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Nissen SE, Menon V, Nicholls SJ, Brennan D, Laffin L, Ridker P, Ray KK, Mason D, Kastelein JJP, Cho L, Libby P, Li N, Foody J, Louie MJ, Lincoff AM. Bempedoic Acid for Primary Prevention of Cardiovascular Events in Statin-Intolerant Patients. JAMA 2023; 330:131-140. [PMID: 37354546 PMCID: PMC10336623 DOI: 10.1001/jama.2023.9696] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/19/2023] [Indexed: 06/26/2023]
Abstract
Importance The effects of bempedoic acid on cardiovascular outcomes in statin-intolerant patients without a prior cardiovascular event (primary prevention) have not been fully described. Objective To determine the effects of bempedoic acid on cardiovascular outcomes in primary prevention patients. Design, Setting, and Participants This masked, randomized clinical trial enrolled 13 970 statin-intolerant patients (enrollment December 2016 to August 2019 at 1250 centers in 32 countries), including 4206 primary prevention patients. Interventions Participants were randomized to oral bempedoic acid, 180 mg daily (n = 2100), or matching placebo (n = 2106). Main Outcome Measures The primary efficacy measure was the time from randomization to the first occurrence of any component of a composite of cardiovascular death, nonfatal myocardial infarction (MI), nonfatal stroke, or coronary revascularization. Results Mean participant age was 68 years, 59% were female, and 66% had diabetes. From a mean baseline of 142.2 mg/dL, compared with placebo, bempedoic acid reduced low-density lipoprotein cholesterol levels by 30.2 mg/dL (21.3%) and high-sensitivity C-reactive protein levels by 0.56 mg/L (21.5%), from a median baseline of 2.4 mg/L. Follow-up for a median of 39.9 months was associated with a significant risk reduction for the primary end point (111 events [5.3%] vs 161 events [7.6%]; adjusted hazard ratio [HR], 0.70 [95% CI, 0.55-0.89]; P = .002) and key secondary end points, including the composite of cardiovascular death, MI, or stroke (83 events [4.0%] vs 134 events [6.4%]; HR, 0.64 [95% CI, 0.48-0.84]; P < .001); MI (29 events [1.4%] vs 47 events [2.2%]; HR, 0.61 [95% CI, 0.39-0.98]); cardiovascular death (37 events [1.8%] vs 65 events [3.1%]; HR, 0.61 [95% CI, 0.41-0.92]); and all-cause mortality (75 events [3.6%] vs 109 events [5.2%]; HR, 0.73 [95% CI, 0.54-0.98]). There was no significant effect on stroke or coronary revascularization. Adverse effects with bempedoic acid included a higher incidence of gout (2.6% vs 2.0%), cholelithiasis (2.5% vs 1.1%), and increases in serum creatinine, uric acid, and hepatic enzyme levels. Conclusions In a subgroup of high-risk primary prevention patients, bempedoic acid treatment was associated with reduced major cardiovascular events. Trial Registration ClinicalTrials.gov Identifier: NCT02993406.
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Affiliation(s)
| | | | | | | | | | - Paul Ridker
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | - Peter Libby
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Na Li
- Esperion Therapeutics Inc, Ann Arbor, Michigan
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Turakhia M, Sundaram V, Smith SN, Ding V, Michael Ho P, Kowey PR, Piccini JP, Foody J, Birmingham MC, Ianus J, Rajmane A, Mahaffey KW. Efficacy of a centralized, blended electronic, and human intervention to improve direct oral anticoagulant adherence: Smartphones to improve rivaroxaban ADHEREnce in atrial fibrillation (SmartADHERE) a randomized clinical trial. Am Heart J 2021; 237:68-78. [PMID: 33676886 DOI: 10.1016/j.ahj.2021.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 02/26/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Improving adherence to direct oral anticoagulants (DOAC) is challenging, and simple text messaging reminders have not been effective. METHODS SmartADHERE was a randomized trial that tested a personalized digital and human direct oral anticoagulant adherence intervention compared to usual care. Eligibility required age ≥ 18, newly-prescribed (≤90 days) rivaroxaban for atrial fibrillation (AF), 1 of 4 at-risk criteria for nonadherence, and a smartphone. The intervention consisted of combination of a medication management smartphone app, daily app-based reminders, adaptive text messaging, and phone-based counseling for severe nonadherence. The primary outcome was the proportion of days covered by rivaroxaban (PDC) at 6 months. There were 25 U.S. sites, all cardiology and electrophysiology outpatient practices, activated for a target sample size of 378, but the study was terminated by the sponsor prior to reaching target enrollment. RESULTS There were 139 participants (age 65±9.6 years, 30% female, median CHA2DS2-VASc score 3 with IQR 2 to 4, mean total medication burden 7.7±4.4). DOAC adherence was high in both arms with no difference in the primary outcome (PDC 0.86±0.25 intervention vs 0.88±0.25 control, p=0.62) or in secondary outcomes including PDC ≥ 0.80 and medication persistence. Per protocol analyses had similar results. Because of the high overall PDC, the likelihood to answer the primary hypothesis was only 51% even if target enrollment were achieved. There were no study-related adverse events. CONCLUSIONS The use of a centralized digital and human adherence intervention was feasible across multiple sites. Overall adherence was much higher than expected despite prescreening for at-risk individuals. SmartADHERE illustrates the challenges of trials of behavioral and technology interventions, where enrollment itself may lead to selection bias or treatment effects. Pragmatic study designs, such as cluster randomization or stepped-wedge implementation, should be considered to improve enrollment and generalizability.
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Blacketer C, Reps J, Wang L, Li Q, Bernholz J, Larbi L, Foody J, Moore K, Hermanowski-Vosatka A, Peters G, Yuan Z, Ryan P. Abstract 23: Patient Level Prediction Models Developed With Large Observational Databases Outperformed Existing Clinical Prediction Scores For Stratifying Bleeding Risk In Patients With Atrial Fibrillation. Circ Cardiovasc Qual Outcomes 2019. [DOI: 10.1161/hcq.12.suppl_1.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Vitamin K antagonists (e.g., warfarin) and direct oral anticoagulants (DOACs; e.g., rivaroxaban, apixaban, dabigatran, edoxaban) are effective therapies for lowering the risk of thrombotic outcomes including stroke in patients with atrial fibrillation (AF). Like all anticoagulants, they are associated with an increased risk of bleeding. Several models (e.g., ATRIA, ORBIT, HAS-BLED, CHADS
2
and CHA
2
DS
2
-VASc) are available to predict the risk of major bleeding but their performance has not been widely evaluated in observational databases.
Objective:
To develop patient-level bleeding risk prediction models and evaluate their performance compared to existing clinical models of bleeding.
Methods:
Based on tools available through the Observational Health Data Science and Informatics Collaborative and Observed Medical Outcomes Partnership Common Data Model framework, we developed patient-level prediction (PLP) models to predict the risk of major bleeding events in patients with non-valvular AF who were new users of warfarin or DOACs. A LASSO regularized logistic regression technique including over 100,000 baseline covariates was performed across each of 4 US databases: IBM MarketScan
®
(Commercial (CCAE), Medicaid (MDCD), and Medicare Supplemental (MDCR)) and Optum Clinformatics
®
Extended Data Mart (Optum). We evaluated the performance of the PLP models compared with the existing models using the Area Under the Curve (AUC), with 75% training and 25% testing sets. The models were then externally validated by applying them to the other three databases.
Results:
In each database, all the PLP models achieved higher internal validity (AUCs 0.69 - 0.83) compared with the existing clinical models. The highest AUC among the existing clinical models was 0.76 for CHA
2
DS
2
-VASc run on the DOACs new user population in the CCAE database; the comparative AUC for the PLP model was 0.79. The external validation of the PLP models was somewhat lower, the lowest being the new user DOACs models learned on the MDCD database and applied to the other three databases with AUCs between 0.56 and 0.58. This is possibly in part due to differences between patients in MDCD versus other databases (e.g., age, disability, socioeconomic status). The highest performing was the new user warfarin model learned on the Optum database validated on the CCAE database with an AUC of 0.75.
Conclusion:
A patient level prediction model outperforms many existing clinical bleeding risk models currently in use.
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Affiliation(s)
| | - Jenna Reps
- Janssen Rsch and Development, Titusville, NJ
| | - Lu Wang
- Janssen Rsch and Development, Titusville, NJ
| | - Qingqin Li
- Janssen Rsch and Development, Pennington, NJ
| | | | | | | | | | | | | | - Zhong Yuan
- Janssen Rsch and Development, Titusville, NJ
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Turakhia MP, Sundaram V, Smith S, Ding V, Ho PM, Kowey PR, Piccini J, Foody J, Birmingham M, Ianus J, Rajmane A, Mahaffey K. EFFICACY OF A CENTRALIZED, BLENDED ELECTRONIC, AND HUMAN INTERVENTION TO IMPROVE DOAC ADHERENCE: THE SMARTADHERE TRIAL. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31118-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
OBJECTIVE Atrial fibrillation, peripheral and coronary artery disease, and venous thromboembolism are major risk factors for stroke, disability, and death in the rapidly growing older (≥ 65 years.) population. In the absence of clear guidelines on the appropriate use of the newer non-vitamin K antagonist oral anticoagulants in this population, this study specifically reviews the available literature for rivaroxaban and the impact of age that may affect the pharmacokinetics, pharmacodynamics, efficacy, and safety of this anticoagulant. METHODS This review includes a summary of data obtained from the available literature concerning both older healthy subjects and older patients with various aspects of cardiovascular disease enrolled in rivaroxaban clinical trials and data from real world evidence studies. RESULTS Evaluation of the clinical pharmacology in healthy, older adults reveal no clinically relevant effect of age on rivaroxaban pharmacokinetics and pharmacodynamics. Population pharmacokinetic studies in older patients with thromboembolic diseases suggest a moderate effect of increasing age on rivaroxaban clearance, albeit not clinically significant. Additionally, sub-group analyses from large, phase 3 clinical trials demonstrate consistent efficacy and safety in the older patient population vs the overall population. These findings are further supported by real-world evidence studies. CONCLUSION A favorable clinical profile with rivaroxaban was observed across age sub-groups, supporting the premise that dosing in older adults does not necessitate adjustment. However, it is prudent that a cautious and individualized approach is taken for treatment with any anticoagulant in older adults.
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Affiliation(s)
- Kenneth T Moore
- a Janssen Pharmaceuticals , Janssen Medical Affairs , Titusville , NJ , USA
| | - Peggy Wong
- b Janssen Pharmaceuticals, Research and Development , Raritan , NJ , USA
| | - Liping Zhang
- b Janssen Pharmaceuticals, Research and Development , Raritan , NJ , USA
| | - Guohua Pan
- b Janssen Pharmaceuticals, Research and Development , Raritan , NJ , USA
| | - JoAnne Foody
- a Janssen Pharmaceuticals , Janssen Medical Affairs , Titusville , NJ , USA
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Foody J, Moore KT. American Geriatrics Society Beers Criteria and Anticoagulant Use in Older Adults With Renal Impairment. Kidney Int Rep 2018; 3:222-223. [PMID: 29340340 PMCID: PMC5762967 DOI: 10.1016/j.ekir.2017.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 11/06/2017] [Accepted: 11/13/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- JoAnne Foody
- Janssen Pharmaceuticals, Inc, Titusville, New Jersey, USA
| | - Kenneth Todd Moore
- Janssen Pharmaceuticals, Inc, Titusville, New Jersey, USA
- Correspondence: Kenneth Todd Moore, Janssen Pharmaceuticals, Inc., 1125 Trenton-Harbourton Road, Titusville, New Jersey 08560, USA.Janssen Pharmaceuticals, Inc.1125 Trenton-Harbourton RoadTitusvilleNew Jersey08560USA
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Foody J, Turpin RS, Tidwell BA, Lawrence D, Schulman KL. Major Cardiovascular Events in Patients with Gout and Associated Cardiovascular Disease or Heart Failure and Chronic Kidney Disease Initiating a Xanthine Oxidase Inhibitor. Am Health Drug Benefits 2017; 10:393-401. [PMID: 29263773 PMCID: PMC5726059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 08/08/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Several observational studies and meta-analyses have suggested that treating hyperuricemia in patients with gout and moderate or severe chronic kidney disease (CKD) may improve renal and cardiovascular (CV) outcomes. OBJECTIVE To evaluate the impact of initiating allopurinol or febuxostat treatment on major CV events in patients with gout, preexisting CV disease (CVD) or heart failure (HF), and stage 3 or 4 CKD in a real-world setting. METHODS Patients with gout (aged >18 years) who initiated allopurinol or febuxostat treatment between 2009 and 2013 after a diagnosis of stage 3 or 4 CKD and CVD-including coronary artery disease (CAD), cerebrovascular disease, and peripheral vascular disease (PVD)-or HF were selected from the MarketScan databases. The major CV events included CAD-specific, cerebrovascular disease-specific, and PVD-specific events. Cox proportional hazards modeling identified the predictors of major CV events in aggregate, and of CAD, cerebrovascular disease, and PVD events, individually. RESULTS During follow-up, 2426 patients (370 receiving febuxostat and 2056 receiving allopurinol; 63% male; mean age, 73 years) had 162 major CV events (3.8% in those receiving febuxostat vs 7.2% in those receiving allopurinol; P = .015). The rates of major CV events per 1000 person-years were 51.8 (95% confidence interval [CI], 28-87) in patients initiating febuxostat and 99.3 (95% CI, 84-117) among those initiating allopurinol. Overall, 49.4% of patients had a CAD event, 32.5% had a PVD event, and 23.5% had a cerebrovascular disease-specific event. Febuxostat initiation was associated with a significantly lower risk for a major CV event versus patients who initiated allopurinol (hazard ratio, 0.52; P = .02), driven in large part by lower PVD-specific events (P = .026). CONCLUSION Patients with moderate-to-severe CKD and CVD or HF who initiated febuxostat treatment had a significantly lower rate of major CV events than patients who initiated allopurinol.
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Affiliation(s)
- JoAnne Foody
- Associate Professor, Harvard Medical School, Boston, MA, and Executive Director-Cardiovascular, Janssen Pharmaceuticals, New Brunswick, NJ
| | - Robin S Turpin
- Director and Head, Health Economics and Outcomes Research, Medical Affairs, Takeda Pharmaceuticals USA, Deerfield, IL
| | - Beni A Tidwell
- Research Associate, Outcomes Research Solutions, Shrewsbury, MA
| | - Debra Lawrence
- Director, Health Economics and Outcomes Research; Medical Affairs, Takeda Pharmaceuticals USA
| | - Kathy L Schulman
- Research Scientist and Principal, Outcomes Research Solutions, Shrewsbury, MA
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Toth PP, Bays H, Farnier M, Jensen E, Tomassini JE, Polis A, Foody J, Tershakovec AM. GW27-e0459 Attainment of acc/aha recommended ldl-c lowering with statin and ezetimibe+statin therapies. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.07.514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Foody J, Turpin R, Tidwell B, Eisenberg Lawrence D, Schulman K. THU0503 Major Cardiovascular Events in Patients with Recurrent Gout, Cardiovascular and Chronic Kidney Disease, Initiating on Allopurinol or Febuxostat. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Toth PP, Catapano AL, Farnier M, Foody J, Tomassini JE, Jensen E, Polis AB, Musliner T, Tershakovec AM. Ezetimibe Does Not Increase Fasting Glucose Levels More than Statins Alone in Non-diabetic, Hypercholesterolemic Patients. J Clin Lipidol 2015. [DOI: 10.1016/j.jacl.2015.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Steen DL, Khan I, Song X, Sanchez R, Gorcyca K, Hollenbeak C, Foody J. CARDIOVASCULAR EVENT RATES IN A HIGH-RISK MANAGED CARE POPULATION IN THE UNITED STATES. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61647-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rodriguez F, Olufade T, Heithoff K, Navaratnam P, Friedman H, Foody J. Abstract 326: High Potency Statins Underutilized in Patients with Atherosclerotic Cardiovascular Disease (ASCVD). Circ Cardiovasc Qual Outcomes 2014. [DOI: 10.1161/circoutcomes.7.suppl_1.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
The 2013 AHA/ACC Cholesterol Guidelines advocate that all patients with ASCVD receive high potency statins (HPS). However, little is known about current patterns of HPS use. Therefore, we determined patterns of HPS in ASCVD patients in a large, contemporary managed-care database.
Methods:
Patients ≥18 years old with documented ASCVD with ≥1 LDL-C test from Jan 2004 to Dec 2012 were identified in the Optum Insight database. HPS use was defined as treatment with atorvastatin (40or 80 mg), rosuvastatin (20or 40mg), or simvastatin 80mg. Patients who received other lipid lowering therapies (LLTs) and those who were untreated were identified. We calculated monthly average LDL-C measures and the proportion of patients that achieve LDL-C goals of <70mg/dL and 100mg/dL
Results:
The number of eligible patients ranged from 45, 101 (2004) to 40,846 (2012). Overall, ASCVD patients treated with HPS increased from 13% (2004) to 26% (2012). Among LLT-treated, the percentage of patients that received HPS increased from 20% (2004) to 38% (2012). HPS patients had a slightly lower average LDL-C than non-HPS LLT patients in January 2004 (101.9 ± 33.6 mg/dL versus 104.1 ± 31.8. mg/dL) but the difference increased substantially by December 2012 (85.6 ± 29.3mg/dL versus 94.0 mg/dL ± 32.2 mg/dL). HPS patients were also more likely to attain an LDL goal of <70 mg/dL relative to non-HPS LLT patients and untreated patients. A similar pattern was observed when a goal of LDL<100 mg/dL was used.
Conclusions:
Using a large managed-care dataset of patients with ASCVD, we found that over the past decade HPS use has increased. However, despite the growing use of high-potency statins for this high-risk population, less than 26% of ASCVD patients were prescribed high potency statins by 2012. Further research and interventions are needed to address substantial gaps in care and how best to implement new, national recommendations in order to improve patient outcomes.
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Toth PP, Catapano A, Farnier M, Foody J, Tomassini J, Jensen E, Polis A, Musliner T, Tershakovec A. Changes in Fasting Glucose Levels Following Longer-Term Treatment with Simvastatin Monotherapy and Combined Ezetimibe+Simvastatin†. J Clin Lipidol 2014. [DOI: 10.1016/j.jacl.2014.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Toth PP, Catapano A, Farnier M, Foody J, Tomassini J, Jensen E, Polis A, Musliner T, Tershakovec A. CHANGES IN FASTING GLUCOSE LEVELS FOLLOWING LONGER-TERM TREATMENT WITH SIMVASTATIN MONOTHERAPY AND COMBINED EZETIMIBE+SIMVASTATIN. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61313-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Foody J. Antiplatelet therapy in women with acute coronary syndrome. J Fam Pract 2014; 63:S3-S8. [PMID: 24527482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- JoAnne Foody
- Associate Professor, Harvard Medical School; Director of the Pollin Cardiovascular Wellness Program, Brigham and Women's Hospital; Director, Pollin Project for Cardiovascular Disease in Women, Boston, MA, USA
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Liu G, Wang Y, Zhao D, Yang W, Jiang Q, Lewis JFM, Yu W, Liu LZ, Foody J. GW24-e3987 Economic Burden of Cardiovascular Disease in China: A systematic review. Heart 2013. [DOI: 10.1136/heartjnl-2013-304613.820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Toth PP, Catapano A, Farnier M, Foody J, Tomassini J, Jensen E, Polis A, Musliner T, Tershakovec A. Effects of Ezetimibe, Ezetimibe Coadministered with Statins and Statin Therapies on Fasting Glucose Changes in Patients with Hypercholesterolemia. J Clin Lipidol 2013. [DOI: 10.1016/j.jacl.2013.03.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chiang CW, Santos RD, Waters DD, Messig M, Tarasenko L, Jukema JW, Ferrières J, Foody J, Seung KB. Reaching C-reactive protein and low-density lipoprotein cholesterol goals in dyslipidemic patients (from the Lipid Treatment Assessment Project [L-TAP] 2). Am J Cardiol 2011; 107:1639-43. [PMID: 21440886 DOI: 10.1016/j.amjcard.2011.01.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 01/22/2011] [Accepted: 01/22/2011] [Indexed: 10/18/2022]
Abstract
The purpose of the present substudy of the Lipid Treatment Assessment Project 2 was to assess dual C-reactive protein (CRP) and low-density lipoprotein (LDL) cholesterol goal attainment across a spectrum of low-, moderate-, and high-risk patients with dyslipidemia in 8 countries in North America, Latin America, Europe, and Asia. Of the 9,518 patients studied overall, 45% were women, 64% had hypertension, 31% had diabetes, 14% were current smokers, 60% were high risk, and 79% were taking a statin. The median CRP level was 1.5 mg/L (interquartile range 0.2 to 2.8). On multivariate analysis, higher CRP levels were associated with older age, female gender, hypertension, current smoking, greater body mass index, larger waist circumference, LDL cholesterol level, and triglyceride/high-density lipoprotein cholesterol ratio. In contrast, being from Asia or taking a statin was associated with lower levels. Across all risk groups, 59% of patients attained the CRP target of <2 mg/L, and 33% had <1 mg/L. Overall, 44% of patients attained both their National Cholesterol Education Program Adult Treatment Panel III LDL cholesterol target and a CRP level of <2 mg/L, but only 26% attained their LDL cholesterol target and a CRP level of <1 mg/L. In the very high-risk group with coronary heart disease and ≥2 risk factors, only 19% attained both their LDL cholesterol goal and a CRP level of <2 mg/L and 12% their LDL cholesterol goal and a CRP level of <1 mg/L. In conclusion, with current treatment, most dyslipidemic patients do not reach the dual CRP and LDL cholesterol goals. Smoking cessation, weight reduction, and the greater use of more potent statins at higher doses might be able to improve these outcomes.
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Tunceli K, Sajjan S, Ramey D, Neff D, Tershakovec A, Hu H, Foody J. MS45 IMPACT OF SWITCHING TO SIMVASTATIN ON LOW DENSITY LIPOPROTEIN CHOLESTEROL GOAL ATTAINMENT. ATHEROSCLEROSIS SUPP 2010. [DOI: 10.1016/s1567-5688(10)70546-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Aslam F, Haque A, Lee V, Foody J. Patient adherence and preference considerations in managing cardiovascular risk: focus on single pill and amlodipine/atorvastatin fixed combination. Patient Prefer Adherence 2009; 3:61-6. [PMID: 19936146 PMCID: PMC2778438 DOI: 10.2147/ppa.s4201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Cardiovascular disease (CVD) accounts for in excess of 930,000 deaths in the United States each year. Risk factors for CVD often co-exist. Studies estimate that over half of the hypertensive population also has dyslipidemia. Observational data suggest that fewer than 10% of patients attain recommended therapeutic targets for both conditions. A variety of patient, regimen and system characteristics have been associated with the risk for non-adherence. Poly-pharmacy and complex drug regimens are associated with poor patient adherence and thus the use of fixed-dose combination therapies, may improve adherence by reducing the pill burden. The fixed-dose combination of amlodipine/atorvastatin offers a convenient and effective approach to manage two important CVD risk factors. The combination of amlodipine/atorvastatin has a synergistic effect. The half-life of both agents facilitates once-daily dosing and both can be administered at any time of the day with or without food. Amlodipine/atorvastatin combined pill can be used to initiate both agents or patients can be switched directly from single-agent therapy with one or both agents. The convenience of single-pill amlodipine/atorvastatin has the potential to improve patient adherence and the management of cardiovascular risk in selected patients, thereby improving clinical outcomes.
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Affiliation(s)
- Farhan Aslam
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Attiya Haque
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Veronica Lee
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - JoAnne Foody
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA, USA
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Waters DD, Brotons C, Chiang CW, Ferrières J, Foody J, Jukema JW, Santos RD, Verdejo J, Messig M, McPherson R, Seung KB, Tarasenko L. Lipid treatment assessment project 2: a multinational survey to evaluate the proportion of patients achieving low-density lipoprotein cholesterol goals. Circulation 2009; 120:28-34. [PMID: 19546386 DOI: 10.1161/circulationaha.108.838466] [Citation(s) in RCA: 248] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Information about physicians' adherence to cholesterol management guidelines remains scant. The present survey updates our knowledge of lipid management worldwide. METHODS AND RESULTS Lipid levels were determined at enrollment in dyslipidemic adult patients on stable lipid-lowering therapy in 9 countries. The primary end point was the success rate, defined as the proportion of patients achieving appropriate low-density lipoprotein cholesterol (LDL-C) goals for their given risk. The mean age of the 9955 evaluable patients was 62+/-12 years; 54% were male. Coronary disease and diabetes mellitus had been diagnosed in 30% and 31%, respectively, and 14% were current smokers. Current treatment consisted of a statin in 75%. The proportion of patients achieving LDL-C goals according to relevant national guidelines ranged from 47% to 84% across countries. In low-, moderate-, and high-risk groups, mean LDL-C was 119, 109, and 91 mg/dL and mean high-density lipoprotein cholesterol was 62, 49, and 50 mg/dL, respectively. The success rate for LDL-C goal achievement was 86% in low-, 74% in moderate-, and 67% in high-risk patients (73% overall). However, among coronary heart disease patients with > or =2 risk factors, only 30% attained the optional LDL-C goal of <70 mg/dL. In the entire cohort, high-density lipoprotein cholesterol was <40 mg/dL in 19%, 40 to 60 mg/dL in 55%, and >60 mg/dL in 26% of patients. CONCLUSIONS Although there is room for improvement, particularly in very-high-risk patients, these results indicate that lipid-lowering therapy is being applied much more successfully than it was a decade ago.
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Affiliation(s)
- David D Waters
- Division of Cardiology, San Francisco General Hospital and University of California, San Francisco, CA 94114, USA.
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Foody J. Abstract: 10 SECONDARY PREVENTION IN WOMEN. ATHEROSCLEROSIS SUPP 2009. [DOI: 10.1016/s1567-5688(09)70014-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Champney KP, Frederick PD, Bueno H, Parashar S, Foody J, Merz CNB, Canto JG, Lichtman JH, Vaccarino V. The joint contribution of sex, age and type of myocardial infarction on hospital mortality following acute myocardial infarction. Heart 2009; 95:895-9. [PMID: 19147625 DOI: 10.1136/hrt.2008.155804] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Younger, but not older, women have a higher mortality than men of similar age after a myocardial infarction (MI). We sought to determine whether this relationship is true for both ST elevation MI (STEMI) and non-ST elevation MI (NSTEMI). DESIGN Retrospective cohort study. SETTING 1057 USA hospitals participant in the National Registry of Myocardial Infarction between 2000 and 2006. PATIENTS 126 172 STEMI and 235 257 NSTEMI patients. MAIN OUTCOME MEASURE Hospital death. RESULTS For both STEMI and NSTEMI, the younger the patient's age, the greater the excess mortality risk for women compared with men, while older women fared similarly (STEMI) or better (NSTEMI) than men (p<0.0001 for the age-sex interaction). In STEMI, the unadjusted women-to-men RR was 1.68 (95% CI 1.41 to 2.01), 1.78 (1.59 to 1.99), 1.45 (1.34 to 1.57), 1.08 (1.02 to 1.14) and 1.03 (0.98 to 1.07) for age <50 years, age 50-59, age 60-69, age 70-79 and age 80-89, respectively. For NSTEMI, corresponding unadjusted RRs were 1.56 (1.31 to 1.85), 1.42 (1.27 to 1.58), 1.17 (1.09 to 1.25), 0.92 (0.88 to 0.96) and 0.86 (0.83 to 0.89). After adjusting for risk status, the excess risk for younger women compared with men decreased to approximately 15-20%, while a better survival of older NSTEMI women compared with men persisted. CONCLUSIONS Sex-related differences in short-term mortality are age-dependent in both STEMI and NSTEMI patients.
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Affiliation(s)
- K P Champney
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA 30306, USA
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Bakris G, Fonseca V, Foody J. Challenges to the diagnosis, evaluation, treatment, and management of clustered cardiometabolic risk factors. J Cardiometab Syndr 2008; 3:119-125. [PMID: 18453814 DOI: 10.1111/j.1559-4572.2008.08338.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A panel was convened on January 10, 2007, to discuss the challenges to the diagnosis, evaluation, treatment, and management of clustered cardiometabolic risk factors. George Bakris, MD, Professor of Medicine, University of Chicago, Chicago, IL, moderated the panel. Vivian Fonseca, MD, Tulane University Health Science Center, New Orleans, LA, and JoAnne Foody, MD, Harvard School of Medicine, Boston, MA, participated in the discussion. This expert panel discussion was supported by and each author received an honorarium from Merck & Co, Inc, and Sanofi-Aventis for time and effort spent participating in the discussion and reviewing the transcript for important intellectual content before publication. The authors maintained full control of the discussion and the resulting content of this article.
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Conti CR, DeMaria AN, Foody J, Harrington RA, Kapadia SR, Knopf WD, Markowitz SM, Rhodes JF, Starling RC, Stein JH, Thomas JD, Tuzcu EM, Villanueva F, Wagoner LE. Highlights of the 56th Annual Scientific Session of the American College of Cardiology—March 24–27, 2007. J Am Coll Cardiol 2007. [DOI: 10.1016/j.jacc.2007.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Safdar B, Foody J, D'Onofrio G. Depression is a Common Coronary Risk Factor in Women Admitted to an ED Chest Pain Center. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.1069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Harrington RA, O’Connor CM, Stein JH, Wolff MR, McLean RC, Mohler ER, Blumenthal RS, Knopf WD, Ambrose JA, Wagoner LE, Starling RC, Kim RJ, Markowitz SM, Landzberg MJ, Ungerleider R, Rahimtoola SH, Resnic FS, Foody J. Highlights of the 55th Annual Scientific Session of the American College of Cardiology—March 11–14, 2006. J Am Coll Cardiol 2006. [DOI: 10.1016/j.jacc.2006.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- Frederic S Resnic
- Cardiovascular Fellowship Program, Yale University School of Medicine, New Haven, Connecticut, USA.
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Foody J, Kelly D, Kumar D, Fitzgerald D, Ward T, Caulfield B, Markham C. A prototype sourceless kinematic-feedback based video game for movement based exercise. Conf Proc IEEE Eng Med Biol Soc 2006; 2006:5366-5369. [PMID: 17946300 DOI: 10.1109/iembs.2006.259249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This paper presents a prototype kinematic and audio feedback based video game, availing of a scalable motion capture acquisition system, based around a number of orientation sensors. The orientation sensors used are USB based tri-axis magnetic and gravitational field transducers. The novel video-game is capable of incorporating the real time data from these sensors to control an on screen avatar, which in turn can be programmed to give appropriate instructions to the user i.e. play a sound file, once the user obtains a certain posture. The video game is designed to promote physical exercise and movement based relaxation, in particular; yoga. In addition, design considerations; implementation and performance of the system are analyzed, discussed and the accuracy qualitatively analyzed by comparing movement data obtained from it to that of a validated motion analysis technique, the CODA motion analysis system.
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Affiliation(s)
- J Foody
- Computer Science Department, National University Maynooth Ireland, Eire.
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Graff L, Chern C, Turnbull D, Wang Y, Foody J, Werdmann M, Radford M. Physicians' Acute Coronary Syndrome Testing Threshold and Diagnostic Performance. Ann Emerg Med 2005. [DOI: 10.1016/j.annemergmed.2005.06.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Gombeski WR, Kramer RK, Freed L, Foody J, Parkosewich J, Wilson T, Wack JT, D'Onofrio G. Women's Heart Advantage Program: the impact 3 years later. J Cardiovasc Manag 2005; 16:27-34. [PMID: 16521611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Yale-New Haven Hospital, in partnership with Voluntary Hospital Association (VHA Inc), launched the Women's Heart Advantage program in March 2001. Major program components implemented include (1) a comprehensive initial and ongoing internal communication program; (2) a health promotion initiative including a 24-hour, 7-days-a-week women's heart line staffed by nurses and an Internet health question-and-answer forum; (3) significant ongoing communication with nurses and physicians; (4) a community outreach effort to educate poor and minority women; and (5) an aggressive effort to secure financial partners to underwrite the cost of the program. Before launching the program, a telephone survey of 300 randomly selected New Haven County women ages 40 to 70 years was initiated in January 2001 and repeated in January 2002, 2003, and 2004. Findings include (1) the percentage of women who recognize heart disease as the number-one killer of women their age increased from 26% in 2001 to 59% in 2004, (2) the percentage of women who would call 9-1-1 or go directly to a hospital emergency department increased from 63% in 2002 to 83% in 2004, and (3) the percentage of women aware of recent Women's Heart Advantage program promotion grew from 33% in 2002 to 50% in 2004. Perhaps most importantly, the number of women with heart problems admitted through the hospital's emergency department increased from 1528 per year in 2001 to 1870 per year in 2004 (7.5% annual increase), whereas the number of men with heart problems admitted through the emergency department during the same time period has been relatively low (0.8% annual increase). By linking clinical, public health, and marketing expertise along with finding ways to partner with other organizations, the Women's Heart Advantage program has contributed to remarkable changes in women's awareness, knowledge, and behaviors, suggesting a model for approaching similar health-related problems.
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Affiliation(s)
- William R Gombeski
- Marketing & Communications, Yale-New Haven Hospital, New Haven, CT 06510, USA
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Graff L, Wang Y, Foody J, Meehan T, Tuozzo K, Krumholz H, Radford M. Delay in diagnosis of acute myocardial infarction: Increasingly common, lower quality of care. Ann Emerg Med 2004. [DOI: 10.1016/j.annemergmed.2004.07.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Graff L, Foody J, Galusha D, Tuozzo K, Meehan T, Radford M. Effect of interhospital transfer patterns on hospitals' quality performance measurement results. Ann Emerg Med 2004. [DOI: 10.1016/j.annemergmed.2004.07.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
The findings are presented of a consensus committee created to address the measuring and improving of quality in emergency medicine. The objective of the committee was to critically evaluate how quality in emergency medicine can be measured and how quality improvement projects can positively affect the care of emergency patients. Medical quality is defined as "the care health professionals would want to receive if they got sick." The literature of quality improvement in emergency medicine is reviewed and analyzed. A summary list of measures of quality is included with four categories: condition-specific diseases, diagnostic syndromes, tasks/procedures, and department efficiency/efficacy. Methods and tools for quantifying these measures are examined as well as their accuracy in assessing quality and adjusting for differences in environment, and patient populations. Successful strategies for changing physician behavior are detailed as well as barriers to change. Examples are given of successful quality improvement efforts. Also examined is how to address the emergency care needs of vulnerable populations such as older persons, women, those without health insurance, and ethnic minorities.
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Affiliation(s)
- Louis Graff
- Section of Emergency Medicine, Department of Traumatology and Emergency Medicine, University of Connecticut School of Medicine, Farmington, CT 06085-1480, USA.
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Masoudi FA, Smith GL, Havranek EP, Fish RH, Wolfe P, Stevens BR, Ordin DL, Krumholz HM, Foody J. Gender is more important than advancing age as a predictor of preserved systolic function in older persons hospitalized with heart failure. J Am Coll Cardiol 2002. [DOI: 10.1016/s0735-1097(02)82072-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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