diabetes, targeted screening tests should be implemented in deprived regions, even among individuals without any comorbidities. Our study also indicates that diagnosis of diabetes is not only important for the timely initiation of therapy, but it can also motivate individuals in deprived areas to lead a healthier lifestyle.
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Affiliation(s)
- Kata Pártos
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - David Major
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Norbert Dósa
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Vince Fazekas-Pongor
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Adam G. Tabak
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Zoltán Ungvári
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- The Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Ildikó Horváth
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Ildikó Barta
- Ormansag Health Center, Ormánság Egészség Központ (OEKP), “AZ ORMANSÁG EGÉSZSÉGÉÉRT” Nonprofit Kft., Sellye, Hungary
| | - Éva Pozsgai
- Department of Public Health Medicine, University of Pécs Medical School, Pécs, Hungary
- Department of Primary Health Care, University of Pécs Medical School, Pécs, Hungary
| | - Tamás Bodnár
- Ormansag Health Center, Ormánság Egészség Központ (OEKP), “AZ ORMANSÁG EGÉSZSÉGÉÉRT” Nonprofit Kft., Sellye, Hungary
- Department of Anesthesia, Luzerner Kantonsspital, Sursee, Switzerland
| | - Gergely Fehér
- Centre for Occupational Medicine, Medical School, University of Pécs, Pecs, Hungary
- Department of Primary Health Care, Medical School, University of Pécs, Pecs, Hungary
| | - Zsófia Lenkey
- Ormansag Health Center, Ormánság Egészség Központ (OEKP), “AZ ORMANSÁG EGÉSZSÉGÉÉRT” Nonprofit Kft., Sellye, Hungary
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
| | - Mónika Fekete
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Zsolt Springó
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Ormansag Health Center, Ormánság Egészség Központ (OEKP), “AZ ORMANSÁG EGÉSZSÉGÉÉRT” Nonprofit Kft., Sellye, Hungary
- Clinical Medicine Doctoral School, Department of Public Health Medicine, University of Pécs Medical School, Pécs, Hungary
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Hashempour R, MirHashemi S, Mollajafari F, Damiri S, ArabAhmadi A, Raei B. Economic burden of diabetic foot ulcer: a case of Iran. BMC Health Serv Res 2024; 24:363. [PMID: 38515182 PMCID: PMC10958898 DOI: 10.1186/s12913-024-10873-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 03/15/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Diabetic foot ulcer (DFU) is known as a serious complication of diabetes mellitus in patients with diabetes, imposing heavy medical costs on healthcare systems due to its chronic nature. patients with severe diabetic foot ulcer are often disabled to work, and some of them may even die, leading to associated productivity losses. Since no previous study has investigated the economic burden of DFU in Iran, this study is to estimate the economic burden of diabetic foot disease in Iran. METHODS In this descriptive cross-sectional study, randomly selected samples consisted of 542 patients with DFU, hospitalized in the hospitals of Shahid Beheshti University of Medical Sciences. The demographic profile and cost data used in this analysis were derived from a researcher-designed checklist. Lost productivity was calculated based on Human Capital Approach, and the total economic cost of DFU was determined using patient-level data on costs and prevalence data from the global burden of diseases reports. All analyses were performed using SPSS software (Version 23), and Microsoft Excel (Version 19). RESULTS The economic burden of DFU in Iran in two scenarios of discounting future costs and not discounting them was about $8.7 billion and $35 billion, respectively (about 0.59 and 2.41% of GDP). 79.25% of the estimated costs in this study were indirect costs and productivity losses, of which 99.34% (7,918.4 million Dollars) were productivity losses due to premature death. 20.75% (2,064.4 million dollars) of the estimated costs in this study were direct costs. The average length of stay (LOS) was 8.10 days (SD = 9.32), and 73.3% of patients recovered and were discharged after hospitalization and 7.6% died. The majority of the costs are imposed on the age group of 60-69 year (53.42% of the productivity lost due to hospital length of stay, 58.91% of the productivity lost due to premature death & 40.41% of direct costs). CONCLUSIONS DFU represents a heavy burden to patients, Iran's health system, and the economy. Early prevention strategies need to be prioritized in making public health policies. These policies and decisions can be in the area of changing lifestyle, health education, changing people's behavior, and encouraging physical activity that targeted high-risk populations in order to reduce the prevalence of diabetic foot and resulting substantial economic burden.
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Affiliation(s)
- Reza Hashempour
- Department of Health Economics and Statistics, Vice-Chancellor's Office in Treatment Affairs, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - SeyedHadi MirHashemi
- Department of General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Mollajafari
- Department of Health Economics and Statistics, Vice-Chancellor's Office in Treatment Affairs, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheila Damiri
- Health Economics, Management, and Policy Department, Virtual School of Medical Education & Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali ArabAhmadi
- Department of Public Health, Qaen School of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran
| | - Behzad Raei
- Razi Educational and Therapeutic Center, Tabriz University of Medical Science, Tabriz, Iran.
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Waibel FWA, Uçkay I, Soldevila-Boixader L, Sydler C, Gariani K. Current knowledge of morbidities and direct costs related to diabetic foot disorders: a literature review. Front Endocrinol (Lausanne) 2024; 14:1323315. [PMID: 38298183 PMCID: PMC10829909 DOI: 10.3389/fendo.2023.1323315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/29/2023] [Indexed: 02/02/2024] Open
Abstract
Diabetes is a chronic disease associated with numerous complications including diabetic foot disorders, which are associated with significant morbidity and mortality as well as high costs. The costs associated with diabetic foot disorders comprise those linked to care (direct) and loss of productivity and poor quality of life (indirect). Due to the constant increase in diabetes prevalence, it is expected that diabetic foot disorder will require more resources, both in terms of caregivers and economically. We reviewed findings on management, morbidity, mortality, and costs related to diabetic foot disorder.
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Affiliation(s)
- Felix W. A. Waibel
- Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Ilker Uçkay
- Infectiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Laura Soldevila-Boixader
- Infectious Diseases, Internal Medicine Department, Consorci Sanitari Integral-CSI, Sant Joan Despí Hospital, Barcelona, Spain
| | - Christina Sydler
- Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Karim Gariani
- Service of Endocrinology, Diabetes, Nutrition, and Therapeutic Education, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
- Diabetes Center of the Faculty of Medicine, University of Geneva Medical School, Geneva, Switzerland
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Deo SV, Al-Kindi S, Motairek I, Elgudin YE, Gorodeski E, Nasir K, Rajagopalan S, Petrie MC, Sattar N. Neighbourhood-level social deprivation and the risk of recurrent heart failure hospitalizations in type 2 diabetes. Diabetes Obes Metab 2023; 25:2846-2852. [PMID: 37311730 PMCID: PMC10528514 DOI: 10.1111/dom.15174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/26/2023] [Accepted: 05/27/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND The importance of type 2 diabetes mellitus (T2D) in heart failure hospitalizations (HFH) is acknowledged. As information on the prevalence and influence of social deprivation on HFH is limited, we studied this issue in a racially diverse cohort. METHODS Linking data from US Veterans with stable T2D (without prevalent HF) with a zip-code derived population-level social deprivation index (SDI), we grouped them according to increasing SDI as follows: SDI: group I: ≤20; II: 21-40; III: 41-60; IV: 61-80; and V (most deprived) 81-100. Over a 10-year follow-up period, we identified the total (first and recurrent) number of HFH episodes for each patient and calculated the age-adjusted HFH rate [per 1000 patient-years (PY)]. We analysed the incident rate ratio between SDI groups and HFH using adjusted analyses. RESULTS In 1 012 351 patients with T2D (mean age 67.5 years, 75.7% White), the cumulative incidence of first HFH was 9.4% and 14.2% in SDI groups I and V respectively. The 10-year total HFH rate was 54.8 (95% CI: 54.5, 55.2)/1000 PY. Total HFH increased incrementally from SDI group I [43.3 (95% CI: 42.4, 44.2)/1000 PY] to group V [68.6 (95% CI: 67.8, 69.9)/1000 PY]. Compared with group I, group V patients had a 53% higher relative risk of HFH. The negative association between SDI and HFH was stronger in Black patients (SDI × Race pinteraction < .001). CONCLUSIONS Social deprivation is associated with increased HFH in T2D with a disproportionate influence in Black patients. Strategies to reduce social disparity and equalize racial differences may help to bridge this gap.
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Affiliation(s)
- Salil V. Deo
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sadeer Al-Kindi
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA
| | - Issam Motairek
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA
| | - Yakov E. Elgudin
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA
| | - Eiran Gorodeski
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA
| | | | - Sanjay Rajagopalan
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA
| | - Mark C. Petrie
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Robertson Center for Biostatistics, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
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