Fatima Rodriguez, MD, MPH is a preventive and general cardiologist in the Division of Cardiovascular Medicine at Stanford. Dr. Rodriguez received her medical training from Harvard Medical School. She completed her residency at Brigham and Women's Hospital and a fellowship in Cardiovascular Medicine at Stanford University. She specializes in common cardiac conditions such as coronary artery disease, valvular heart disease, lipid disorders, and cardiovascular risk assessment in high-risk populations.

Dr. Rodriguez’s research includes a range of topics relating to racial, ethnic, and gender disparities in cardiovascular disease prevention and developing novel interventions to address disparities.

Clinical Focus

  • Cardiovascular Medicine
  • Prevention
  • Lipid disorders
  • General Cardiology
  • Cardiovascular Disease

Academic Appointments

Honors & Awards

  • Zuckerman Fellow, Harvard Center for Public Leadership (2009)
  • Medical Scholars Award, Massachusetts Medical Society (2011)
  • Presidential Scholars Public Service Initiative, Harvard Medical School (2011)
  • Arnold C. Dunne Award for Compassionate Patient Care, Brigham and Women's Hospital (2012)
  • Golden Stethoscope Award, Brigham and Women's Hospital (2014)
  • Trainee Award for Excellence in Medical Education in Medicine and Medical Subspecialties, Harvard Medical School (2014)
  • Edwin Alderman Award for Excellence in Clinical Research, Stanford University (2015)
  • Timothy F. Beckett, Jr. Award, Best Clinical Teaching by a Medicine Fellow, Stanford University (2015)
  • Women in Cardiology Trainee Award for Excellence, American Heart Association (2015)
  • Outstanding Clinical Fellow Award, Stanford University, Division of Cardiology (2016)
  • Research Fellowship Award, American College of Cardiology (ACC)/Merck (2016)
  • Ruth L. Kirschstein National Research Service Award, National Institutes of Health (2016)
  • Edwin Alderman Award for Excellence in Clinical Research, Stanford University (2017)
  • Health Disparities Research Loan Repayment Program, National Institutes of Health (2017)
  • Stanford Cardiovascular Institute Manuscript Award, Stanford University (2017)
  • Center of Excellence Faculty Fellowship, Stanford University (2018)
  • Fellow, American College of Cardiology (2018)
  • McCormick Galiban Faculty Award, Stanford University (2018)

Boards, Advisory Committees, Professional Organizations

  • Member, American Heart Association (2010 - Present)
  • Fellow, American College of Cardiology (2014 - Present)
  • Member, National Lipid Association (2016 - Present)
  • Associate Editor, New England Journal of Medicine Journal Watch Cardiology (2018 - Present)

Professional Education

  • Board Certification: Cardiovascular Disease, American Board of Internal Medicine (2017)
  • B.A., University of Pennsylvania (2006)
  • M.D., Harvard Medical School (2011)
  • M.P.H., Harvard School of Public Health (2011)
  • Residency, Brigham and Women's Hospital, Harvard Medical School, Internal Medicine (2014)
  • Fellowship:Stanford University Cardiovascular Medicine Fellowship (2017) CA
  • Board Certification: Internal Medicine, American Board of Internal Medicine (2014)
  • Board Certification, American Board of Internal Medicine, Cardiovascular Disease (2017)

Clinical Trials

  • International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA) Recruiting

    The purpose of the ISCHEMIA trial is to determine the best management strategy for higher-risk patients with stable ischemic heart disease (SIHD). This is a multicenter randomized controlled trial with 5179 randomized participants with moderate or severe ischemia on stress testing. A blinded coronary computed tomography angiogram (CCTA) was performed in most participants with eGFR ≥60 mL/min/1.73m2 to identify and exclude participants with either significant unprotected left main disease (≥50% stenosis) or those without obstructive CAD (<50% stenosis in all major coronary arteries). Of 8720 participants enrolled, those that had insufficient ischemia, ineligible anatomy demonstrated on CCTA or another exclusion criterion, did not go on to randomization. Eligible participants were then assigned at random to a routine invasive strategy (INV) with cardiac catheterization followed by revascularization plus optimal medical therapy (OMT) or to a conservative strategy (CON) of OMT, with cardiac catheterization and revascularization reserved for those who fail OMT. SPECIFIC AIMS A. Primary Aim The primary aim of the ISCHEMIA trial is to determine whether an initial invasive strategy of cardiac catheterization followed by optimal revascularization, if feasible, in addition to OMT, will reduce the primary composite endpoint of cardiovascular death, nonfatal myocardial infarction, resuscitated cardiac arrest, or hospitalization for unstable angina or heart failure in participants with SIHD and moderate or severe ischemia over an average follow-up of approximately 3.5 years compared with an initial conservative strategy of OMT alone with catheterization reserved for failure of OMT. B. Secondary Aims Secondary aims are to determine whether an initial invasive strategy compared to a conservative strategy will improve: 1) the composite of CV death or MI; 2) angina symptoms and quality of life, as assessed by the Seattle Angina Questionnaire Angina Frequency and Quality of Life scales; 3) all-cause mortality; 4) net clinical benefit assessed by including stroke in the primary and secondary composite endpoints; and 5) individual components of the composite endpoints. Condition: Coronary Disease Procedure: Coronary CT Angiogram Procedure: Cardiac catheterization Phase: Phase III Condition: Cardiovascular Diseases Procedure: Angioplasty, Transluminal, Percutaneous Coronary, other catheter-based interventions Phase: Phase III Condition: Heart Diseases Procedure: Coronary Artery Bypass Surgery Phase: Phase III

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  • Limited-English Proficiency (LEP) Virtual Reality (VR) Study Recruiting

    The purpose of this study is to determine if non-invasive distracting devices (Virtual Reality headset) are more effective than the standard of care (i.e., no technology based distraction) for preventing anxiety in parental and pediatric populations with limited English proficiency (LEP).

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Graduate and Fellowship Programs

All Publications

  • Years of Potential Life Lost Because of Cardiovascular Disease in Asian-American Subgroups, 2003-2012. Journal of the American Heart Association Iyer, D. G., Shah, N. S., Hastings, K. G., Hu, J., Rodriguez, F., Boothroyd, D. B., Krishnan, A. V., Falasinnu, T., Palaniappan, L. 2019; 8 (7): e010744


    Background Asian-American subgroups (Asian-Indian, Chinese, Filipino, Korean, Japanese, and Vietnamese) display varied cardiovascular disease mortality patterns, especially at younger ages. This study aims to examine the years of potential life lost because of ischemic heart disease and cerebrovascular disease among the 6 largest Asian-American subgroups compared with non-Hispanic whites. Methods and Results We used National Center for Health Statistics Multiple Causes of Death mortality files from 2003 to 2012 to calculate race-specific life expectancy, mean years of potential life lost, and years of potential life lost per 100000 population for each Asian subgroup and non-Hispanic whites. Asian-American subgroups display heterogeneity in cardiovascular disease burden. Asian-Indians had a high burden of ischemic heart disease; Asian-Indian men lost 724years per 100000 population in 2012 and a mean of 17years to ischemic heart disease. Respectively, Vietnamese and Filipino men and women lost a mean of 17 and 16years of life to cerebrovascular disease; Filipino men lost 352years per 100000 population in 2012. All Asian subgroups for both sexes had higher years of life lost to cerebrovascular disease compared with non-Hispanic whites. Conclusions Cardiovascular disease burden varies among Asian subgroups, and contributes to greater premature mortality in certain subgroups. Asian-Indian and Filipino populations have the highest years of life lost because of ischemic heart disease and Filipino and Vietnamese have the highest years of life lost because of cerebrovascular disease. Analysis of risk factors and development of subgroup-specific interventions are required to address these health disparities.

    View details for PubMedID 30890022

  • Let Them Eat Cake. Academic medicine : journal of the Association of American Medical Colleges Rees, J., Rodriguez, F. 2019; 94 (3): 320

    View details for DOI 10.1097/ACM.0000000000002544

    View details for PubMedID 30817343

  • Baseline Characteristics and Risk Profiles of Participants in the ISCHEMIA Randomized Clinical Trial. JAMA cardiology Hochman, J. S., Reynolds, H. R., Bangalore, S., O'Brien, S. M., Alexander, K. P., Senior, R., Boden, W. E., Stone, G. W., Goodman, S. G., Lopes, R. D., Lopez-Sendon, J., White, H. D., Maggioni, A. P., Shaw, L. J., Min, J. K., Picard, M. H., Berman, D. S., Chaitman, B. R., Mark, D. B., Spertus, J. A., Cyr, D. D., Bhargava, B., Ruzyllo, W., Wander, G. S., Chernyavskiy, A. M., Rosenberg, Y. D., Maron, D. J., ISCHEMIA Research Group 2019


    Importance: It is unknown whether coronary revascularization, when added to optimal medical therapy, improves prognosis in patients with stable ischemic heart disease (SIHD) at increased risk of cardiovascular events owing to moderate or severe ischemia.Objective: To describe baseline characteristics of participants enrolled and randomized in the International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA) trial and to evaluate whether qualification by stress imaging or nonimaging exercise tolerance test (ETT) influenced risk profiles.Design, Setting, and Participants: The ISCHEMIA trial recruited patients with SIHD with moderate or severe ischemia on stress testing. Blinded coronary computed tomography angiography was performed in most participants and reviewed by a core laboratory to exclude left main stenosis of at least 50% or no obstructive coronary artery disease (CAD) (<50% for imaging stress test and <70% for ETT). The study included 341 enrolling sites (320 randomizing) in 38 countries and patients with SIHD and moderate or severe ischemia on stress testing. Data presented were extracted on December 17, 2018.Main Outcomes and Measures: Enrolled, excluded, and randomized participants' baseline characteristics. No clinical outcomes are reported.Results: A total of 8518 patients were enrolled, and 5179 were randomized. Common reasons for exclusion were core laboratory determination of insufficient ischemia, unprotected left main stenosis of at least 50%, or no stenosis that met study obstructive CAD criteria on study coronary computed tomography angiography. Randomized participants had a median age of 64 years, with 1168 women (22.6%), 1726 nonwhite participants (33.7%), 748 Hispanic participants (15.5%), 2122 with diabetes (41.0%), and 4643 with a history of angina (89.7%). Among the 3909 participants randomized after stress imaging, core laboratory assessment of ischemia severity (in 3901 participants) was severe in 1748 (44.8%), moderate in 1600 (41.0%), mild in 317 (8.1%) and none or uninterpretable in 236 (6.0%), Among the 1270 participants who were randomized after nonimaging ETT, core laboratory determination of ischemia severity (in 1266 participants) was severe (an eligibility criterion) in 1051 (83.0%), moderate in 101 (8.0%), mild in 34 (2.7%) and none or uninterpretable in 80 (6.3%). Among the 3912 of 5179 randomized participants who underwent coronary computed tomography angiography, 79.0% had multivessel CAD (n=2679 of 3390) and 86.8% had left anterior descending (LAD) stenosis (n=3190 of 3677) (proximal in 46.8% [n=1749 of 3739]). Participants undergoing ETT had greater frequency of 3-vessel CAD, LAD, and proximal LAD stenosis than participants undergoing stress imaging.Conclusions and Relevance: The ISCHEMIA trial randomized an SIHD population with moderate or severe ischemia on stress testing, of whom most had multivessel CAD.Trial Registration: Identifier: NCT01471522.

    View details for PubMedID 30810700

  • Association Between Female Corresponding Authors and Female Co-Authors in Top Contemporary Cardiovascular Medicine Journals. Circulation Ouyang, D., Harrington, R. A., Rodriguez, F. 2019; 139 (8): 1127–29

    View details for DOI 10.1161/CIRCULATIONAHA.118.037763

    View details for PubMedID 30779644

  • One Size Does Not Fit All: Improving Recruitment and Retention of Women in Cardiovascular Device-Related Clinical Trials. JACC. Cardiovascular interventions Rodriguez, F., Harrington, R. A. 2019; 12 (3): 309–11

    View details for DOI 10.1016/j.jcin.2018.11.012

    View details for PubMedID 30732737

  • Diabetes-Attributable Mortality in the United States from 2003-2016 Using a Multiple-Cause-of-Death Approach. Diabetes research and clinical practice Rodriguez, F., Blum, M. R., Falasinnu, T., Hastings, K. G., Hu, J., Cullen, M. R., Palaniappan, L. P. 2019


    AIMS: Deaths attributable to diabetes may be underestimated using an underlying cause of death (COD) approach in U.S. death records. This study sought to characterize the burden of diabetes deaths using a multiple-cause of death approach and to identify temporal changes in co-reported causes of death among those with diabetes listed anywhere on their death records.METHODS: COD were identified using data from the National Center for Health Statistics from 2003-2016. We calculated age-adjusted mortality rates for diabetes as the underlying or contributing COD by race/ethnicity. We used ICD-10 codes to identify leading causes of death among those with and without diabetes on their death records. We compared temporal changes in deaths due to cardiovascular disease, cerebrovascular disease, cancer, and other causes.RESULTS: The study population included 34,313,964 decedents aged ≥25 from 2003-2016. Diabetes was listed as an underlying COD in approximately 3.0% (n=1,031,000) and 6.7% (n=2,295,510) of the death records, respectively. Decedents with diabetes listed as an underlying COD experienced a 16% decline in mortality, and the race/ethnicity-specific average annual percentage changes (AAPC) showed significant declining trends for most groups (AAPC ranged from 0.18 to -2.83%). Cardiovascular disease remained the leading underlying COD among diabetes-attributable deaths, although its proportion of deaths fell from 31 to 27% over time. Co-reported COD diversified, and were more likely to include hypertension and hypertensive renal disease among those with diabetes on their death records.CONCLUSIONS: Our findings underscore the importance of using a multiple-cause-of-death approach for more completely characterizing diabetes' contribution to mortality.

    View details for DOI 10.1016/j.diabres.2019.01.015

    View details for PubMedID 30641162

  • Association of Statin Adherence With Mortality in Patients With Atherosclerotic Cardiovascular Disease. JAMA cardiology Rodriguez, F., Maron, D. J., Knowles, J. W., Virani, S. S., Lin, S., Heidenreich, P. A. 2019


    Statins decrease mortality in those with atherosclerotic cardiovascular disease (ASCVD), but statin adherence remains suboptimal.To determine the association between statin adherence and mortality in patients with ASCVD who have stable statin prescriptions.This retrospective cohort analysis included patients who were between ages 21 and 85 years and had 1 or more International Classification of Diseases, Ninth Revision, Clinical Modification codes for ASCVD on 2 or more dates in the previous 2 years without intensity changes to their statin prescription who were treated within the Veterans Affairs Health System between January 1, 2013, and April 2014.Statin adherence was defined by the medication possession ratio (MPR). Adherence levels were categorized as an MPR of less than 50%, 50% to 69%, 70% to 89%, and 90% or greater. For dichotomous analyses, adherence was defined as an MPR of 80% or greater.The primary outcome was death of all causes adjusted for demographic and clinical characteristics, as well as adherence to other cardiac medications.Of 347 104 eligible adults with ASCVD who had stable statin prescriptions, 5472 (1.6%) were women, 284 150 (81.9%) were white, 36 208 (10.4%) were African American, 16 323 (4.7%) were Hispanic, 4093 (1.2%) were Pacific Islander, 1293 (0.4%) were Native American, 1145 (0.3%) were Asian, and 1794 (0.5%) were other races. Patients taking moderate-intensity statin therapy were more adherent than patients taking high-intensity statin therapy (odds ratio [OR], 1.18; 95% CI, 1.16-1.20). Women were less adherent (OR, 0.89; 95% CI, 0.84-0.94), as were minority groups. Younger and older patients were less likely to be adherent compared with adults aged 65 to 74 years. During a mean (SD) of 2.9 (0.8) years of follow-up, there were 85 930 deaths (24.8%). Compared with the most adherent patients (MPR ≥ 90%), patients with an MPR of less than 50% had a hazard ratio (HR; adjusted for clinical characteristics and adherence to other cardiac medications) of 1.30 (95% CI, 1.27-1.34), those with an MPR of 50% to 69% had an HR of 1.21 (95% CI, 1.18-1.24), and those with an MPR of 70% to 89% had an HR of 1.08 (95% CI, 1.06-1.09).Using a national sample of Veterans Affairs patients with ASCVD, we found that a low adherence to statin therapy was associated with a greater risk of dying. Women, minorities, younger adults, and older adults were less likely to adhere to statins. Our findings underscore the importance of finding methods to improve adherence.

    View details for PubMedID 30758506

  • Identification of Factors Associated With Variation in US County-Level Obesity Prevalence Rates Using Epidemiologic vs Machine Learning Models. JAMA network open Scheinker, D., Valencia, A., Rodriguez, F. 2019; 2 (4): e192884


    Obesity is a leading cause of high health care expenditures, disability, and premature mortality. Previous studies have documented geographic disparities in obesity prevalence.To identify county-level factors associated with obesity using traditional epidemiologic and machine learning methods.Cross-sectional study using linear regression models and machine learning models to evaluate the associations between county-level obesity and county-level demographic, socioeconomic, health care, and environmental factors from summarized statistical data extracted from the 2018 Robert Wood Johnson Foundation County Health Rankings and merged with US Census data from each of 3138 US counties. The explanatory power of the linear multivariate regression and the top performing machine learning model were compared using mean R2 measured in 30-fold cross validation.County-level demographic factors (population; rural status; census region; and race/ethnicity, sex, and age composition), socioeconomic factors (median income, unemployment rate, and percentage of population with some college education), health care factors (rate of uninsured adults and primary care physicians), and environmental factors (access to healthy foods and access to exercise opportunities).County-level obesity prevalence in 2018, its association with each county-level factor, and the percentage of variation in county-level obesity prevalence explained by linear multivariate and gradient boosting machine regression measured with R2.Among the 3138 counties studied, the mean (range) obesity prevalence was 31.5% (12.8%-47.8%). In multivariate regressions, demographic factors explained 44.9% of variation in obesity prevalence; socioeconomic factors, 33.0%; environmental factors, 15.5%; and health care factors, 9.1%. The county-level factors with the strongest association with obesity were census region, median household income, and percentage of population with some college education. R2 values of univariate regressions of obesity prevalence were 0.238 for census region, 0.218 for median household income, and 0.160 for percentage of population with some college education. Multivariate linear regression and gradient boosting machine regression (the best-performing machine learning model) of obesity prevalence using all county-level demographic, socioeconomic, health care, and environmental factors had R2 values of 0.58 and 0.66, respectively (P < .001).Obesity prevalence varies significantly between counties. County-level demographic, socioeconomic, health care, and environmental factors explain the majority of variation in county-level obesity prevalence. Using machine learning models may explain significantly more of the variation in obesity prevalence..

    View details for PubMedID 31026030

  • Cardiovascular Risk Factors and Dehydroepiandrosterone Sulfate Among Latinos in the Boston Puerto Rican Health Study. Journal of the Endocrine Society Jimenez, M. C., Tucker, K. L., Rodriguez, F., Porneala, B. C., Meigs, J. B., Lopez, L. 2019; 3 (1): 291–303


    Low blood dehydroepiandrosterone sulfate (DHEAS) levels have strong positive associations with stroke and coronary heart disease. However, it is unclear whether DHEAS is independently associated with cardiovascular risk factors. Therefore, we examined the association between cardiovascular risk factors and DHEAS concentration among a high-risk population of Latinos (Puerto Ricans aged 45 to 75 years at baseline) in a cross-sectional analysis of the Boston Puerto Rican Health Study. Of eligible participants, 72% completed baseline interviews and provided blood samples. Complete data were available for 1355 participants. Associations between cardiovascular risk factors (age, sex, total cholesterol, high-density lipid cholesterol, triglycerides, and glucose) and log-transformed DHEAS (mug/dL) were assessed. In robust multivariable regression analyses, DHEAS was significantly inversely associated with age (beta = -12.4; 95% CI: -15.2, -9.7; per 5 years), being female (vs. male) (beta = -46; 95% CI: -55.3, -36.6), and plasma triglyceride concentration (beta = -0.2; 95% CI: -0.3, -0.1; per 10 mg/dL) and was positively associated with total cholesterol and plasma glucose levels (beta = 1.8; 95% CI: 0.6, 3 and beta = 0.2; 95% CI: 0.04, 0.3, respectively, per 10 mg/dL) after adjustment for smoking, alcohol, and physical activity and for postmenopausal hormone use in women. Estimates were unchanged after adjustment for measures of chronic disease and inflammation. Women exhibited a stronger age-related decline in DHEAS and a positive association with glucose in contrast to findings among men (P interaction < 0.05). In conclusion, in this large study of Latinos with a heavy cardiovascular risk factor burden, we observed significant associations between cardiovascular disease (CVD) risk factors and DHEAS, with variations by sex. These findings improve our understanding of the role DHEAS may play in CVD etiology.

    View details for DOI 10.1210/js.2018-00205

    View details for PubMedID 30623167

  • Stroke Outcomes With Vorapaxar Versus Placebo in Patients With Acute Coronary Syndromes: Insights From the TRACER Trial. Journal of the American Heart Association Ungar, L., Clare, R. M., Rodriguez, F., Kolls, B. J., Armstrong, P. W., Aylward, P., Held, C., Moliterno, D. J., Strony, J., Van de Werf, F., Wallentin, L., White, H. D., Tricoci, P., Harrington, R. A., Mahaffey, K. W., Melloni, C. 2018; 7 (24): e009609


    Background Vorapaxar, a protease-activated receptor-1 antagonist, is approved for secondary prevention of cardiovascular events but is associated with increased intracranial hemorrhage. Methods and Results TRACER (Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome) was a trial of vorapaxar versus placebo among patients with acute coronary syndrome. Strokes were adjudicated by a central events committee. Of 12944 patients, 199 (1.5%) had ≥1 stroke during the study period (median follow-up, 477days). Four patients had a single stroke of unknown type; 195 patients had ≥1 stroke classified as hemorrhagic or nonhemorrhagic (165 nonhemorrhagic, 28 hemorrhagic, and 2 both). Strokes occurred in 96 of 6473 patients (1.5%) assigned vorapaxar and 103 of 6471 patients (1.6%) assigned placebo. Kaplan-Meier incidence of stroke for vorapaxar versus placebo was higher for hemorrhagic stroke (0.45% versus 0.14% [hazard ratio, 2.74; 95% confidence interval, 1.22-6.15]), lower but not significantly different for nonhemorrhagic stroke (1.53% versus 1.98% at 2years [hazard ratio, 0.79; 95% confidence interval, 0.58-1.07]), and similar for stroke overall (1.93% versus 2.13% at 2years [hazard ratio, 0.94; 95% confidence interval, 0.71-1.24]). Conclusions Stroke occurred in <2% of patients. Vorapaxar-assigned patients had increased hemorrhagic stroke but a nonsignificant trend toward lower nonhemorrhagic stroke. Overall stroke frequency was similar with vorapaxar versus placebo.

    View details for DOI 10.1161/JAHA.118.009609

    View details for PubMedID 30526198

  • Nativity and Occupational Determinants of Physical Activity Participation Among Latinos. American journal of preventive medicine Echeverria, S. E., Divney, A., Rodriguez, F., Sterling, M., Vasquez, E., Murillo, R., Lopez, L. 2018


    INTRODUCTION: Latinos in the U.S. bear a disproportionate burden of cardiovascular risk factors, including physical inactivity. Previous research among Latinos has focused on leisure-time physical activity, limiting understanding of the different ways in which populations, particularly working-class groups, achieve recommended levels of physical activity. This study examined associations of race/ethnicity; nativity; and leisure-time, transportation, and occupation-related physical activity among Latino and non-Latino white adults.METHODS: Participants sampled in the 2007-2012 waves of the National Health and Nutrition Examination Survey self-reported domain-specific physical activity. Data were analyzed in 2016-2017 using multivariable log binomial regression models to examine differences in meeting guidelines for each physical activity domain separately and as total physical activity among Latinos (n=4,692) and non-Latino whites (n=7,788). Models were adjusted for sociodemographic characteristics and health status and tested interactions between nativity and occupational categories.RESULTS: In adjusted models, foreign-born Latinos (prevalence ratio=0.70, 95% CI=0.63, 0.77) and U.S.-born Latinos (prevalence ratio=0.85, 95% CI=0.76, 0.95) were least likely to meet physical activity guidelines through occupation-related and leisure time physical activity, when compared with non-Latino whites. By contrast, foreign-born Latinos were more likely to meet physical activity guidelines through transportation physical activity than non-Latino whites (prevalence ratio=1.26, 95% CI=1.01, 1.56) and were proportionately more likely to participate in vigorous modes of physical activity. Interaction results indicated that foreign-born Latinos were the least likely to meet physical activity guidelines compared with U.S.-born Latinos and non-Latino whites if they worked in non-manual occupational categories. All racial/ethnic groups working in manual occupations saw the largest increase (40%-50%) in meeting physical activity guidelines when occupation-related physical activity was combined with leisure-time and transportation physical activity.CONCLUSIONS: These findings suggest variability in the relationship between nativity and the physical activity domain Latinos engage in compared with non-Latino whites, with occupation contributing substantially to meeting physical activity recommendations for all population groups.

    View details for DOI 10.1016/j.amepre.2018.07.036

    View details for PubMedID 30442464

  • 27-Year-Old Man with a Positive Troponin: A Case Report. Cardiology and therapy Manjunath, L., Yeluru, A., Rodriguez, F. 2018


    In this case report, we describe a young athletic male with a family history of early sudden cardiac death who presented with atypical chest pain and was found to have a positive serum troponin. Although his symptoms resolved without intervention, workup revealed hypertension, hyperlipidemia, mild left ventricular hypertrophy, non-obstructive coronary artery disease, and the presence of serum heterophile antibodies. Ultimately, it was concluded that his rigorous exercise regimen as well as the presence of heterophile antibodies may have contributed to his positive serum troponin. This case serves as a reminder of the nonspecific diagnostic value of modern troponin assays, and that the results of these tests should always be incorporated into the clinical context.

    View details for DOI 10.1007/s40119-018-0120-3

    View details for PubMedID 30367446

  • County-Level Hispanic Ethnic Density and Cardiovascular Disease Mortality. Journal of the American Heart Association Rodriguez, F., Hu, J., Kershaw, K., Hastings, K. G., Lopez, L., Cullen, M. R., Harrington, R. A., Palaniappan, L. P. 2018; 7 (19): e009107


    Background Hispanics are the fastest growing ethnic group in the United States, and little is known about how Hispanic ethnic population density impacts cardiovascular disease ( CVD ) mortality. Methods and Results We examined county-level deaths for Hispanics and non-Hispanic whites from 2003 to 2012 using data from the National Center for Health Statistics' Multiple Cause of Death mortality files. Counties with more than 20 Hispanic deaths (n=715) were included in the analyses. CVD deaths were identified using International Classification of Diseases, Tenth Revision (ICD-10), I00 to I78, and population estimates were calculated using linear interpolation from 2000 and 2010 census data. Multivariate linear regression was used to examine the association of Hispanic ethnic density with Hispanic and non-Hispanic white age-adjusted CVD mortality rates. County-level age-adjusted CVD mortality rates were adjusted for county-level demographic, socioeconomic, and healthcare factors. There were a total of 4769040 deaths among Hispanics (n=382416) and non-Hispanic whites (n=4386624). Overall, cardiovascular age-adjusted mortality rates were higher among non-Hispanic whites compared with Hispanics (244.8 versus 189.0 per 100000). Hispanic density ranged from 1% to 96% in each county. Counties in the highest compared with lowest category of Hispanic density had 60% higher Hispanic mortality (215.3 versus 134.2 per 100000 population). In linear regression models, after adjusting for county-level demographic, socioeconomic, and healthcare factors, increasing Hispanic ethnic density remained strongly associated with mortality for Hispanics but not for non-Hispanic whites. Conclusions CVD mortality is higher in counties with higher Hispanic ethnic density. County-level characteristics do not fully explain the higher CVD mortality among Hispanics in ethnically concentrated counties.

    View details for DOI 10.1161/JAHA.118.009107

    View details for PubMedID 30371295

  • Frequency of Statin Use in Patients With Low-Density Lipoprotein Cholesterol ≥190 mg/dl from the Veterans Affairs Health System. The American journal of cardiology Rodriguez, F., Knowles, J. W., Maron, D. J., Virani, S. S., Heidenreich, P. A. 2018


    Patients with low-density lipoprotein cholesterol (LDL-C) ≥190 mg/dl have severe hypercholesterolemia and are at markedly increased risk for adverse cardiovascular events. This study sought to examine the prevalence and treatment of patients with uncontrolled severe hypercholesterolemia in the Veterans Affairs (VA) Health System. The study population was comprised of VA outpatients ≥21 years of age without atherosclerotic disease or diabetes mellitus and an index LDL-C ≥190 mg/dl during April 2011 to March 2014. Patients needed to have filled medications at the VA within the past 6 months. Patient and facility-level predictors of statin use, high-intensity statin use, and statin intensification were analyzed using multivariate logistic regressions. There were a total of 63,576 patients meeting inclusion criteria, including 8,553 (13.5%) women and 26,879 (29.0%) nonwhite patients. The mean (±S.D.) age was 55 (±13) years and the mean of the most recent LDL-C values was 207 ± 22 mg/dl. Only 52% of all eligible patients were on any statin therapy and 9.7% received high-intensity statin therapy. High-intensity statin use increased from 8.6% in 2011 to 13.6% in 2014 (p < 0.001). In adjusted analysis, patients <35 or >75 years of age were less likely to be on a statin (p < 0.001). Women were less likely to be treated than men, odds ratio = 0.88; 95% confidence interval (0.83, 0.92). Similar patterns were observed for predictors of high-intensity statin use and statin intensification. In conclusion, only half of high-risk VA patients with uncontrolled severe hypercholesterolemia were treated with statins and a small minority was on high-intensity statin therapy.

    View details for PubMedID 30055758

  • Assessing the Relationship between Atherosclerotic Cardiovascular Disease Risk Score and Carotid Artery Imaging Findings. Journal of neuroimaging : official journal of the American Society of Neuroimaging Li, Y., Zhu, G., Ding, V., Huang, Y., Jiang, B., Ball, R. L., Rodriguez, F., Fleischmann, D., Desai, M., Saloner, D., Saba, L., Hom, J., Wintermark, M. 2018


    To characterize the relationship between computed tomography angiography (CTA) imaging characteristics of carotid artery and the 10-year risk of atherosclerotic cardiovascular disease (ASCVD) score.We retrospectively identified all patients who underwent a cervical CTA at our institution from January 2013 to July 2016, extracted clinical information, and calculated the 10-year ASCVD score using the Pooled Cohort Equations from the 2013 ACC/AHA guidelines. We compared the imaging features of artery atherosclerosis derived from the CTAs between low and high risk.One hundred forty-six patients met our inclusion criteria. Patients with an ASCVD score ≥7.5% (64.4%) had significantly more arterial stenosis than patients with an ASCVD score <7.5% (35.6%, P < .001). Maximal plaque thickness was significantly higher (mean 2.33 vs. .42 mm, P < .001) and soft plaques (55.3% vs. 13.5%, P < .001) were significantly more frequent in patients with an ASCVD score ≥7.5%. However, among patients with a 10-year ASCVD score ≥7.5%, 33 (35.1%) had no arterial stenosis, 35 (37.2%) had a maximal plaque thickness less than. 9 mm, and 42 (44.7%) had no soft plaque. Furthermore, among the patients with a 10-year ASCVD score <7.5%, 8 (15.4%) had some arterial stenosis, 8 (15.4%) had a maximal plaque thickness more than. 9 mm, and 7 (13.5%) had soft plaque.There is some concordance but not a perfect overlap between the 10-year ASCVD risk scores calculated from clinical and blood assessment and carotid artery imaging findings.

    View details for PubMedID 30357980

  • Men Versus Women. Circulation. Cardiovascular interventions Rodriguez, F., Harrington, R. A. 2018; 11 (8): e007016
  • Promise and Perils of Big Data and Artificial Intelligence in Clinical Medicine and Biomedical Research. Circulation research Rodriguez, F., Scheinker, D., Harrington, R. A. 2018; 123 (12): 1282–84

    View details for DOI 10.1161/CIRCRESAHA.118.314119

    View details for PubMedID 30566055

  • Assessing the Relationship Between American Heart Association Atherosclerotic Cardiovascular Disease Risk Score and Coronary Artery Imaging Findings. Journal of computer assisted tomography Li, Y., Zhu, G., Ding, V., Jiang, B., Ball, R. L., Ahuja, N., Rodriguez, F., Fleischmann, D., Desai, M., Saloner, D., Saba, L., Wintermark, M., Hom, J. 2018


    The aim of this study was to characterize the relationship between computed tomography angiography imaging characteristics of coronary artery and atherosclerotic cardiovascular disease (ASCVD) score.We retrospectively identified all patients who underwent a coronary computed tomography angiography at our institution from December 2013 to July 2016, then we calculated the 10-year ASCVD score. We characterized the relationship between coronary artery imaging findings and ASCVD risk score.One hundred fifty-one patients met our inclusion criteria. Patients with a 10-year ASCVD score of 7.5% or greater had significantly more arterial segments showing stenosis (46.4%, P = 0.008) and significantly higher maximal plaque thickness (1.25 vs 0.53, P = 0.001). However, among 56 patients with a 10-year ASCVD score of 7.5% or greater, 30 (53.6%) had no arterial stenosis. Furthermore, among the patients with a 10-year ASCVD score of less than 7.5%, 24 (25.3%) had some arterial stenosis.There is some concordance but not a perfect overlap between 10-year ASCVD risk scores and coronary artery imaging findings.

    View details for PubMedID 30407249

  • Sex Disparities in Authorship Order of Cardiology Scientific Publications. Circulation. Cardiovascular quality and outcomes Ouyang, D., Sing, D., Shah, S., Hu, J., Duvernoy, C., Harrington, R. A., Rodriguez, F. 2018; 11 (12): e005040


    Despite advances in the representation of women in medical training, women continue to be underrepresented in cardiology, academic medicine, and more specifically, in senior positions within academic medicine. Identifying disparities in research productivity and acknowledgment can highlight barriers to female representation in academic cardiology leadership, as well as in academic promotion.This bibliometric analysis included all authors of original research articles between 1980 and 2017 from 3 high-impact cardiology journals ( Journal of the American College of Cardiology, Circulation, and European Heart Journal). We identified 71 345 unique authors of 55 085 primary research articles during our study period. Female authors accounted for 33.1% of all authors; however, they represented only 26.7% of first authors and 19.7% of senior authors. Looking at the most prolific authors within this time period, female authors were not well represented, accounting for only 5% of the top 100 authors. Articles with a female senior author had more female middle authors than articles with a male senior author (mean 1.41 versus 0.97, P<0.001) and were more likely to have a female first author (0.37 versus 0.18, P<0.001). There was an increased representation of female authors as first and senior authors compared with the total number of articles with female authors over time ( P<0.001 for trend); however, female senior authorship rates continued to lag first authorship rates.Using a large database of published manuscripts, we found that female representation in published cardiology research has increased over the past 4 decades. However, women continue to be not well represented as first authors, senior authors, and in the number of publications. When women were senior authors, they published more articles with female first authors and had more female authors. In addition to recruiting more women into the field of cardiology, additional work is needed to identify and address barriers to academic advancement for female physician-scientists.

    View details for PubMedID 30562072

  • Association of Educational Attainment and Cardiovascular Risk in Hispanic Individuals: Findings From the Cooper Center Longitudinal Study. JAMA cardiology Rodriguez, F., Leonard, D., DeFina, L., Barlow, C. E., Willis, B. L., Haskell, W. L., Maron, D. J. 2018


    Hispanic individuals are the fastest growing ethnic group in the United States and face lower socioeconomic status compared with non-Hispanic white (NHW) individuals. However, Hispanic individuals tend to experience better health outcomes than expected, a phenomenon known as the Hispanic paradox. Little is known about how higher socioeconomic status is associated with Hispanic cardiovascular risk factor burden and outcomes.To determine cardiovascular risk and outcomes among highly educated Hispanic vs NHW individuals in a preventive medicine clinic.Retrospective cohort analysis of participants from the Cooper Center Longitudinal Study who underwent preventive medical examinations at the Cooper Clinic in Dallas, Texas, from October 1972 to November 2017. Analysis began April 2018.Ethnicity, self-defined as Hispanic or NHW.Prevalence of major metabolic risk factors and cardiorespiratory fitness were compared, as were changes among participants with at least 2 visits. Ethnic differences adjusted for age, examination year, and educational attainment were estimated using regression models. Age-matched comparisons of coronary artery calcium scores were performed. All-cause mortality was summarized using the Kaplan-Meier method.This study included 1351 Hispanic and 43 736 NHW participants aged 20 to 80 years, body mass index between 18.5 and 50.0, and were not missing key cardiometabolic or fitness variables. Both Hispanic and NHW participants had high educational attainment, with a mean of more than 15 years of total education. Hispanic women and men had a higher prevalence of metabolic syndrome (71 of 518 [13.1%] vs 1477 of 13 732 [10.8%] for women and 255 of 833 [30.6%] vs 7902 of 30 004 [26.3%] for men, respectively). Although Hispanic individuals were twice as likely to have diabetes, there was no difference in calculated 10-year atherosclerotic cardiovascular disease risk scores by ethnicity. Both Hispanic and NWH individuals experienced a statistically significant worsening in cardiometabolic parameters during follow-up, although this was not statistically significantly different between groups. In age-matched analyses, there were no significant differences in the prevalence of coronary artery calcium scores between Hispanic and NWH individuals. During a mean (SD) follow-up of 12.9 (7.5) years, there was no difference in mortality between Hispanic and NHW individuals.Hispanic and NHW men and women with high educational attainment had similar atherosclerotic cardiovascular disease risk, subclinical coronary atherosclerosis, and mortality during follow-up. These findings do not support the Hispanic paradox in a highly educated Hispanic population.

    View details for PubMedID 30566183

  • Choosing a Career in Cardiology: Where Are the Women? JAMA cardiology Curtis, A. B., Rodriguez, F. 2018

    View details for DOI 10.1001/jamacardio.2018.1286

    View details for PubMedID 29847614

  • Intensity of Statin Treatment and Mortality-Reply. JAMA cardiology Rodriguez, F., Maron, D. J., Heidenreich, P. A. 2017

    View details for DOI 10.1001/jamacardio.2017.0549

    View details for PubMedID 28445560

  • Disaggregation of Cause-Specific Cardiovascular Disease Mortality Among Hispanic Subgroups. JAMA cardiology Rodriguez, F., Hastings, K. G., Boothroyd, D. B., Echeverria, S., Lopez, L., Cullen, M., Harrington, R. A., Palaniappan, L. P. 2017


    Hispanics are the largest minority group in the United States and face a disproportionate burden of risk factors for cardiovascular disease (CVD) and low socioeconomic position. However, Hispanics paradoxically experience lower all-cause mortality rates compared with their non-Hispanic white (NHW) counterparts. This phenomenon has been largely observed in Mexicans, and whether this holds true for other Hispanic subgroups or whether these favorable trends persist over time remains unknown.To disaggregate a decade of national CVD mortality data for the 3 largest US Hispanic subgroups.Deaths from CVD for the 3 largest US Hispanic subgroups-Mexicans, Puerto Ricans, and Cubans-compared with NHWs were extracted from the US National Center for Health Statistics mortality records using the underlying cause of death based on coding from the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (I00-II69). Mortality data were evaluated from January 1, 2003, to December 31, 2012. Population estimates were calculated using linear interpolation from the 2000 and 2010 US Census reports. Data were analyzed from November 2015 to July 2016.Mortality due to CVD.Participants included 688 074 Mexican, 163 335 Puerto Rican, 130 397 Cuban, and 19 357 160 NHW individuals (49.0% men and 51.0% women; mean [SD] age, 75 [15] years). At the time of CVD death, Mexicans (age, 67 [18] years) and Puerto Ricans (age, 68 [17] years) were younger compared with NHWs (age, 76 [15] years). Mortality rates due to CVD decreased from a mean of 414.2 per 100 000 in 2003 to 303.3 per 100 000 in 2012. Estimated decreases in mortality rate for CVD from 2003 to 2012 ranged from 85 per 100 000 for all Hispanic women to 144 per 100 000 for Cuban men, but rate differences between groups vary substantially, with Puerto Ricans exhibiting similar mortality patterns to NHWs, and Mexicans experiencing lower mortality. Puerto Ricans experienced higher mortality rates for ischemic and hypertensive heart disease compared with other subgroups, whereas Mexicans experienced higher rates of cerebrovascular disease deaths.Significant differences in CVD mortality rates and changes over time were found among the 3 largest Hispanic subgroups in the United States. Findings suggest that the current aggregate classification of Hispanics masks heterogeneity in CVD mortality reporting, leading to an incomplete understanding of health risks and outcomes in this population.

    View details for DOI 10.1001/jamacardio.2016.4653

    View details for PubMedID 28114655

  • Association Between Intensity of Statin Therapy and Mortality in Patients With Atherosclerotic Cardiovascular Disease. JAMA cardiology Rodriguez, F., Maron, D. J., Knowles, J. W., Virani, S. S., Lin, S., Heidenreich, P. A. 2017; 2 (1): 47-54


    High-intensity statin therapy is recommended for the secondary prevention of atherosclerotic cardiovascular disease (ASCVD). Nevertheless, statin therapy in general, and high-intensity statin therapy in particular, is underused in patients with established ASCVD.To determine the association between all-cause mortality and intensity of statin therapy in the Veterans Affairs health care system.A retrospective cohort analysis was conducted of patients aged 21 to 84 years with ASCVD treated in the Veterans Affairs health care system from April 1, 2013, to April 1, 2014. Patients who were included had 1 or more International Classification of Diseases, Ninth Revision codes for ASCVD on 2 or more different dates in the prior 2 years.Intensity of statin therapy was defined by the 2013 American College of Cardiology/American Heart Association guidelines, and use was defined as a filled prescription in the prior 6 months. Patients were excluded if they were taking a higher statin dose in the prior 5 years.The primary outcome was death from all causes adjusted for the propensity to receive high-intensity statins.The study sample included 509 766 eligible adults with ASCVD at baseline (mean [SD] age, 68.5 [8.8] years; 499 598 men and 10 168 women), including 150 928 (29.6%) receiving high-intensity statin therapy, 232 293 (45.6%) receiving moderate-intensity statin therapy, 33 920 (6.7%) receiving low-intensity statin therapy, and 92 625 (18.2%) receiving no statins. During a mean follow-up of 492 days, there was a graded association between intensity of statin therapy and mortality, with 1-year mortality rates of 4.0% (5103 of 126 139) for those receiving high-intensity statin therapy, 4.8% (9703 of 200 709) for those receiving moderate-intensity statin therapy, 5.7% (1632 of 28 765) for those receiving low-intensity statin therapy, and 6.6% (4868 of 73 728) for those receiving no statin (P < .001). After adjusting for the propensity to receive high-intensity statins, the hazard ratio for mortality was 0.91 (95% CI, 0.88-0.93) for those receiving high- vs moderate-intensity statins. The magnitude of benefit of high- vs moderate-intensity statins was similar, for an incident cohort hazard ratio of 0.93 (95% CI, 0.85-1.01). For patients aged 76 to 84 years, the hazard ratio was 0.91 (95% CI, 0.87-0.95). Patients treated with maximal doses of high-intensity statins had lower mortality (hazard ratio, 0.90; 95% CI, 0.87-0.94) compared with those receiving submaximal doses.We found a graded association between intensity of statin therapy and mortality in a national sample of patients with ASCVD. High-intensity statins were associated with a small but significant survival advantage compared with moderate-intensity statins, even among older adults. Maximal doses of high-intensity statins were associated with a further survival benefit.

    View details for DOI 10.1001/jamacardio.2016.4052

    View details for PubMedID 27829091

  • Dietary Patterns and Long-Term Survival: a Retrospective Study of Healthy Primary Care Patients. The American journal of medicine Shah, N. S., Leonard, D., Finley, C. E., Rodriguez, F., Sarraju, A., Barlow, C. E., DeFina, L. F., Willis, B. L., Haskell, W. L., Maron, D. J. 2017


    Dietary patterns are related to mortality in selected populations with comorbidities. We studied whether dietary patterns are associated with long-term survival in a middle-aged, healthy population.In this observational cohort study at the Cooper Clinic preventive medicine center (Dallas, Texas), a volunteer sample of 11,376 men and women with no history of myocardial infarction or stroke completed a baseline dietary assessment between 1987-1999 and were observed for an average of 18 years. Proportional hazard regressions, including a tree-augmented model, were used to assess the association of the Dietary Approaches to Stop Hypertension (DASH) dietary pattern, Mediterranean dietary pattern, and individual dietary components with mortality. The primary outcome was death from all causes. The secondary outcome was death from cardiovascular disease.Mean baseline age was 47 years. Each quintile increase in the DASH diet score was associated with a 6% lower adjusted risk for all-cause mortality (P<0.02). The Mediterranean diet was not independently associated with all-cause or cardiovascular mortality. Solid fats and added sugars were the most predictive of mortality. Individuals who consumed >34% of their daily calories as solid fats had the highest risk for all-cause mortality.The DASH dietary pattern was associated with significantly lower all-cause mortality over nearly two decades of follow-up in a middle-aged, generally healthy population. Added solid fat and added sugar intake were the most predictive of all-cause mortality. These results suggest that promotion of a healthy dietary pattern should begin in middle age, before the development of comorbid risk factors.

    View details for DOI 10.1016/j.amjmed.2017.08.010

    View details for PubMedID 28860032

  • 2017 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. Journal of the American College of Cardiology Tomaselli, G. F., Mahaffey, K. W., Cuker, A., Dobesh, P. P., Doherty, J. U., Eikelboom, J. W., Florido, R., Hucker, W., Mehran, R., Messé, S. R., Pollack, C. V., Rodriguez, F., Sarode, R., Siegal, D., Wiggins, B. S. 2017; 70 (24): 3042–67

    View details for DOI 10.1016/j.jacc.2017.09.1085

    View details for PubMedID 29203195

  • Nativity Status and Cardiovascular Disease Mortality Among Hispanic Adults. Journal of the American Heart Association Rodriguez, F., Hastings, K. G., Hu, J., Lopez, L., Cullen, M., Harrington, R. A., Palaniappan, L. P. 2017; 6 (12)


    Hispanic persons represent a heterogeneous and growing population of any race with origins in Mexico, the Caribbean, Central America, South America, or other Spanish-speaking countries. Previous studies have documented variation in cardiovascular risk and outcomes among Hispanic subgroups. Few studies have investigated whether these patterns vary by nativity status among Hispanic subgroups.We used the National Center for Health Statistics mortality file to compare deaths of Hispanic (n=1 258 229) and non-Hispanic white (n=18 149 774) adults (aged ≥25 years) from 2003 to 2012. We identified all deaths related to cardiovascular disease (CVD) and categorized them by subtype (all CVD, ischemic, or cerebrovascular) using the underlying cause of death (International Classification of Diseases, 10th Revision codes I00-I78, I20-I25, and I60-I69, respectively). Population estimates were calculated using linear interpolation from the 2000 and 2010 US censuses. CVD accounted for 31% of all deaths among Hispanic adults. Race/ethnicity and nativity status were recorded on death certificates by the funeral director using state guidelines. Nativity status was defined as foreign versus US born; 58% of Hispanic decedents were foreign born. Overall, Hispanic adults had lower age-adjusted CVD mortality rates than non-Hispanic white adults (296 versus 385 per 100 000). Foreign-born Cubans, Mexicans, and Puerto Ricans had higher CVD mortality than their US-born counterparts (rate ratio: 2.64 [95% confidence interval, 2.46-2.81], 1.17 [95% confidence interval, 1.15-1.21], and 1.91 [95% confidence interval, 1.83-1.99], respectively).Mortality rates for total cardiovascular, ischemic, and cerebrovascular disease are higher among foreign- than US-born Hispanic adults. These findings suggest the importance of disaggregating CVD mortality by disease subtype, Hispanic subgroup, and nativity status.

    View details for DOI 10.1161/JAHA.117.007207

    View details for PubMedID 29237590

  • Use of high-intensity statins for patients with atherosclerotic cardiovascular disease in the Veterans Affairs Health System: Practice impact of the new cholesterol guidelines AMERICAN HEART JOURNAL Rodriguez, F., Lin, S., Maron, D. J., Knowles, J. W., Virani, S. S., Heidenreich, P. A. 2016; 182: 97-102


    The November 2013 American College of Cardiology/American Heart Association cholesterol guidelines recommend the use of high-intensity statins for patients with atherosclerotic cardiovascular disease (ASCVD). We sought to determine how these guidelines are being adopted at the Veterans Affairs (VA) Health System and identify treatment gaps.We examined administrative data from the VA 12 months prior to the index dates of April 1, 2013, and after April 1, 2014, to identify patients ≤75 years of age with ≥2 codes for ASCVD. We identified those on high-intensity statin therapy (atorvastatin 40 mg or 80 mg, rosuvastatin 20 mg or 40 mg, and simvastatin 80 mg) during the 6 months after the index date.The study sample included 331,927 and 326,759 eligible adults with ASCVD before and after the release of the new guidelines, respectively. Overall, high-intensity statin use increased from 28% to 35% after guideline release. High-intensity statin use was lowest in Hispanics and Native Americans, although all groups showed an increase over time. Among those on low- or moderate-intensity statin therapy, 15.6% were intensified to a high-intensity statin after guideline release. Groups less likely to undergo statin intensification were older adults (odds ratio=0.78 for each 10-year increase, 95% CI 0.76-0.81), women (odds ratio=0.86, 95% CI 0.75-0.99), and certain minority groups. Academic teaching hospitals and hospitals on the West Coast were more likely to intensify statins after release of the new guidelines.High-intensity statin use increased in the VA following release of the American College of Cardiology/American Heart Association cholesterol treatment guidelines, although disparities persist for certain patient groups including older adults, women, and certain minority groups.

    View details for DOI 10.1016/j.ahj.2016.09.007

    View details for Web of Science ID 000389136600012

    View details for PubMedID 27914506

  • Vorapaxar: emerging evidence and clinical questions in a new era of PAR-1 inhibition. Coronary artery disease Ungar, L., Rodriguez, F., Mahaffey, K. W. 2016; 27 (7): 604-615


    Despite the use of therapies recommended in practice guidelines for secondary prevention in patients with atherosclerotic coronary artery disease, the residual risk for cardiovascular events remains high. Some of the residual risk is believed to result from incomplete platelet inhibition with current therapy. Vorapaxar is a first-in-class, novel antiplatelet agent that acts by antagonizing the PAR-1 receptor, inhibiting thrombin-mediated platelet activation. Vorapaxar was recently approved by the Food and Drug Administration for secondary prevention of cardiovascular events in patients with a history of myocardial infarction or peripheral artery disease who do not have a history of transient ischemic attack or stroke. We review the data from two key phase III cardiovascular outcome trials with vorapaxar: TRACER and TRA 2P-TIMI 50. We will focus on identifying the key patient populations that should be identified for treatment, highlight practical clinical issues when prescribing vorapaxar, and review unanswered questions. Vorapaxar should be considered in patients at high risk for recurrent ischemic events and low risk of bleeding.

    View details for DOI 10.1097/MCA.0000000000000409

    View details for PubMedID 27398626

  • Management of Patients With NSTE-ACS A Comparison of the Recent AHA/ACC and ESC Guidelines JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Rodriguez, F., Mahaffey, K. W. 2016; 68 (3): 313-321


    Non-ST-segment elevation acute coronary syndromes (NSTE-ACS) are the leading cause of morbidity and mortality from cardiovascular disease worldwide. The American Heart Association/American College of Cardiology and the European Society of Cardiology periodically release practice guidelines to guide clinicians in the management of NSTE-ACS, most recently in in 2014 and 2015, respectively. The present review compares and contrasts the 2 guidelines, with a focus on the strength of recommendation and level of evidence in the approach to initial presentation and diagnosis of NSTE-ACS, risk assessment, treatments, and systems of care. Important differences include the use of a rapid rule-out protocol with high-sensitivity troponin assays, a preference for prasugrel/ticagrelor and fondaparinux for anticoagulation therapy, and a preference for radial arterial access in the European Society of Cardiology guidelines compared with the American Heart Association/American College of Cardiology guidelines. We also highlight the similarities and differences in the guidelines for special patient populations and suggest areas of further study.

    View details for DOI 10.1016/j.jacc.2016.03.599

    View details for Web of Science ID 000379518600012

    View details for PubMedID 27417010

  • Enough Evidence, Time to Act! CIRCULATION Rodriguez, F., Knowles, J. W. 2016; 134 (1): 20-23
  • Gender Disparities in Lipid-Lowering Therapy in Cardiovascular Disease: Insights from a Managed Care Population. Journal of women's health (2002) Rodriguez, F., Olufade, T. O., Ramey, D. R., Friedman, H. S., Navaratnam, P., Heithoff, K., Foody, J. M. 2016; 25 (7): 697-706


    Numerous studies have documented the strong inverse relationship between low-density lipoprotein cholesterol (LDL-C) levels and atherosclerotic cardiovascular disease (ASCVD). However, women are less likely to be screened for hypercholesterolemia, receive lipid-lowering therapy (LLT), and achieve optimal LDL-C levels.Data were extracted from a U.S. administrative claims database between January 2008 and December 2012 for patients with established ASCVD. The earliest date of valid LDL-C value was defined as the index date. Patients were followed for ±12 months from the index date and were stratified by gender, by baseline LDL-C level, and whether they were initially treated with a LLT then propensity score matched by gender using demographic and clinical characteristics. Both descriptive statistics and logistic regression models were used to explore the association of gender with the frequency of LDL-C monitoring, LLT treatment initiation in initially untreated patients, and prescribing patterns in initially treated patients.A total of 76,414 subjects with established ASCVD were identified; 42% of the sample was women. In the unmatched cohort, 50.3% of men and 32.0% of women were prescribed a preindex statin (p < 0.0001). Among matched patients (n = 51,764), women initially treated with LLT were significantly less likely to receive a prescription for a higher potency LLT. Even among those with LDL-C levels above 160 mg/dL, women were more likely to discontinue LLT, odds ratio (95% confidence interval) 1.8 (1.2-2.3). Female gender and older age were significant predictors of discontinuation, and the potency of the index medication was the strongest predictor of dose titration. Initially untreated women were less likely to initiate LLT treatment than men, irrespective of index LDL-C levels (p < 0.0001).The observed disparities further reinforce the need for targeted efforts to reduce the gender gap for secondary prevention in women at high risk of cardiovascular disease.

    View details for DOI 10.1089/jwh.2015.5282

    View details for PubMedID 26889924

  • Racial and ethnic differences in atrial fibrillation risk factors and predictors in women: Findings from the Women's Health Initiative AMERICAN HEART JOURNAL Rodriguez, F., Stefanick, M. L., Greenland, P., Soliman, E. Z., Manson, J. E., Parikh, N., Martin, L. W., Larson, J. C., Hlatky, M., Nassir, R., Cene, C. W., Rodriguez, B. L., Albert, C., Perez, M. V. 2016; 176: 70-77


    The incidence of atrial fibrillation (AF) is higher in non-Hispanic whites (NHWs) compared with other race-ethnic groups, despite more favorable cardiovascular risk profiles. To explore reasons for this paradox, we compared the hazards of AF from traditional and other risk factors between 4 race-ethnic groups in a large cohort of postmenopausal women.We included 114,083 NHWs, 11,876 African Americans, 5,174 Hispanics, and 3,803 Asians from the Women's Health Initiative free of AF at baseline. Women, averaging 63 years old, were followed up for incident AF using hospitalization records and diagnostic codes from Medicare claims.Over a mean of 13.7 years, 19,712 incident cases of AF were recorded. Despite a higher burden of hypertension, diabetes, and obesity, annual AF incidence was lower among nonwhites (0.7%, 0.4%, and 0.4% for African American, Hispanic, and Asian participants, respectively, compared with 1.2% for NHWs). The hazards of AF from hypertension, diabetes, obesity, heart failure, and coronary artery disease were similar across race-ethnic groups. Major risk factors, including hypertension, obesity, diabetes, smoking, peripheral arterial disease, coronary artery disease, and heart failure, accounted for an attributable risk of 50.3% in NHWs, 83.1% in African Americans, 65.6% in Hispanics, and 37.4% in Asians. Established AF prediction models performed comparably across race-ethnic groups.In this large study of postmenopausal women, traditional cardiovascular risk factors conferred a similar degree of individual risk of AF among 4 race-ethnic groups. However, major AF risk factors conferred a higher-attributable risk in African Americans and Hispanics compared with NHWs and Asians.

    View details for DOI 10.1016/j.ahj.2016.03.004

    View details for PubMedID 27264222

  • Vivir Con Un Corazón Saludable: a Community-Based Educational Program Aimed at Increasing Cardiovascular Health Knowledge in High-Risk Hispanic Women. Journal of racial and ethnic health disparities Romero, D. C., Sauris, A., Rodriguez, F., Delgado, D., Reddy, A., Foody, J. M. 2016; 3 (1): 99-107


    Hispanic women suffer from high rates of cardiometabolic risk factors and an increasingly disproportionate burden of cardiovascular disease (CVD). Particularly, Hispanic women with limited English proficiency suffer from low levels of CVD knowledge associated with adverse CVD health outcomes.Thirty-two predominantly Spanish-speaking Hispanic women completed, Vivir Con un Corazón Saludable (VCUCS), a culturally tailored Spanish language-based 6-week intensive community program targeting CVD health knowledge through weekly interactive health sessions. A 30-question CVD knowledge questionnaire was used to assess mean changes in CVD knowledge at baseline and postintervention across five major knowledge domains including CVD epidemiology, dietary knowledge, medical information, risk factors, and heart attack symptoms.Completion of the program was associated with a statistically significant (p < 0.001) increase in total mean CVD knowledge scores from 39 % (mean 11.7/30.0) to 66 % (mean 19.8/30.0) postintervention consistent with a 68 % increase in overall mean CVD scores. There was a statistically significant (p < 0.001) increase in mean knowledge scores across all five CVD domains.A culturally tailored Spanish language-based health program is effective in increasing CVD awareness among high CVD risk Hispanic women with low English proficiency and low baseline CVD knowledge.

    View details for DOI 10.1007/s40615-015-0119-6

    View details for PubMedID 26896109

  • Cholesterol, Cardiovascular Risk, Statins, PCSK9 Inhibitors, and the Future of LDL-C Lowering. JAMA Rodriguez, F., Harrington, R. A. 2016; 316 (19): 1967–68

    View details for DOI 10.1001/jama.2016.16575

    View details for PubMedID 27838727

  • Insidious: Takayasu Arteritis AMERICAN JOURNAL OF MEDICINE Rodriguez, F., Degnan, K. O., Nagpal, P., Blankstein, R., Gerhard-Herman, M. D. 2015; 128 (12): 1288-1291

    View details for DOI 10.1016/j.amjmed.2015.07.007

    View details for Web of Science ID 000365264700024

    View details for PubMedID 26210640

  • Lost to Follow-up and Withdrawal of Consent in Contemporary Global Cardiovascular Randomized Clinical Trials. Critical pathways in cardiology Rodriguez, F., Harrison, R. W., Wojdyla, D., Mahaffey, K. W. 2015; 14 (4): 150-153


    High rates of lost to follow-up (LTFU) and withdrawal of consent (WDC) may introduce uncertainty around the validity of the results of clinical trials. We sought to better understand published proportions of LTFU and WDC in large contemporary cardiovascular clinical trials.Large (>5000 randomized subjects) cardiovascular clinical trials published between 2007 and 2012 in N Engl J Med were systematically reviewed. Data regarding LTFU and WDC were extracted from the primary manuscripts and supplementary online material.Twenty-five published randomized trials were identified. Trials ranged in size from 5518 to 26449 subjects. All trials reported LTFU with 15 separately reporting WDC. The duration of follow-up ranged from 30 days to 6.2 years. The number of subjects LTFU ranged from 8 to 905, and the median proportion of subjects LTFU was 0.23% (interquartile range: 0.12%-0.58%). Individual LTFU proportions varied 300-fold, from 0.03% to 9.7%. Proportions of WDC ranged from 0.02% to 8.3%-a 400-fold difference-with a median of 1.1% (interquartile range: 0.2%-2.6%). WDC occurred more frequently than LTFU in all but 2 studies.Contemporary cardiovascular clinical trials typically have low proportions of LTFU or WDC, but some trials have approximately 10% of subjects with LTFU or WDC. WDC occurred more frequently than LTFU but was only reported in 60% of the trials. These results emphasize the need to standardize reporting of LTFU and WDC as important trial metrics of quality and to develop strategies to minimize their occurrence.

    View details for DOI 10.1097/HPC.0000000000000055

    View details for PubMedID 26569655

  • Young Hispanic Women Experience Higher In-Hospital Mortality Following an Acute Myocardial Infarction JOURNAL OF THE AMERICAN HEART ASSOCIATION Rodriguez, F., Foody, J. M., Wang, Y., Lopez, L. 2015; 4 (9)


    Although mortality rates for acute myocardial infarction (AMI) have declined for men and women, prior studies have reported a sex gap in mortality such that younger women were most likely to die after an AMI.We sought to explore the impact of race and ethnicity on the sex gap in AMI patterns of care and mortality for younger women in a contemporary patient cohort. We constructed multivariable hierarchical logistic regression models to examine trends in AMI hospitalizations, procedures, and in-hospital mortality by sex, age (<65 and ≥65 years), and race/ethnicity (white, black, and Hispanic). Analyses were derived from 194 071 patients who were hospitalized for an AMI with available race and ethnicity data from the 2009-2010 National Inpatient Sample. Hospitalization rates, procedures (coronary angiography, percutaneous coronary interventions, and cardiac bypass surgery), and inpatient mortality were analyzed across age, sex, and race/ethnic groups. There was significant variation in hospitalization rates by age and race/ethnicity. All racial/ethnic groups were less likely to undergo invasive procedures compared with white men (P<0.001). After adjustment for comorbidities, younger Hispanic women experienced higher in-hospital mortality compared with younger white men, with an odds ratio of 1.5 (95% CI 1.2 to 1.9), adjusted for age and comorbidities.We found significant racial and sex disparities in AMI hospitalizations, care patterns, and mortality, with higher in-hospital mortality experienced by younger Hispanic women. Future studies are necessary to explore determinants of these significant racial and sex disparities in outcomes for AMI.

    View details for DOI 10.1161/JAHA.115.002089

    View details for Web of Science ID 000364152100010

    View details for PubMedID 26353998

  • Antiplatelet Therapy During PCI for Patients with Stable Angina and Atrial Fibrillation CURRENT CARDIOLOGY REPORTS Iqbal, A., Rodriguez, F., Schirmer, H. 2015; 17 (8)


    The pharmacological treatment options for anticoagulation in patients with atrial fibrillation (Afib) have increased with the introduction of novel oral anticoagulants, compared with earlier times, when vitamin K antagonist was the drug of choice. As they age, many Afib patients require percutaneous coronary intervention (PCI), necessitating antiplatelet medication in addition to anticoagulation therapy. Choosing the appropriate combination and duration of anticoagulation and antiplatelet therapies may be challenging in stable coronary artery disease (CAD) and even more complicated during and after coronary intervention with the introduction of additional antithrombotic drugs. In this article, we review the scientific basis for the recent guidelines for anticoagulation and antithrombotic therapy in patients with Afib and stable CAD before, during, and after elective PCI.

    View details for DOI 10.1007/s11886-015-0615-7

    View details for Web of Science ID 000358937200003

    View details for PubMedID 26104508

  • Use of Interpreters by Physicians for Hospitalized Limited English Proficient Patients and Its Impact on Patient Outcomes JOURNAL OF GENERAL INTERNAL MEDICINE Lopez, L., Rodriguez, F., Huerta, D., Soukup, J., Hicks, L. 2015; 30 (6): 783-789


    Few studies have examined the impact of inpatient interpreter use for limited English proficient (LEP) patients on length of stay (LOS), 30-day post discharge emergency department (ED) visits and 30-day hospital readmission rates for LEP patients.A retrospective cohort analysis was conducted of all hospitalized patients admitted to the general medicine service at a large academic center. For patients self-reported as LEP, use of interpreters during each episode of hospitalization was categorized as: 1) interpreter used by non-MD (i.e., nurse); 2) interpreter used by a non-Hospitalist MD; 3) interpreter used by Hospitalist; and 4) no interpreter used during hospitalization. We examined the association of English proficiency and interpreter use on outcomes utilizing Poisson and logistic regression models.Of 4,224 patients, 564 (13 %) were LEP. Of these LEP patients, 65.8 % never had a documented interpreter visit, 16.8 % utilized an interpreter with a non-MD, 12.6 % utilized an interpreter with a non-Hospitalist MD and 4.8 % utilized an interpreter with a hospitalist present. In adjusted models, compared to English speakers, LEP patients with no interpreters had significantly shorter LOS. There were no differences in readmission rates and ED utilization between LEP and English-speaking patients. Compared to LEP patients with no interpreter use, those who had a physician use an interpreter had odds for a longer LOS, but there was no difference in odds of readmission or ED utilization.Academic hospital clinician use of interpreters remains highly variable and physicians may selectively be using interpreters for the sickest patients.

    View details for DOI 10.1007/s11606-015-3213-x

    View details for Web of Science ID 000354961100017

    View details for PubMedID 25666220

  • Hypertension in Minority Populations: New Guidelines and Emerging Concepts ADVANCES IN CHRONIC KIDNEY DISEASE Rodriguez, F., Ferdinand, K. C. 2015; 22 (2): 145-153


    Persistent disparities in hypertension, CKD, and associated cardiovascular disease have been noted in the United States among racial/ethnic minority groups. Overall, these disparities are largely mediated by social determinants of health. Yet, emerging data suggest additional biologic factors in racial/ethnic disparities in hypertension prevalence, complications, particularly CKD, and responses to treatment. Nevertheless, race is a social construct and not a physiologic concept, and ethnicity, federally defined as the binary "Hispanic/Latino" or "not Hispanic/Latino," is also imprecise. However, race/ethnicity categories may help interpret health-related data, including surveillance and research, and are important in ensuring that clinical trials remain generalizable to diverse populations. There is significant heterogeneity among prespecified groups and, perhaps, greater genetic differences within than between certain racial/ethnic groups. This review will explore hypertension epidemiology, pathophysiology, and management among the diverse and growing US minority groups, specifically African Americans and Hispanics because much less data are available across the wide spectrum of diverse populations. We will highlight the intersection of hypertension and increasingly prevalent CKD, particularly in African Americans. Finally, we propose multidimensional treatment approaches to hypertension among diverse populations, encompassing population, community, health system, and individual-based approaches.

    View details for DOI 10.1053/j.ackd.2014.08.004

    View details for Web of Science ID 000350267700011

    View details for PubMedID 25704352

  • PCSK9 Inhibition: Current Concepts and Lessons from Human Genetics CURRENT ATHEROSCLEROSIS REPORTS Rodriguez, F., Knowles, J. W. 2015; 17 (3)


    Low-density lipoprotein cholesterol (LDL-C) plays a central role in the pathogenesis of atherosclerotic cardiovascular disease (ASCVD). Statins are the cornerstone of therapy for the treatment of elevated LDL-C and for the primary and secondary prevention of ASCVD. However, some patients are intolerant of statins or are unable to achieve acceptable lipid levels on statin-based regimens alone. Proprotein convertase subtilisin/kexin type 9 (PCSK9) serves as an important regulator of hepatocyte LDL receptor expression and degradation, and recent genetic studies have highlighted the critical role of PCSK9 in human disease. Gain-of-function mutations in PCSK9 are associated with familial hypercholesterolemia, whereas loss-of-function mutations are protective against ASCVD. Therefore, PCSK9 inhibition offers a promising supplement or alternative to statin therapy in the reduction of LDL-C. Numerous phase II and III randomized control trials have demonstrated the tolerability of monoclonal antibodies against PCSK9 and their efficacy in lowering LDL-C by an additional 40-70 %. In this article, we review the growing role of PSCK9 inhibition in LDL-C reduction for diverse patient populations.

    View details for DOI 10.1007/s11883-015-0487-8

    View details for Web of Science ID 000349629400002

    View details for PubMedID 25637042

  • Frequency of High-Risk Patients Not Receiving High-Potency Statin (from a Large Managed Care Database) AMERICAN JOURNAL OF CARDIOLOGY Rodriguez, F., Olufade, T., Heithoff, K., Friedman, H. S., Navaratnam, P., Foody, J. M. 2015; 115 (2): 190-195


    We examined trends in low-density lipoprotein cholesterol (LDL-C) goal attainment in high-risk patients and use of high-potency statins (HPS) in a large, managed-care database from 2004 to 2012. The 2013 American Heart Association/American College of Cardiology prevention guidelines recommend that subjects with atherosclerotic cardiovascular disease (ASCVD) should be prescribed HPS therapy, irrespective of LDL-C levels. Previous guidelines recommend an LDL-C target <70 mg/dl. Patients diagnosed with ASCVD based on International Classification of Diseases, Ninth Revision codes with ≥1 LDL-C test from January 2004 to December 2012 were identified in the Optum Insight database. Patients were identified as treated if they received lipid-lowering therapy (LLT) within 90 days of the LDL-C measurement and untreated if they did not receive LLT treatment. LLT treated patients were stratified into HPS users or non-HPS LLT users. There were 45,101 eligible patients in 2004 and 40,846 in 2012. The proportion of high-risk patients who were treated with LLT increased from 61.4% (2004) to 70.5% (2008) then remained relatively constant until 2012 (67.9%). Mean LDL-C values in treated patients decreased from 103.7 ± 32.1 (2004) to 90.8 ± 31.4 mg/dl (2012). The proportion of patients treated with HPS increased from 13% in 2004 to 26% in 2012. Although the proportion of treated high-risk patients who achieve LDL-C <70 mg/dl levels has increased sharply from 2004, approximately 3 of 4 patients still did not meet this target. Only 1/4 of ASCVD patients are on HPS. In conclusion, our findings highlight the need for renewed efforts to support guideline-based LDL-C treatment for high-risk patients.

    View details for DOI 10.1016/j.amjcard.2014.10.021

    View details for Web of Science ID 000348407700007

    View details for PubMedID 25432414

  • Serial Classic and Inverted Pattern Takotsubo Cardiomyopathy in a Middle-Aged Woman CANADIAN JOURNAL OF CARDIOLOGY Rodriguez, F., Nathan, A. S., Navathe, A. S., Ghosh, N., Shah, P. B. 2014; 30 (11)


    We report the case of a 56-year-old woman with no significant medical history who was diagnosed with recurrent Takotsubo cardiomyopathy with variations in ventricular regional involvement including the classic and inverted patterns. She presented on 3 separate occasions with these findings; emotional stressors provoked all presentations. We present echocardiography, cardiac catheterization, and magnetic resonance images from her consecutive presentations. This case of emotional stress repeatedly eliciting classic and inverted forms of Takotsubo cardiomyopathy within the same patient highlights the importance of elucidating the pathological mechanisms of regional ventricular dysfunction.

    View details for DOI 10.1016/j.cjca.2014.04.002

    View details for Web of Science ID 000344484300042

    View details for PubMedID 25228131

  • Echocardiography and Cardiac MRI in Mutation-Negative Hypertrophic Cardiomyopathy in an Older Patient: A Case Defining the Need for ICD ECHOCARDIOGRAPHY-A JOURNAL OF CARDIOVASCULAR ULTRASOUND AND ALLIED TECHNIQUES Rodriguez, F., Degnan, K. O., Seidman, C. E., Mangion, J. R. 2014; 31 (7): E204-E206


    We report the case of a 67-year-old man with hypertrophic cardiomyopathy who presented for a second opinion about implantable cardio-defibrillator (ICD) placement after a witnessed syncopal episode. Despite his older age, being mutation-negative, and having a maximal septal thickness of 2.2 cm on echocardiography, he demonstrated rapid progression of myocardial fibrosis on cardiac MRI, correlating to ventricular tachyarrhythmias and syncope. We review the role of echocardiography and cardiac MRI in optimizing medical care for such patients who may not otherwise meet criteria for an ICD placement or further interventions.

    View details for DOI 10.1111/echo.12614

    View details for Web of Science ID 000340408300002

    View details for PubMedID 24816179



    To explore racial differences in characteristics, procedural treatments, and mortality of hospitalized atrial fibrillation (AF) patients.Despite a higher burden of AF risk factors, Black individuals have a lower prevalence of AF than their White counterparts. There is suggestion that AF may go undetected in minority groups, and there may be disparities in both diagnosis and treatment of AF.The study sample was drawn from the Healthcare Cost and Utilization Project database created by the Agency for Healthcare Research and Quality. Outcomes included AF hospitalization rate, in-hospital procedures performed, and in-hospital mortality within 6 defined sex-race subgroups: Black males, Black females, White males, White females, other males, and other females.165,319 hospitalizations (41% White male, 41% White female, 4% Black male, 4% Black female, 5% other male, 5% other female) with a primary discharge diagnosis of AF were identified. Black males and females were significantly younger than White patients and had more traditional and non-traditional risk factors. Black males and females were significantly less likely to have an ablation procedure or cardioversion than White males. Black race was an independent predictor of in-hospital mortality (Odds Ratio [95% CI] of 1.90 [1.5, 2.5] for Black males and 1.38 [1.1, 1.8] for Black females).Using a large, contemporary sample of inpatients, we found significant racial differences in baseline characteristics, treatments, and outcomes of patients hospitalized with AF. There appear to be important racial disparities in the care of minorities who are hospitalized with AF that require further investigation.

    View details for Web of Science ID 000363717200002

    View details for PubMedID 24804358

  • The Impact of Age on the Epidemiology of Atrial Fibrillation Hospitalizations AMERICAN JOURNAL OF MEDICINE Naderi, S., Wang, Y., Miller, A. L., Rodriguez, F., Chung, M. K., Radford, M. J., Foody, J. M. 2014; 127 (2)


    Given that 4 million individuals in the United States have atrial fibrillation, understanding the epidemiology of this disease is crucial. We sought to identify and characterize the impact of age on national atrial fibrillation hospitalization patterns.The study sample was drawn from the 2009-2010 Nationwide Inpatient Sample. Patients hospitalized with a principal International Classification of Diseases, 9th Revision discharge diagnosis of atrial fibrillation were included. Patients were categorized as "older" (≥65 years) or "younger" (<65 years) for the purposes of analysis. The outcomes measured included hospitalization rate, length of stay, in-hospital mortality, and discharge status.We identified 192,846 atrial fibrillation hospitalizations. There was significant geographic variation in hospitalizations for both younger and older age groups. States with high hospitalizations differed from those states known to have high stroke mortality. Younger patients (33% of the sample) were more likely to be obese (21% vs 8%, P < .001) and to use alcohol (8% vs 2%, P < .001). Older patients were more likely to have kidney disease (14% vs 7%, P < .001). Both age groups had high rates of hypertension and diabetes. Older patients had higher in-hospital mortality and were more likely to be discharged to a nursing or intermediate care facility.Younger patients account for a substantial minority of atrial fibrillation hospitalizations in contemporary practice. Younger patients are healthier, with a different distribution of risk factors, than older patients who have higher associated morbidity and mortality.

    View details for DOI 10.1016/j.amjmed.2013.10.005

    View details for Web of Science ID 000329985800022

    View details for PubMedID 24332722

  • Cardiorenal Metabolic Syndrome and Cardiometabolic Risks in Minority Populations CARDIORENAL MEDICINE Ferdinand, K. C., Rodriguez, F., Nasser, S. A., Caballero, A. E., Puckrein, G. A., Zangeneh, F., Mansour, M., Foody, J. M., Pemu, P. E., Ofili, E. O. 2014; 4 (1): 1-11


    Cardiovascular disease (CVD), including heart disease and stroke, is the leading cause of death in the USA, regardless of self-determined race/ethnicity, and largely driven by cardiometabolic risk (CMR) and cardiorenal metabolic syndrome (CRS). The primary drivers of increased CMR include obesity, hypertension, insulin resistance, hyperglycemia, dyslipidemia, chronic kidney disease as well as associated adverse behaviors of physical inactivity, smoking, and unhealthy eating habits. Given the importance of CRS for public health, multiple stakeholders, including the National Minority Quality Forum (the Forum), the American Association of Clinical Endocrinologists (AACE), the American College of Cardiology (ACC), and the Association of Black Cardiologists (ABC), have developed this review to inform clinicians and other health professionals of the unique aspects of CMR in racial/ethnic minorities and of potential means to improve CMR factor control, to reduce CRS and CVD in diverse populations, and to provide more effective, coordinated care. This paper highlights CRS and CMR as sources of significant morbidity and mortality (particularly in racial/ethnic minorities), associated health-care costs, and an evolving index tool for cardiometabolic disease to determine geographical and environmental factors. Finally, this work provides a few examples of interventions potentially successful at reducing disparities in cardiometabolic health.

    View details for DOI 10.1159/000357236

    View details for Web of Science ID 000334156500001

    View details for PubMedID 24847329

  • Predictors of Long-term Adherence to Evidence-based Cardiovascular Disease Medications in Outpatients With Stable Atherothrombotic Disease: Findings From the REACH Registry CLINICAL CARDIOLOGY Rodriguez, F., Cannon, C. P., Steg, G., Kumbhani, D. J., Goto, S., Smith, S. C., Eagle, K. A., Ohman, E. M., Umez-Eronini, A. A., Hoffman, E., Bhatt, D. L. 2013; 36 (12): 721-727


    Despite overall improvements in cardiovascular-disease therapies and outcomes, medication nonadherence remains an important barrier to effective secondary prevention of atherothrombotic disease.Long-term medication adherence in outpatients with stable atherothrombotic disease is impacted by demographic and clinical factors.We examined data from the prospective international Reduction of Atherothrombosis for Continued Health (REACH) Registry. Analyses were derived from 25 737 patients with established atherothrombotic disease with complete adherence data at enrollment and at year 4. Adherence was defined as patients' self-report of taking medications based on class I American College of Cardiology/American Heart Association guidelines for secondary prevention as defined, including antiplatelet agents, statins, and antihypertensive medications.Among patients with atherothrombotic disease, 12 500 (48.6%) were deemed adherent to guideline-recommended medications. Adherent patients were younger, white, and had less polyvascular disease. Hispanic and East Asian patients were less likely to be adherent as compared with white patients (odds ratio [OR]: 0.72, 95% confidence interval [CI]: 0.59-0.88; and OR: 0.67, 95% CI: 0.53-0.83, respectively). Patients who had a nonfatal MI or underwent coronary angioplasty/stenting during follow-up were more likely to be adherent compared with patients without these events (OR: 1.73, 95% CI: 1.25-2.38; and OR: 2.15, 95% CI: 1.72-2.67, respectively). On the other hand, nonfatal stroke during follow-up was inversely associated with adherence (OR: 0.77, 95% CI: 0.61-0.97).Using a large international registry of outpatients with atherothrombotic disease, we found that age, region, race/ethnicity, and incident cardiovascular events were predictive of long-term guideline adherence for secondary prevention, suggesting that certain patient groups may benefit from targeted interventions to improve adherence.

    View details for DOI 10.1002/clc.22217

    View details for Web of Science ID 000327824100006

    View details for PubMedID 24166484

  • National Patterns of Heart Failure Hospitalizations and Mortality by Sex and Age JOURNAL OF CARDIAC FAILURE Rodriguez, F., Wang, Y., Johnson, C. E., Foody, J. M. 2013; 19 (8): 542-549


    Earlier work has demonstrated significant sex and age disparities in ischemic heart disease. However, it remains unclear if an age or sex gap exists for heart failure (HF) patients.Using data from the 2007-2008 Healthcare Cost and Utilization Project, we constructed hierarchic regression models to examine sex differences and age-sex interactions in HF hospitalizations and in-hospital mortality. Among 430,665 HF discharges, 51% were women and 0.3%, 27%, and 73% were aged <25, 25-64, and >64 years respectively. There were significant sex differences among HF risk factors, with a higher prevalence of coronary disease among men. Men had higher hospitalization rates for HF and in-hospital mortality across virtually all ages. The relationship between age and HF mortality appeared U-shaped; mortality rates for ages <25, 25-64, and >64 years were 2.9%, 1.4%, and 3.8%, respectively. No age-sex interaction was found for in-hospital mortality for adults >25 years old.Using a large nationally representative administrative dataset we found age and sex disparities in HF outcomes. In general, men fared worse than women regardless of age. Furthermore, we found a U-shaped relationship between age and in-hospital mortality during an HF hospitalization, such that young adults have similar mortality rates to older adults. Additional studies are warranted to elucidate the patient-specific and treatment characteristics that result in these patterns.

    View details for DOI 10.1016/j.cardfail.2013.05.016

    View details for Web of Science ID 000323142400004

    View details for PubMedID 23910583

  • Limited English Proficient Patients and Time Spent in Therapeutic Range in a Warfarin Anticoagulation Clinic JOURNAL OF THE AMERICAN HEART ASSOCIATION Rodriguez, F., Hong, C., Chang, Y., Oertel, L. B., Singer, D. E., Green, A. R., Lopez, L. L. 2013; 2 (4)


    While anticoagulation clinics have been shown to deliver tailored, high-quality care to patients receiving warfarin therapy, communication barriers with limited English proficient (LEP) patients may lead to disparities in anticoagulation outcomes.We analyzed data on 3770 patients receiving care from the Massachusetts General Hospital Anticoagulation Management Service (AMS) from 2009 to 2010. This included data on international normalized ratio (INR) tests and patient characteristics, including language and whether AMS used a surrogate for primary communication. We calculated percent time in therapeutic range (TTR for INR between 2.0 and 3.0) and time in danger range (TDR for INR <1.8 or >3.5) using the standard Rosendaal interpolation method. There were 241 LEP patients; LEP patients, compared with non-LEP patients, had a higher number of comorbidities (3.2 versus 2.9 comorbidities, P=0.004), were more frequently uninsured (17.0% versus 4.3%, P<0.001), and less educated (47.7% versus 6.0% ≤high school education, P<0.001). LEP patients compared with non-LEP patients spent less TTR (71.6% versus 74.0%, P=0.007) and more TDR (12.9% versus 11.3%, P=0.018). In adjusted analyses, LEP patients had lower TTR as compared with non-LEP patients (OR 1.5, 95% CI [1.1, 2.2]). LEP patients who used a communication surrogate spent less TTR and more TDR.Even within a large anticoagulation clinic with a high average TTR, a small but significant decrease in TTR was observed for LEP patients compared with English speakers. Future studies are warranted to explore how the use of professional interpreters impact TTR for LEP patients.

    View details for DOI 10.1161/JAHA.113.000170

    View details for Web of Science ID 000326340900032

    View details for PubMedID 23832325

  • Community-Level Cardiovascular Risk Factors Impact Geographic Variation in Cardiovascular Disease Hospitalizations for Women JOURNAL OF COMMUNITY HEALTH Rodriguez, F., Wang, Y., Naderi, S., Johnson, C. E., Foody, J. M. 2013; 38 (3): 451-457


    Prior work has shown significant geographic variation in cardiovascular (CV) risk factors including metabolic syndrome, obesity, and hypercholesterolemia. However, little is known about how variations in CV risk impact cardiovascular disease (CVD)-related hospitalizations. Community-level CV risk factors (hypertension, dyslipidemia, hyperglycemia, and elevated waist circumference) were assessed from community-wide health screenings sponsored by Sister to Sister (STS) from 2008 to 2009 in 17 major US cities. Using data from the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS), CVD hospitalizations were identified based on ICD-9 codes for acute myocardial infarction (AMI), congestive heart failure (CHF), and stroke. We linked STS data with HCUP-NIS hospitalizations based on common cities and restricted the analysis to women discharged from hospitals inside the STS cities. Using hierarchical models with city as the random intercept, we assessed the impact of city-specific CV risk factors on between-city variance of AMI, CHF, and stroke. Analyses were also adjusted for patient age and clinical comorbidities. Our analysis yielded a total of 742,445 all-cause discharges across 70 hospitals inside of 13 linked cities. The overall city-specific range proportion of AMI, CHF, and stroke hospitalizations were 1.13 % (0.75-1.59 %), 2.57 % (1.44-3.92 %), and 1.24 % (0.66-1.84 %), respectively. After adjusting for city-specific CV risk factors, between-city variation was no longer statistically significant for all CVD conditions explored. In conclusion, we found that geographic variations in AMI, CHF, and stroke hospitalizations for women may be partially explained by community-level CV risk factors. This finding suggests that interventions to reduce CVD should be tailored to the unique risk profile and needs of high-risk communities.

    View details for DOI 10.1007/s10900-012-9640-2

    View details for Web of Science ID 000318373500006

    View details for PubMedID 23197135

  • Is cardiovascular disease in young women overlooked? Women's health (London, England) Rodriguez, F., Foody, J. M. 2013; 9 (3): 213-215

    View details for DOI 10.2217/whe.13.18

    View details for PubMedID 23638775

  • High Prevalence of Metabolic Syndrome in Young Hispanic Women: Findings from the National Sister to Sister Campaign METABOLIC SYNDROME AND RELATED DISORDERS Rodriguez, F., Naderi, S., Wang, Y., Johnson, C. E., Foody, J. M. 2013; 11 (2): 81-86


    Hispanics are the fastest growing segment of the U.S. population and have a higher prevalence of cardiometabolic risk factors as compared with non-Hispanic whites. Further data suggests that Hispanics have undiagnosed complications of metabolic syndrome, namely diabetes mellitus, at an earlier age. We sought to better understand the epidemiology of metabolic syndrome in Hispanic women using data from a large, community-based health screening program.Using data from the Sister to Sister: The Women's Heart Health Foundation community health fairs from 2008 to 2009 held in 17 U.S. cities, we sought to characterize how cardiometabolic risk profiles vary across age for women by race and ethnicity. Metabolic syndrome was defined using the updated National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines, which included three or more of the following: Waist circumference ≥35 inches, triglycerides ≥150 mg/dL, high-density lipoprotein (HDL) <50 mg/dL, systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥85 mmHg, or a fasting glucose ≥100 mg/dL.A total of 6843 community women were included in the analyses. Metabolic syndrome had a prevalence of 35%. The risk-adjusted odds ratio for metabolic syndrome in Hispanic women versus white women was 1.7 (95% confidence interval, 1.4, 2.0). Dyslipidemia was the strongest predictor of metabolic syndrome among Hispanic women. This disparity appeared most pronounced for younger women. Additional predictors of metabolic syndrome included black race, increasing age, and smoking.In a large, nationally representative sample of women, we found that metabolic syndrome was highly prevalent among young Hispanic women. Efforts specifically targeted to identifying these high-risk women are necessary to prevent the cardiovascular morbidity and mortality associated with metabolic syndrome.

    View details for DOI 10.1089/met.2012.0109

    View details for Web of Science ID 000316300300002

    View details for PubMedID 23259587



    Cardiovascular disease remains the leading cause of death for women, and racial and ethnic minority groups disproportionately suffer from cardiovascular risk factors. We developed an intensive, culturally-tailored 12-week nutrition and physical activity program, Love Your Heart, to reduce cardiovascular risk factors for African American women in the Boston area from January to April 2011. The pilot study partnered an academic institution with two community-based organizations, the Boston Black Women's Health Institute (BBWHI) and Body by Brandy Wellness Center (BBBWC). The study sample consisted of 34 women with a mean age of 48 years (SD +/- 3), with high rates of hypertension (79%), obesity (79%), and elevated waist circumference (94%). Over 12 weeks of follow-up, there were substantial reductions in hypertension and elevated waist circumference. We found that a culturally tailored weight management program reduced weight and cardiovascular risk factors for African American women in an urban community. While small, our study suggests that targeted community-based interventions focusing on personal and group wellness have the power to reduce health disparities and improve cardiovascular health for African American women.

    View details for Web of Science ID 000310559400005

    View details for PubMedID 23140071

  • Comparison of C-Reactive Protein Levels in Less Versus More Acculturated Hispanic Adults in the United States (from the National Health and Nutrition Examination Survey 1999-2008) AMERICAN JOURNAL OF CARDIOLOGY Rodriguez, F., Peralta, C. A., Green, A. R., Lopez, L. 2012; 109 (5): 665-669


    Greater acculturation has been linked to increased risk of cardiovascular disease in Hispanics. C-reactive protein (CRP), a marker of inflammation, is known to be associated with an increased risk of cardiovascular disease morbidity and mortality. Whether acculturation is associated with CRP levels in Hispanics has not been established. We examined the association between acculturation and CRP in 11,858 Hispanic-American adults participating in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2008. Acculturation was measured by the Short Acculturation Scale (SAS), a validated language-based scale. We used multivariate linear regression to examine the independent association between acculturation and CRP after adjusting for clinical and demographic covariates and appropriate sampling weights. We back-transformed the beta coefficients into relative differences (RDs). Higher acculturation was independently associated with higher CRP levels in Hispanics. Compared to those less acculturated, the RD in CRP levels was 52% higher (p = 0.003) for more acculturated Hispanics. Other significant predictors of CRP in Hispanics included a higher body mass index (RD 139% higher per 5 kg/m(2)), female gender (RD 36% higher), education level (RD 19% higher levels for at least a high school education, p <0.001), being insured (RD 27% higher CRP level, p = 0.006), having hypertension (RD 40% higher CRP levels, p <0.001), and statin use (RD 22% lower CRP levels, p = 0.002). In conclusion, higher acculturation was associated with increased CRP levels in Hispanics in a nationally representative population survey. Inflammation may play an important role in explaining the association between acculturation and increased cardiovascular risk.

    View details for DOI 10.1016/j.amjcard.2011.10.020

    View details for Web of Science ID 000301394200011

    View details for PubMedID 22169128

  • Readmission rates for Hispanic Medicare beneficiaries with heart failure and acute myocardial infarction AMERICAN HEART JOURNAL Rodriguez, F., Joynt, K. E., Lopez, L., Saldana, F., Jha, A. K. 2011; 162 (2): 254-U73


    Hispanics are the fastest growing segment of the US population and have a higher prevalence of cardiovascular risk factors than non-Hispanic whites. However, little is known about whether elderly Hispanics have higher readmission rates for heart failure (HF) and acute myocardial infarction (AMI) than whites and whether this is due to site of care.We examined hospitalizations for Medicare patients with a primary discharge diagnosis of HF and AMI in 2006 to 2008. We categorized hospitals in the top decile of proportion of Hispanic patients as "Hispanic serving" and used logistic regression to examine the relationship between patient ethnicity, hospital Hispanic-serving status, and readmissions.Hispanic patients had higher risk-adjusted readmission rates than whites for both HF (27.9% vs 25.9%, odds ratio [OR] 1.11, 95% CI 1.07-1.14, P < .001) and AMI (23.0% vs 21.0%, OR 1.12, 95% CI 1.07-1.18, P < .001). Similarly, Hispanic-serving hospitals had higher readmission rates than non-Hispanic-serving hospitals for both HF (27.4% vs 25.8%, OR 1.09, 95% CI 1.06-1.12, P < .001) and AMI (23.0% vs 20.8%, OR 1.13, 95% CI 1.09-1.18, P < .001). In analyses considering ethnicity and site of care simultaneously, both Hispanics and whites had higher readmission rates at Hispanic-serving hospitals.Elderly Hispanic patients are more likely to be readmitted for HF and AMI than whites, partly due to the hospitals where they receive care. Our findings suggest that targeting the site of care and these high-risk patients themselves will be necessary to reduce disparities in readmissions for this growing group of patients.

    View details for DOI 10.1016/j.ahj.2011.05.009

    View details for Web of Science ID 000293729400007

    View details for PubMedID 21835285

  • Evaluation of medical student self-rated preparedness to care for limited english proficiency patients BMC MEDICAL EDUCATION Rodriguez, F., Cohen, A., Betancourt, J. R., Green, A. R. 2011; 11


    Patients with limited English proficiency (LEP) represent a growing proportion of the US population and are at risk of receiving suboptimal care due to difficulty communicating with healthcare providers who do not speak their language. Medical school curricula are required to prepare students to care for all patients, including those with LEP, but little is known about how well they achieve this goal. We used data from a survey of medical students' cross-cultural preparedness, skills, and training to specifically explore their self-rated preparedness to care for LEP patients.We electronically surveyed students at one northeastern US medical school. We used bivariate analyses to identify factors associated with student self-rated preparedness to care for LEP patients including gender, training year, first language, race/ethnicity, percent LEP and minority patients seen, and skill with interpreters. We used multivariate logistic regression to examine the independent effect of each factor on LEP preparedness. In a secondary analysis, we explored the association between year in medical school and self-perceived skill level in working with an interpreter.Of 651 students, 416 completed questionnaires (63.9% response rate). Twenty percent of medical students reported being very well or well-prepared to care for LEP patients. Of these, 40% were in their fourth year of training. Skill level working with interpreters, prevalence of LEP patients seen, and training year were correlated (p < 0.001) with LEP preparedness. Using multivariate logistic regression, only student race/ethnicity and self-rated skill with interpreters remained statistically significant. Students in third and fourth years were more likely to feel skilled with interpreters (p < 0.001).Increasingly, medical students will need to be prepared to care for LEP patients. Our study supports two strategies to improve student preparedness: training students to work effectively with interpreters and increasing student diversity to better reflect the changing US demographics.

    View details for DOI 10.1186/1472-6920-11-26

    View details for Web of Science ID 000292256300001

    View details for PubMedID 21631943

  • Set-Point Theory and Obesity METABOLIC SYNDROME AND RELATED DISORDERS Magdalena Farias, M., Cuevas, A. M., Rodriguez, F. 2011; 9 (2): 85-89


    Obesity is a consequence of the complex interplay between genetics and environment. Several studies have shown that body weight is maintained at a stable range, known as the "set-point," despite the variability in energy intake and expenditure. Additionally, it has been shown that the body is more efficient protecting against weight loss during caloric deprivation compared to conditions of weight gain with overfeeding, suggesting an adaptive role of protection during periods of low food intake. Emerging evidence on bariatric surgery outcomes, particularly gastric bypass, suggests a novel role of these surgical procedures in establishing a new set-point by alterations in body weight regulatory physiology, therefore resulting in sustainable weight loss results. Continuing research is necessary to elucidate the biological mechanisms responsible for this change, which may offer new options for the global burden of obesity.

    View details for DOI 10.1089/met.2010.0090

    View details for Web of Science ID 000288847200002

    View details for PubMedID 21117971