Fatima Rodriguez

All Publications

• Temporal trends in lipoprotein(a) testing among United States veterans from 2014 to 2023 AMERICAN JOURNAL OF PREVENTIVE CARDIOLOGY Gomez, S. E., Furst, A., Chen, T., Din, N., Maron, D. J., Heidenreich, P., Kalwani, N., Nallamshetty, S., Ward, J. H., Lozama, A., Sandhu, A., Rodriguez, F. 2024; 20

  View details for DOI 10.1016/j.ajpc.2024.100872

  View details for Web of Science ID 001331656700001

• Temporal trends in lipoprotein(a) testing among United States veterans from 2014 to 2023. American journal of preventive cardiology Gomez, S. E., Furst, A., Chen, T., Din, N., Maron, D. J., Heidenreich, P., Kalwani, N., Nallamshetty, S., Ward, J. H., Lozama, A., Sandhu, A., Rodriguez, F. 2024; 20: 100872

  Abstract

  Lipoprotein (a) [Lp(a)] is a causal, genetically-inherited risk amplifier for atherosclerotic cardiovascular disease (ASCVD). Practice guidelines increasingly recommend broad Lp(a) screening among various populations to optimize preventive care. Corresponding changes in testing rates and population-level detection of elevated Lp(a) in recent years has not been well described.Using Veterans Affairs electronic health record data, we performed a retrospective cohort study evaluating temporal trends in Lp(a) testing and detection of elevated Lp(a) levels (defined as greater than 50 mg/dL) from January 1, 2014 to December 31, 2023 among United States Veterans without prior Lp(a) testing. Testing rates were stratified based on demographic and clinical factors to investigate possible drivers for and disparities in testing: age, sex, race and ethnicity, history of ASCVD, and neighborhood social vulnerability.Lp(a) testing increased nationally from 1 test per 10,000 eligible Veterans (558 tests) in 2014 to 9 tests per 10,000 (4,440 tests) in 2023, while the proportion of elevated Lp(a) levels remained stable. Factors associated with higher likelihood of Lp(a) testing over time were a history of ASCVD, Asian race, and residing in neighborhoods with less social vulnerability.Despite a 9-fold increase in Lp(a) testing among US Veterans over the last decade, the overall testing rate remains extremely low. The steady proportion of Veterans with elevated Lp(a) over time supports the clinical utility of testing expansion. Efforts to increase testing, especially among Veterans living in neighborhoods with high social vulnerability, will be important to reduce emerging disparities as novel therapeutics to target Lp(a) become available.

  View details for DOI 10.1016/j.ajpc.2024.100872

  View details for PubMedID 39430431

  View details for PubMedCentralID PMC11489823

• Leveraging Social Determinants of Health to Enhance Recruitment of Underrepresented Populations in Clinical Trials. Methodist DeBakey cardiovascular journal King, S., Trabanino, S., Azizi, Z., Rodriguez, F. 2024; 20 (5): 81-88

  Abstract

  Historically marginalized communities are disproportionately affected by cardiometabolic diseases yet are underrepresented in clinical trials that investigate needed interventions. This review investigates the barriers to equitable inclusion in clinical trials, identifying opportunities for improvement at the institutional, trial, community, and individual level. It proposes a social determinants-based approach that serves as a toolkit to target these barriers using structural, economic, community, healthcare access, and technology solutions, supporting constructive improvement in the clinical trial recruitment process.

  View details for DOI 10.14797/mdcvj.1447

  View details for PubMedID 39525382

  View details for PubMedCentralID PMC11546174

• Factors Associated with Lipoprotein(a) Testing Among Multiethnic Individuals. Journal of general internal medicine Brar, S., Huang, Q., Yan, X., Dudum, R., Jose, P., Sarraju, A., Palaniappan, L., Rodriguez, F. 2024

  Abstract

  Lipoprotein(a) [Lp(a)] is a causal risk factor for atherosclerotic cardiovascular disease (ASCVD) and clinical guidelines recommend incorporating Lp(a) testing in routine care.Examine real-world, contemporary clinical testing patterns of Lp(a) among multiethnic populations.In this nested case-control study, we assessed the prevalence and factors associated with Lp(a) testing within a large Northern Californian health system between 2010 and 2021. Incident density matching was used to select controls matched with a case for a case:control ratio of up to 1:5. Conditional logistic regression was used to assess the relationship between Lp(a) testing, sociodemographic, and clinical characteristics.We included individuals aged 18 years or older with ≥ 2 primary care visits during the study period.Lp(a) testing rates over time and factors associated with testing based on demographic, medical, and healthcare utilization variables.Of the 1,484,410 individuals in the cohort, 14,818 (1.0%) underwent Lp(a) testing. The median Lp(a) level was 35 mg/dL and over a third of individuals had Lp(a) levels > 50 mg/dL. After adjustment, South Asian individuals were three times more likely to have undergone Lp(a) testing, as compared to non-Hispanic White individuals [OR = 3.19, (95% CI = 2.98, 3.41)], while those identified as non-Hispanic Black and Hispanic were significantly less likely to have undergone Lp(a) testing [OR = 0.70, (95% CI = 0.62, 0.80) and 0.64 (95% CI = 0.59, 0.69), respectively]. Those with a history of ASCVD had over twice the odds of undergoing testing [OR = 2.14 (95% CI = 1.99, 2.29)], as did individuals with more frequent primary care visits [OR = 1.99 (95% CI = 1.84, 2.15)].Lp(a) testing rates in real-world settings are low, with significant disparities by race, ethnicity, and healthcare utilization. Expanding access to Lp(a) testing may help reduce disparities within ASCVD risk assessment and treatment as new targeted therapeutic agents become available.

  View details for DOI 10.1007/s11606-024-09126-6

  View details for PubMedID 39455482

  View details for PubMedCentralID 10547299

• Seeing Is Knowing: Noninvasive Imaging Outperforms Traditional Risk Assessment. Journal of the American College of Cardiology Maron, D. J., Rodriguez, F. 2024; 84 (15): 1404-1406

  View details for DOI 10.1016/j.jacc.2024.06.048

  View details for PubMedID 39357938

• Low-Density Lipoprotein Cholesterol Control as a Performance Measure: A National Analysis of the VHA. Journal of the American College of Cardiology Jain, S. S., Skye, M., Din, N., Furst, A., Maron, D. J., Heidenreich, P., Kalwani, N., Bhatt, A. S., Sandhu, A. T., Rodriguez, F. 2024; 84 (13): 1272-1275

  View details for DOI 10.1016/j.jacc.2024.07.025

  View details for PubMedID 39293887

• International Variation in Health Status Benefits in Patients Undergoing Initial Invasive Versus Conservative Management for Chronic Coronary Disease: Insights From the ISCHEMIA Trial. Circulation. Cardiovascular quality and outcomes Ikemura, N., Spertus, J. A., Nguyen, D., Fu, Z., Jones, P. G., Reynolds, H. R., Bangalore, S., Bhargava, B., Senior, R., Elghamaz, A., Goodman, S. G., Lopes, R. D., Pracoń, R., López-Sendón, J., Maggioni, A. P., Kohsaka, S., Roth, G. A., White, H. D., Mavromatis, K., Boden, W. E., Rodriguez, F., Hochman, J. S., Maron, D. J. 2024: e010534

  Abstract

  The ISCHEMIA trial (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) demonstrated greater health status benefits with an initial invasive strategy, as compared with a conservative one, for patients with chronic coronary disease and moderate or severe ischemia. Whether these benefits vary globally is important to understand to support global adoption of the results.We analyzed participants' disease-specific health status using the validated 7-item Seattle Angina Questionnaire (SAQ: >5-point differences are clinically important) at baseline and over 1-year follow-up across 37 countries in 6 international regions. The average effect of initial invasive versus conservative strategies on 1-year SAQ scores was estimated using Bayesian proportional odds regression and compared across regions.Considerable regional variation in baseline health status was observed among 4617 participants (mean age=64.4±9.5 years, 24% women), with the mean SAQ summary scores of 67.4±19.5 in Eastern Europe participants (17% of the total), 71.4±15.4 in Asia-Pacific (18%), 74.9±16.7 in Central and South America (10%), 75.5±19.5 in Western Europe (26%), and 78.6±19.2 in North America (28%). One-year improvements in SAQ scores were greater in regions with lower baseline scores with initial invasive management (17.7±20.9 in Eastern Europe and 11.4±19.3 in North America), but similar in the conservative arm. Adjusting for baseline SAQ scores, similar health status benefits of an initial invasive strategy on 1-year SAQ scores were observed (ranging from 2.38 points [95% CI, 0.04-4.50] in North America to 4.66 points [95% CI, 2.46-6.94] in Eastern Europe), with an 88.3% probability that the difference in benefit across regions was <5 points.In patients with chronic coronary disease and moderate or severe ischemia, initial invasive management was associated with a consistent health status benefit across regions, with modest regional variability, supporting the international generalizability of health status benefits from invasive management of chronic coronary disease.URL: https://www.clinicaltrials.gov; Unique identifier: NCT01471522.

  View details for DOI 10.1161/CIRCOUTCOMES.123.010534

  View details for PubMedID 39301726

• Equity in Heart Failure Care: A Get With the Guidelines Analysis of Between- and Within-Hospital Differences in Care by Sex, Race, Ethnicity, and Insurance. Circulation. Heart failure Sandhu, A. T., Grau-Sepulveda, M. V., Witting, C., Tisdale, R. L., Zheng, J., Rodriguez, F., Edward, J. A., Ambrosy, A. P., Greene, S. J., Alhanti, B., Fonarow, G. C., Joynt Maddox, K. E., Heidenreich, P. A. 2024: e011177

  Abstract

  BACKGROUND: Disparities in guideline-based quality measures likely contribute to differences in heart failure (HF) outcomes. We evaluated between- and within-hospital differences in the quality of care across sex, race, ethnicity, and insurance for patients hospitalized for HF.METHODS: This retrospective analysis included patients hospitalized for HF across 596 hospitals in the Get With the Guidelines-HF registry between 2016 and 2021. We evaluated performance across 7 measures stratified by patient sex, race, ethnicity, and insurance. We evaluated differences in performance with and without adjustment for the treating hospital. We also measured variation in hospital-specific disparities.RESULTS: Among 685 227 patients, the median patient age was 72 (interquartile range, 61-82) and 47.2% were women. Measure performance was significantly lower (worse) for women compared with men for all 7 measures before adjustment. For 4 of 7 measures, there were no significant sex-related differences after patient-level adjustment. For 20 of 25 other comparisons, racial and ethnic minorities and Medicaid/uninsured patients had similar or higher (better) adjusted measure performance compared with White and Medicare/privately insured patients, respectively. Angiotensin receptor neprilysin inhibitor measure performance was significantly lower for Asian, Hispanic, and Medicaid/uninsured patients, and cardiac resynchronization therapy implant/prescription was lower among women and Black patients after hospital adjustment, indicating within-hospital differences. There was hospital-level variation in these differences. For cardiac resynchronization therapy implantation/prescription, 278 hospitals (46.6%) had ≥2% lower implant/prescription for Black versus White patients compared with 109 hospitals (18.3%) with the same or higher cardiac resynchronization therapy implantation/prescription for Black patients.CONCLUSIONS: HF quality measure performance was equitable for most measures. There were within-hospital differences in angiotensin receptor neprilysin inhibitor and cardiac resynchronization therapy implant/prescription for historically marginalized groups. The magnitude of hospital-specific disparities varied across hospitals.

  View details for DOI 10.1161/CIRCHEARTFAILURE.123.011177

  View details for PubMedID 39291393

• Low prevalence of testing for apolipoprotein B and lipoprotein (a) in the real world AMERICAN JOURNAL OF PREVENTIVE CARDIOLOGY Murdock, D. J., Moll, K., Sanchez, R. J., Gu, J., Fazio, S., Geba, G. P., Rodriguez, F. 2024; 19

  View details for DOI 10.1016/j.ajpc.2024.100721

  View details for Web of Science ID 001304013600001

• Low prevalence of testing for apolipoprotein B and lipoprotein (a) in the real world. American journal of preventive cardiology Murdock, D. J., Moll, K., Sanchez, R. J., Gu, J., Fazio, S., Geba, G. P., Rodriguez, F. 2024; 19: 100721

  Abstract

  Apolipoprotein B (ApoB) and lipoprotein (a) (Lp[a]) are predictors of cardiovascular disease (CVD) risk; therefore, current recommendations for CVD risk assessment and management advocate that patients receive testing for ApoB and Lp(a) in addition to the standard lipid panel. However, US guidelines around ApoB and Lp(a) testing have evolved over time and vary slightly by expert committee. The objective of this analysis was to estimate the number of insured individuals in the USA who received any component of a lipid test, or ApoB and/or Lp(a) testing, during 2019.We conducted a cross-sectional analysis to estimate the prevalence of any component of a lipid test, ApoB, and/or Lp(a) in the USA using four different claim data sources (including Medicaid, Medicare, and commercially insured enrollees). Prevalence estimates were age-, sex-, payor-, and region-standardized to the 2019 US Annual Social and Economic Supplement of the Current Population Survey. We also described the clinical profile of patients who received lipid testing between 2019 and 2021 (cohort analysis) in Optum claims database. Enrollees were grouped into four non-mutually exclusive cohorts based on their completion of any component of the lipid panel, ApoB, Lp(a), or ApoB and Lp(a).In the prevalence cohort, over a third (38 %) of insured adults in the USA underwent testing for any component of a lipid panel in 2019. This proportion was higher for individuals aged ≥65 years compared to younger adults (62% vs 31 %). The proportion of ApoB and Lp(a) testing represented only <1 % of testing for any component of a lipid panel. In the cohort analysis, we found that lipid testing increased with age and comorbidities.These data should be considered by guideline-issuing agencies and organizations to develop education campaigns encouraging more frequent use of tests beyond the standard lipid panel.

  View details for DOI 10.1016/j.ajpc.2024.100721

  View details for PubMedID 39281349

  View details for PubMedCentralID PMC11399648

• Gender disparities in utilization of statins for low density lipoprotein management across the spectrum of atherosclerotic cardiovascular disease: Insights from the houston methodist cardiovascular disease learning health system registry. American journal of preventive cardiology Shahid, I., Satish, P., Gullapelli, R., Nicholas, J. C., Javed, Z., Avenatti, E., Bose, B., Mahajan, S., Roy, T., Sharma, G., Rodriguez, F., Andrieni, J., Jones, S. L., Al-Kindi, S., Cainzos-Achirica, M., Nasir, K. 2024; 19: 100722

  Abstract

  Lower statin utilization is reported among women compared to men, however large-scale studies evaluating gender disparities in LDL-C management in individuals with ASCVD and its subtypes remain limited, particularly across age and racial/ethnic subgroups. In this study, we address this knowledge gap using data from a large US healthcare system.All adult patients with established ASCVD in the Houston Methodist Learning Health System Registry during 2016-2022 were included. Statin use and dose were extracted from the database. The association between gender and statin utilization was evaluated using multivariate logistic regression analyses in patients with ASCVD overall, across ASCVD subtypes, and by age, racial/ethnic subgroups, and socioeconomic risk factors.A total of 97,819 patients with prevalent ASCVD were included. Women with ASCVD had lower utilization of any statin (64.3% vs 72.6 %; p < 0.001) and high-intensity statin (29.8% vs 42.5 % p < 0.001) compared with men. In fully adjusted models, women had 40 % lower odds of any (adjusted odds ratio [aOR]:0.58, 95 % CI 0.57-0.60) and high-intensity statin use (aOR:0.59, 0.57-0.61) relative to men. Women were also less likely to have guideline-recommended LDL-C < 70 mg/dL (30.2% vs 42.7 %; p < 0.01). These differences persisted across age, racial/ethnic and socioeconomic subgroups.Significant gender disparities exist in contemporary lipid management among patients with ASCVD, with women being less likely to receive any and high-intensity statin and achieving guideline defined LDL-C goal compared with men across age and racial/ethnic subgroups. These disparities underscore the need to further understand potential socioeconomic drivers of the observed lower statin uptake in women.

  View details for DOI 10.1016/j.ajpc.2024.100722

  View details for PubMedID 39281350

  View details for PubMedCentralID PMC11402022

• Gender disparities in utilization of statins for low density lipoprotein management across the spectrum of atherosclerotic cardiovascular disease: Insights from the houston methodist cardiovascular disease learning health system registry AMERICAN JOURNAL OF PREVENTIVE CARDIOLOGY Shahid, I., Satish, P., Gullapelli, R., Nicholas, J. C., Javed, Z., Avenatti, E., Bose, B., Mahajan, S., Roy, T., Sharma, G., Rodriguez, F., Andrieni, J., Jones, S. L., Al-Kindi, S., Cainzos-Achirica, M., Nasir, K. 2024; 19

  View details for DOI 10.1016/j.ajpc.2024.100722

  View details for Web of Science ID 001307353200001

• Digital Footprints of Obesity Treatment: GLP-1 Receptor Agonists and the Health Equity Divide. Circulation Azizi, Z., Rodriguez, F., Assimes, T. L. 2024; 150 (3): 171-173

  Abstract

  Our research investigates the societal implications of access to glucagon-like peptide-1 (GLP-1) agonists, particularly in light of recent clinical trials demonstrating the efficacy of semaglutide in reducing cardiovascular mortality. A decade-long analysis of Google Trends indicates a significant increase in searches for GLP-1 agonists, primarily in North America. This trend contrasts with the global prevalence of obesity. Given the high cost of GLP-1 agonists, a critical question arises: Will this disparity in medication accessibility exacerbate the global health equity gap in obesity treatment? This viewpoint explores strategies to address the health equity gap exacerbated by this emerging medication. Because GLP-1 agonists hold the potential to become a cornerstone in obesity treatment, ensuring equitable access is a pressing public health concern.

  View details for DOI 10.1161/CIRCULATIONAHA.124.069680

  View details for PubMedID 39008562

• Using large language models to assess public perceptions around glucagon-like peptide-1 receptor agonists on social media. Communications medicine Somani, S., Jain, S. S., Sarraju, A., Sandhu, A. T., Hernandez-Boussard, T., Rodriguez, F. 2024; 4 (1): 137

  Abstract

  The prevalence of obesity has been increasing worldwide, with substantial implications for public health. Obesity is independently associated with cardiovascular morbidity and mortality and is estimated to cost the health system over $200 billion dollars annually. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as a practice-changing therapy for weight loss and cardiovascular risk reduction independent of diabetes.We used large language models to augment our previously reported artificial intelligence-enabled topic modeling pipeline to analyze over 390,000 unique GLP-1 RA-related Reddit discussions.We find high interest around GLP-1 RAs, with a total of 168 topics and 33 groups focused on the GLP-1 RA experience with weight loss, comparison of side effects between differing GLP-1 RAs and alternate therapies, issues with GLP-1 RA access and supply, and the positive psychological benefits of GLP-1 RAs and associated weight loss. Notably, public sentiment in these discussions was mostly neutral-to-positive.These findings have important implications for monitoring new side effects not captured in randomized control trials and understanding the public health challenge of drug shortages.

  View details for DOI 10.1038/s43856-024-00566-z

  View details for PubMedID 38987347

  View details for PubMedCentralID PMC11237093

• Characterization of Peripheral Artery Disease and Associations with Traditional Risk Factors, Mobility, and Biomarkers in the Project Baseline Health Study. American heart journal Kercheval, J. B., Narcisse, D. I., Nguyen, M., Rao, S. V., Gutierrez, J. A., Leeper, N. J., Maron, D. J., Rodriguez, F., Hernandez, A. F., Mahaffey, K. W., Shah, S. H., Swaminathan, R. V. 2024

  Abstract

  There is a dearth of research on immunophenotyping in peripheral artery disease (PAD). This study aimed to describe the baseline characteristics, immunophenotypic profile, and quality of life (QoL) of participants with PAD in the Project Baseline Health Study (PBHS).The PBHS study is a prospective, multi-center, longitudinal cohort study that collected clinical, molecular, and biometric data from participants recruited between 2017 and 2018. In this analysis, baseline demographic, clinical, mobility, QoL, and flow cytometry data were stratified by the presence of PAD (ankle brachial index [ABI] ≤0.90).Of 2,209 participants, 58 (2.6%) had lower-extremity PAD, and only 2 (3.4%) had pre-existing PAD diagnosed prior to enrollment. Comorbid smoking (29.3% vs. 14%, p<0.001), hypertension (54% vs. 30%, p<0.001), diabetes (25% vs. 14%, p=0.031), and at least moderate coronary calcifications (Agatston score >100: 32% vs. 17%, p=0.01) were significantly higher in participants with PAD than in those with normal ABIs, as were high-sensitivity C-reactive protein levels (5.86 vs. 2.83, p<0.001). After adjusting for demographic and risk factors, participants with PAD had significantly fewer circulating CD56-high natural killer cells, IgM+ memory B cells, and CD10/CD27 double-positive B cells (p<0.05 for all).This study reinforces existing evidence that a large proportion of PAD without claudication may be underdiagnosed, particularly in female and Black or African American participants. We describe a novel immunophenotypic profile of participants with PAD that could represent a potential future screening or diagnostic tool to facilitate earlier diagnosis of PAD.NCT03154346, https://clinicaltrials.gov/ct2/show/NCT03154346.

  View details for DOI 10.1016/j.ahj.2024.06.010

  View details for PubMedID 38969081

• Sociodemographic Differences Among Patients Receiving Coronary Artery Calcium Imaging vs Nongated Chest Computed Tomography Imaging. JACC. Advances Peng, A. W., Skye, M., Jain, S. S., Dudum, R., Maron, D. J., Din, N., Patel, B. N., Chaudhari, A. S., Sandhu, A. T., Rodriguez, F. 2024; 3 (7): 100963

  View details for DOI 10.1016/j.jacadv.2024.100963

  View details for PubMedID 39129975

  View details for PubMedCentralID PMC11312303

• Sex, Age, and Patient Experience in Cardiologist Reviews: A Large-Scale Artificial Intelligence-Enabled Analysis. JACC. Advances Yang, A., Rodriguez, F., Woo, J. P. 2024; 3 (7): 101046

  Abstract

  Patients are increasingly using online reviews to evaluate cardiologists. Online reviews can provide insights into factors driving patient satisfaction. Little is known about the effects of age and sex on the patient experience with cardiologists.The purpose of this study was to apply natural language processing techniques on online reviews to determine the factors underlying positive and negative patient experiences and the effects of age and sex on the patient experience with cardiologists.Mixed effects logistic regression and sentiment analysis were applied to online cardiologist reviews from Healthgrades between 1998 and 2023. The results were then analyzed by sex and age to show trends with respect to rating statistics, sentiment analysis, and frequency of 2-word phrases.There were 100,334 online reviews of 9,461 cardiologists. Female cardiologists received lower average ratings compared to male cardiologists and were 34.5% less likely to receive a positive review (OR: 0.655; 95% CI: 0.481-0.893; P = 0.015). Older cardiologists received lower average ratings compared to younger cardiologists (4.145 ± 0.908 vs 4.348 ± 0.795; P < 0.01). Positive reviews were associated with time spent with patients (OR: 1.383; 95% CI: 1.251-1.528; P < 0.01), answering questions (OR: 2.622; 95% CI: 2.324-2.959; P < 0.01), and patients feeling they could trust their providers' decisions (OR: 2.285; 95% CI: 2.053-2.543; P < 0.01).Positive reviews were associated with cardiologists being comprehensive and patients feeling a sense of trust in the relationship. There was a difference in ratings based on age and sex with female and older cardiologists receiving lower ratings.

  View details for DOI 10.1016/j.jacadv.2024.101046

  View details for PubMedID 39129993

  View details for PubMedCentralID PMC11312787

• Relationship between body mass index and cardiometabolic health in a multi-ethnic population: A project baseline health study. American journal of preventive cardiology Shah, N. P., Lu, R., Haddad, F., Shore, S., Schaack, T., Mega, J., Pagidipati, N. J., Palaniappan, L., Mahaffey, K., Shah, S. H., Rodriguez, F. 2024; 18: 100646

  Abstract

  Obesity is associated with a higher risk of cardiovascular disease. Understanding the associations between comprehensive health parameters and body mass index (BMI) may lead to targeted prevention efforts.Project Baseline Health Study (PBHS) participants were divided into six BMI categories: underweight (BMI <18.5 kg/m2), normal weight (BMI 18.5-24.9 kg/m2), overweight (BMI 25-29.9 kg/m2), class I obesity (30-34.9 kg/m2), class II obesity (35-39.9 kg/m2), and class III obesity (BMI ≥40 kg/m2). Demographic, cardiometabolic, mental health, and physical health parameters were compared across BMI categories, and multivariable logistic regression models were fit to evaluate associations.A total of 2,493 PBHS participants were evaluated. The mean age was 50±17.2 years; 55 % were female, 12 % Hispanic, 16 % Black, and 10 % Asian. The average BMI was 28.4 kg/m2±6.9. The distribution of BMI by age group was comparable to the 2017-2018 National Health and Nutrition Examination Survey (NHANES) dataset. The obesity categories had higher proportions of participants with CAC scores >0, hypertension, diabetes, lower HDL-C, lower vitamin D, higher triglycerides, higher hsCRP, lower mean step counts, higher mean PHQ-9 scores, and higher mean GAD-7 scores.We identified associations of cardiometabolic and mental health characteristics with BMI, thereby providing a deeper understanding of cardiovascular health across BMI.

  View details for DOI 10.1016/j.ajpc.2024.100646

  View details for PubMedID 38550633

  View details for PubMedCentralID PMC10966449

• Lipoprotein(a) Levels in Disaggregated Racial and Ethnic Subgroups Across Atherosclerotic Cardiovascular Disease Risk Levels. JACC. Advances Dudum, R., Huang, Q., Yan, X. S., Fonseca, M. A., Jose, P., Sarraju, A., Palaniappan, L., Rodriguez, F. 2024; 3 (6): 100940

  Abstract

  Lipoprotein(a) [Lp(a)] is a causal risk factor for atherosclerotic cardiovascular disease (ASCVD).The authors assessed differences in Lp(a) testing and levels by disaggregated race, ethnicity, and ASCVD risk.This was a retrospective cohort study of patients from a large California health care system from 2010 to 2021. Eligible individuals were ≥18 years old, with ≥2 primary care visits, and complete race and ethnicity data who underwent Lp(a) testing. Race and ethnicity were self-reported and categorized as follows: non-Hispanic (NH) White, NH-Black, Hispanic (Mexican, Puerto Rican, other), NH-Asian (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, other). Logistic regression models tested associations between elevated Lp(a) (≥50 mg/dL) and race, ethnicity, and ASCVD risk.13,689 (0.9%) individuals underwent Lp(a) testing with a mean age of 54.6 ± 13.8 years, 49% female, 28.8% NH Asian. Over one-third of those tested had Lp(a) levels ≥50 mg/dL, ranging from 30.7% of Mexican patients to 62.6% of NH-Black patients. The ASCVD risk of those tested varied by race: 73.6% of Asian Indian individuals had <5% 10-year risk, whereas 27.2% of NH-Black had established ASCVD. Lp(a) prevalence ≥50 mg/dL increased across the ASCVD risk spectrum. After adjustment, Hispanic (OR: 0.76 [95% CI: 0.66-0.88]) and Asian (OR: 0.88 [95% CI: 0.81-0.96]) had lower odds of Lp(a) ≥50 mg/dL, whereas Black individuals had higher odds (OR: 2.46 [95% CI: 1.97-3.07]).Lp(a) testing is performed infrequently. Of those tested, Lp(a) levels were frequently elevated and differed significantly across disaggregated race and ethnicity groups. The prevalence of elevated Lp(a) increased with increasing ASCVD risk, with significant variation by race and ethnicity.

  View details for DOI 10.1016/j.jacadv.2024.100940

  View details for PubMedID 38938854

  View details for PubMedCentralID PMC11198068

• Statin utilization and cardiovascular outcomes in a real-world primary prevention cohort of older adults. American journal of preventive cardiology Walker, A. J., Zhu, J., Thoma, F., Marroquin, O., Makani, A., Gulati, M., Gianos, E., Virani, S. S., Rodriguez, F., Reis, S. E., Ballantyne, C., Mulukutla, S., Saeed, A. 2024; 18: 100664

  Abstract

  Background: Statins are a cost-effective therapy for prevention of atherosclerotic cardiovascular disease (ASCVD). Guidelines on statins for primary prevention are unclear for older adults (>75 years).Objective: Investigate statin utility in older adults without ASCVD events, by risk stratifying in a large healthcare network.Methods: We included 8,114 older adults, without CAD, PVD or ischemic stroke. Statin utilization based on ACC/AHA 10-year ASCVD risk calculation, was evaluated in intermediate (7.5%-19.9%) and high-risk patients (≥ 20%); and categorized using low and 'moderate or high' intensity statins with a follow up period of 7 years. Cox regression models were used to calculate hazard ratios for incident ASCVD and mortality across risk categories stratified by statin utilization. Data was adjusted for competing risk using Elixhauser Comorbidity Index.Results: Compared with those on moderate or high intensity statins, high-risk older patients not on any statin had a significantly increased risk of MI [HR 1.51 (1.17-1.95); p<0.01], stroke [HR 1.47 (1.14-1.90); p<0.01] and all-cause mortality [HR 1.37 (1.19-1.58); p<0.001] in models adjusted for Elixhauser Comorbidity Index. When comparing the no statin group versus the moderate or high intensity statin group in the intermediate risk cohort, although a trend for increased risk was seen, it did not meet statistical significance thresholds for MI, stroke or all-cause mortality.Conclusion: Lack of statin use was associated with increased cardiovascular events and mortality in high-risk older adults. Given the benefits appreciated, statin use may need to be strongly considered for primary ASCVD prevention among high-risk older adults. Future studies will assess the risk-benefit ratio of statin intervention in older adults.

  View details for DOI 10.1016/j.ajpc.2024.100664

  View details for PubMedID 38665251

• Artificial Intelligence in Cardiovascular Disease Prevention: Is it Ready for Prime Time? Current atherosclerosis reports Parsa, S., Somani, S., Dudum, R., Jain, S. S., Rodriguez, F. 2024

  Abstract

  PURPOSE OF REVIEW: This review evaluates how Artificial Intelligence (AI) enhances atherosclerotic cardiovascular disease (ASCVD) risk assessment, allows for opportunistic screening, and improves adherence to guidelines through the analysis of unstructured clinical data and patient-generated data. Additionally, it discusses strategies for integrating AI into clinical practice in preventive cardiology.RECENT FINDINGS: AI models have shown superior performance in personalized ASCVD risk evaluations compared to traditional risk scores. These models now support automated detection of ASCVD risk markers, including coronary artery calcium (CAC), across various imaging modalities such as dedicated ECG-gated CT scans, chest X-rays, mammograms, coronary angiography, and non-gated chest CT scans. Moreover, large language model (LLM) pipelines are effective in identifying and addressing gaps and disparities in ASCVD preventive care, and can also enhance patient education. AI applications are proving invaluable in preventing and managing ASCVD and are primed for clinical use, provided they are implemented within well-regulated, iterative clinical pathways.

  View details for DOI 10.1007/s11883-024-01210-w

  View details for PubMedID 38780665

• Inequities in atherosclerotic cardiovascular disease prevention. Progress in cardiovascular diseases Gomez, S., Dudum, R., Rodriguez, F. 2024

  Abstract

  Atherosclerotic cardiovascular (CV) disease (ASCVD) prevention encompasses interventions across the lifecourse: from primordial to primary and secondary prevention. Primordial prevention begins in childhood and involves the promotion of ideal CV health (CVH) via optimizing physical activity, body mass index, blood glucose levels, total cholesterol levels, blood pressure, and sleep while minimizing tobacco use. Primary and secondary prevention of ASCVD thereafter centers around mitigating ASCVD risk factors via medical therapy and lifestyle interventions. Disparities in optimal preventive efforts exist among historically marginalized groups in each of these three prongs of ASCVD prevention. Children and adults with a high burden of social determinants of health also face inequity in preventive measures. Inadequate screening, risk factor management and prescription of preventive therapeutics permeate the care of certain groups, especially women, Black, and Hispanic individuals in the United States. Beyond this, individuals belonging to historically marginalized groups also are much more likely to experience other ASCVD risk-enhancing factors, placing them at higher risk for ASCVD over their lifetime. These disparities translate to worse outcomes, with higher rates of ASCVD and CV mortality among these groups. Possible solutions to promoting equity involve community-based youth lifestyle interventions, improved risk-factor screening, and increasing accessibility to healthcare resources and novel preventive diagnostics and therapeutics.

  View details for DOI 10.1016/j.pcad.2024.05.002

  View details for PubMedID 38734044

• Racial and Ethnic Disparities in the Management of Chronic Coronary Disease. The Medical clinics of North America Tang, W. L., Rodriguez, F. 2024; 108 (3): 595-607

  Abstract

  Chronic coronary disease (CCD) comprises a continuum of conditions that include obstructive and non-obstructive coronary artery disease with or without prior acute coronary syndrome. Racial and ethnic representation disparities are pervasive in CCD guideline-informing clinical trials and evidence-based management. These disparities manifest across the entire spectrum of CCD management, spanning from non-pharmacological lifestyle changes to guideline-directed medical therapy, and cardiac rehabilitation to invasive procedures. Recognizing and addressing the historical factors underlying these disparities is crucial for enhancing the quality and equity of CCD management within an increasingly diverse population.

  View details for DOI 10.1016/j.mcna.2023.11.008

  View details for PubMedID 38548466

  View details for PubMedCentralID PMC10979033

• Cardiovascular Disease in Hispanic Women: JACC Review Topic of the Week. Journal of the American College of Cardiology Quesada, O., Crousillat, D., Rodriguez, F., Bravo-Jaimes, K., Briller, J., Ogunniyi, M. O., Mattina, D. J., Aggarwal, N. R., Rodriguez, C. J., De Oliveira, G. M., Velarde, G. 2024; 83 (17): 1702-1712

  Abstract

  Cardiovascular disease affects 37% of Hispanic women and is the leading cause of death among Hispanic women in the United States. Hispanic women have a higher burden of cardiovascular risk factors, are disproportionally affected by social determinants of health, and face additional barriers related to immigration, such as discrimination, language proficiency, and acculturation. Despite this, Hispanic women show lower rates of cardiovascular disease and mortality compared with non-Hispanic White women. However, this "Hispanic paradox" is challenged by recent studies that account for the diversity in culture, race, genetic background, country of origin, and social determinants of health within Hispanic subpopulations. This review provides a comprehensive overview of the cardiovascular risk factors in Hispanic women, emphasizing the role of social determinants, and proposes a multipronged approach for equitable care.

  View details for DOI 10.1016/j.jacc.2024.02.039

  View details for PubMedID 38658109

• Shorter Door-to-ECG Time Is Associated with Improved Mortality in STEMI Patients. Journal of clinical medicine Yiadom, M. Y., Gong, W., Bloos, S. M., Bunney, G., Kabeer, R., Pasao, M. A., Rodriguez, F., Baugh, C. W., Mills, A. M., Gavin, N., Podolsky, S. R., Salazar, G. A., Patterson, B., Mumma, B. E., Tanski, M. E., Liu, D. 2024; 13 (9)

  Abstract

  Background: Delayed intervention for ST-segment elevation myocardial infarction (STEMI) is associated with higher mortality. The association of door-to-ECG (D2E) with clinical outcomes has not been directly explored in a contemporary US-based population. Methods: This was a three-year, 10-center, retrospective cohort study of ED-diagnosed patients with STEMI comparing mortality between those who received timely (<10 min) vs. untimely (>10 min) diagnostic ECG. Among survivors, we explored left ventricular ejection fraction (LVEF) dysfunction during the STEMI encounter and recovery upon post-discharge follow-up. Results: Mortality was lower among those who received a timely ECG where one-week mortality was 5% (21/420) vs. 10.2% (26/256) among those with untimely ECGs (p = 0.016), and in-hospital mortality was 6.0% (25/420) vs. 10.9% (28/256) (p = 0.028). Data to compare change in LVEF metrics were available in only 24% of patients during the STEMI encounter and 46.5% on discharge follow-up. Conclusions: D2E within 10 min may be associated with a 50% reduction in mortality among ED STEMI patients. LVEF dysfunction is the primary resultant morbidity among STEMI survivors but was infrequently assessed despite low LVEF being an indication for survival-improving therapy. It will be difficult to assess the impact of STEMI care interventions without more consistent LVEF assessment.

  View details for DOI 10.3390/jcm13092650

  View details for PubMedID 38731180

  View details for PubMedCentralID PMC11084706

• Factors Associated With Coronary Angiography Performed Within 6 Months of Randomization to the Conservative Strategy in the ISCHEMIA Trial. Circulation. Cardiovascular interventions Pracoń, R., Spertus, J. A., Broderick, S., Bangalore, S., Rockhold, F. W., Ruzyllo, W., Demchenko, E., Nageh, T., Grossman, G. B., Mavromatis, K., Manjunath, C. N., Smanio, P. E., Stone, G. W., Mancini, G. B., Boden, W. E., Newman, J. D., Reynolds, H. R., Hochman, J. S., Maron, D. J. 2024: e013435

  Abstract

  ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) did not find an overall reduction in cardiovascular events with an initial invasive versus conservative management strategy in chronic coronary disease; however, there were conservative strategy participants who underwent invasive coronary angiography early postrandomization (within 6 months). Identifying factors associated with angiography in conservative strategy participants will inform clinical decision-making in patients with chronic coronary disease.Factors independently associated with angiography performed within 6 months of randomization were identified using Fine and Gray proportional subdistribution hazard models, including demographics, region of randomization, medical history, risk factor control, symptoms, ischemia severity, coronary anatomy based on protocol-mandated coronary computed tomography angiography, and medication use.Among 2591 conservative strategy participants, angiography within 6 months of randomization occurred in 8.7% (4.7% for a suspected primary end point event, 1.6% for persistent symptoms, and 2.6% due to protocol nonadherence) and was associated with the following baseline characteristics: enrollment in Europe versus Asia (hazard ratio [HR], 1.81 [95% CI, 1.14-2.86]), daily and weekly versus no angina (HR, 5.97 [95% CI, 2.78-12.86] and 2.63 [95% CI, 1.51-4.58], respectively), poor to fair versus good to excellent health status (HR, 2.02 [95% CI, 1.23-3.32]) assessed with Seattle Angina Questionnaire, and new/more frequent angina prerandomization (HR, 1.80 [95% CI, 1.34-2.40]). Baseline low-density lipoprotein cholesterol <70 mg/dL was associated with a lower risk of angiography (HR, 0.65 [95% CI, 0.46-0.91) but not baseline ischemia severity nor the presence of multivessel or proximal left anterior descending artery stenosis >70% on coronary computed tomography angiography.Among ISCHEMIA participants randomized to the conservative strategy, angiography within 6 months of randomization was performed in <10% of patients. It was associated with frequent or increasing baseline angina and poor quality of life but not with objective markers of disease severity. Well-controlled baseline low-density lipoprotein cholesterol was associated with a reduced likelihood of angiography. These findings point to the importance of a comprehensive assessment of symptoms and a review of guideline-directed medical therapy goals when deciding the initial treatment strategy for chronic coronary disease.URL: https://www.clinicaltrials.gov; Unique identifier: NCT01471522.

  View details for DOI 10.1161/CIRCINTERVENTIONS.123.013435

  View details for PubMedID 38629312

• Atherosclerosis evaluation and cardiovascular risk estimation using coronary computed tomography angiography. European heart journal Nurmohamed, N. S., van Rosendael, A. R., Danad, I., Ngo-Metzger, Q., Taub, P. R., Ray, K. K., Figtree, G., Bonaca, M. P., Hsia, J., Rodriguez, F., Sandhu, A. T., Nieman, K., Earls, J. P., Hoffmann, U., Bax, J. J., Min, J. K., Maron, D. J., Bhatt, D. L. 2024

  Abstract

  Clinical risk scores based on traditional risk factors of atherosclerosis correlate imprecisely to an individual's complex pathophysiological predisposition to atherosclerosis and provide limited accuracy for predicting major adverse cardiovascular events (MACE). Over the past two decades, computed tomography scanners and techniques for coronary computed tomography angiography (CCTA) analysis have substantially improved, enabling more precise atherosclerotic plaque quantification and characterization. The accuracy of CCTA for quantifying stenosis and atherosclerosis has been validated in numerous multicentre studies and has shown consistent incremental prognostic value for MACE over the clinical risk spectrum in different populations. Serial CCTA studies have advanced our understanding of vascular biology and atherosclerotic disease progression. The direct disease visualization of CCTA has the potential to be used synergistically with indirect markers of risk to significantly improve prevention of MACE, pending large-scale randomized evaluation.

  View details for DOI 10.1093/eurheartj/ehae190

  View details for PubMedID 38606889

• IMPACT OF CLINICIAN TELEMEDICINE USE ON NEW MEDICATION ORDERS FOR PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION Joshi, M., Koos, H. T., Sandhu, A., Scheinker, D., Rodriguez, F., Kalwani, N. ELSEVIER SCIENCE INC. 2024: 632

  View details for Web of Science ID 001291434300633

• CHARACTERISTICS AND OUTCOMES FOR STATIN-INTOLERANT HISPANIC/LATINX PATIENTS RECEIVING BEMPEDOIC ACID: RESULTS FROM A CLEAR OUTCOMES PRE-SPECIFIED SUBANALYSIS Rodriguez, F., Brennan, D., Lei, L., Nissen, S. E., Powell, H., Plutzky, J. ELSEVIER SCIENCE INC. 2024: 1811

  View details for Web of Science ID 001324901501843

• ARTIFICIAL INTELLIGENCE-ENABLED ANALYSIS OF CORONARY ARTERY CALCIUM TOPICS ON SOCIAL MEDIA Somani, S., Balla, S., Peng, A. W., Dudum, R., Rodriguez, F. ELSEVIER SCIENCE INC. 2024: 4611

  View details for Web of Science ID 001324901504649

• IMPACT OF CLINICIAN TELEMEDICINE USE ON NEW MEDICATION ORDERS FOR PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION Joshi, M., Koos, H. T., Sandhu, A., Scheinker, D., Rodriguez, F., Kalwani, N. ELSEVIER SCIENCE INC. 2024: 632

  View details for Web of Science ID 001324901500633

• LOW-DENSITY LIPOPROTEIN CHOLESTEROL TESTING AND CONTROL AS PERFORMANCE METRICS: A NATIONAL ANALYSIS OF VETERANS AFFAIRS HEALTH CARE SYSTEMS Jain, S. S., Skye, M., Din, N., Maron, D., Heidenreich, P. A., Kalwani, N., Bhatt, A., Sandhu, A., Rodriguez, F. ELSEVIER SCIENCE INC. 2024: 2014

  View details for Web of Science ID 001324901502048

• An Inclisiran First Strategy vs Usual Care in Patients with Atherosclerosis. Journal of the American College of Cardiology Koren, M. J., Rodriguez, F., East, C., Toth, P. P., Watwe, V., Abbas, C. A., Sarwat, S., Kleeman, K., Kumar, B., Ali, Y., Jaffrani, N. 2024

  Abstract

  Most patients with atherosclerotic cardiovascular disease (ASCVD) fail to achieve guideline-directed low-density lipoprotein cholesterol (LDL-C) goals. Twice-yearly inclisiran lowers LDL-C by ∼50% when added to statins.To evaluate the effectiveness of an "inclisiran first" implementation strategy (adding inclisiran immediately upon failure to reach LDL-C <70 mg/dL despite receiving maximally tolerated statins) versus representative usual care in US patients with ASCVD.VICTORION-INITIATE, a prospective, pragmatically designed trial, randomized patients 1:1 to inclisiran (284 mg at Days 0, 90, and 270) plus usual care (lipid management at treating physician's discretion) versus usual care alone. Primary endpoints were percentage change in LDL-C from baseline and statin discontinuation rates.We randomized 450 patients (30.9% female, 12.4% Black, 15.3% Hispanic); mean baseline LDL-C 97.4 mg/dL. The "inclisiran first" strategy led to significantly greater reductions in LDL-C from baseline to Day 330 versus usual care (60.0% vs 7.0%; p<0.001). Statin discontinuation rates with "inclisiran first" (6.0%) were noninferior versus usual care (16.7%). More "inclisiran first" patients achieved LDL-C goals vs usual care (<70 mg/dL: 81.8% vs 22.2%; <55 mg/dL: 71.6% vs 8.9%; p<0.001). Treatment-emergent adverse event (TEAE) and serious TEAE rates compared similarly between treatment strategies (62.8% vs 53.7% and 11.5% vs 13.4%, respectively). Injection-site TEAEs and TEAEs causing treatment withdrawal occurred more commonly with "inclisiran first" than usual care (10.3% vs 0.0%, and 2.6% vs 0.5%, respectively).An "inclisiran first" implementation strategy led to greater LDL-C lowering compared with usual care without discouraging statin use or raising new safety concerns.

  View details for DOI 10.1016/j.jacc.2024.03.382

  View details for PubMedID 38593947

• Contemporary attitudes and beliefs on coronary artery calcium from social media using artificial intelligence. NPJ digital medicine Somani, S., Balla, S., Peng, A. W., Dudum, R., Jain, S., Nasir, K., Maron, D. J., Hernandez-Boussard, T., Rodriguez, F. 2024; 7 (1): 83

  Abstract

  Coronary artery calcium (CAC) is a powerful tool to refine atherosclerotic cardiovascular disease (ASCVD) risk assessment. Despite its growing interest, contemporary public attitudes around CAC are not well-described in literature and have important implications for shared decision-making around cardiovascular prevention. We used an artificial intelligence (AI) pipeline consisting of a semi-supervised natural language processing model and unsupervised machine learning techniques to analyze 5,606 CAC-related discussions on Reddit. A total of 91 discussion topics were identified and were classified into 14 overarching thematic groups. These included the strong impact of CAC on therapeutic decision-making, ongoing non-evidence-based use of CAC testing, and the patient perceived downsides of CAC testing (e.g., radiation risk). Sentiment analysis also revealed that most discussions had a neutral (49.5%) or negative (48.4%) sentiment. The results of this study demonstrate the potential of an AI-based approach to analyze large, publicly available social media data to generate insights into public perceptions about CAC, which may help guide strategies to improve shared decision-making around ASCVD management and public health interventions.

  View details for DOI 10.1038/s41746-024-01077-w

  View details for PubMedID 38555387

  View details for PubMedCentralID PMC10981728

• Characteristics and Outcomes for Hispanic/Latinx Participants with Statin-Intolerance Receiving Bempedoic Acid. Journal of the American College of Cardiology Rodriguez, F., Cho, L., Foody, J., Lincoff, A. M., Lei, L., Nicholls, S. J., Nissen, S. E., Powell, H. A., Plutzky, J. 2024

  View details for DOI 10.1016/j.jacc.2024.03.390

  View details for PubMedID 38537915

• Beyond Primary Prevention: The Intersection of Severe Coronary Calcium, Left Main Coronary Calcium, and Diabetes. JACC. Cardiovascular imaging Rodriguez, F., Dudum, R. 2024

  View details for DOI 10.1016/j.jcmg.2024.01.013

  View details for PubMedID 38520427

• Patterns and gaps in guideline-directed statin use for atherosclerotic cardiovascular disease by race and ethnicity. American journal of preventive cardiology Sarraju, A., Yan, X., Huang, Q., Dudum, R., Palaniappan, L., Rodriguez, F. 2024; 17: 100647

  Abstract

  There remain disparities by race and ethnicity in atherosclerotic cardiovascular disease (ASCVD). Statins reduce low-density lipoprotein cholesterol (LDL-c) and improve ASCVD outcomes. ASCVD treatment patterns across disaggregated race and ethnicity groups are incompletely understood. We aimed to evaluate statin use and LDL-c control for ASCVD by race and ethnicity.From an electronic health record (EHR)-based cohort from a multisite Northern California health system, we included adults with an ASCVD diagnosis from 2010 to 2021 and at least 2 primary care visits, stratified by race and ethnicity (Non-Hispanic White [NHW], Non-Hispanic Black [Black], Hispanic, and Asian). Hispanic (Mexican, Puerto Rican, Other) and Asian (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Other) groups were disaggregated. Primary outcomes were 1-year post-ASCVD statin use (prescription) and LDL-c control (at least one value <70 mg/dL). Adjusted odds ratios (ORs) were estimated using logistic regression.Of 133,158 patients, there were 89,944 NHW, 6,294 Black, 12,478 (9.4 %) Hispanic and 13,179 (9.9 %) Asian patients. At 1 year after incident ASCVD, there was suboptimal statin use (any statins <60 %, high-intensity <25 %) and LDL-c control (<30 %) across groups, with lowest proportions in Black patients for statin use (46.7 %, any statin) and LDL-c control (10.7 %, OR 0.89 (0.81-0.97), referent NHW). Disaggregation of Asian and Hispanic groups unmasked within-group heterogeneity.In patients with incident ASCVD, we describe suboptimal and heterogenous 1-year post-ASCVD guideline-directed statin use and 1-year post-ASCVD LDL-c control across disaggregated race and ethnicity groups. Findings may improve understanding of ASCVD treatment disparities and guide implementation.

  View details for DOI 10.1016/j.ajpc.2024.100647

  View details for PubMedID 38525197

  View details for PubMedCentralID PMC10958062

• Ten simple rules to leverage large language models for getting grants. PLoS computational biology Seckel, E., Stephens, B. Y., Rodriguez, F. 2024; 20 (3): e1011863

  View details for DOI 10.1371/journal.pcbi.1011863

  View details for PubMedID 38427611

• Sex Differences in Revascularization, Treatment Goals, and Outcomes of Patients With Chronic Coronary Disease: Insights From the ISCHEMIA Trial. Journal of the American Heart Association Reynolds, H. R., Cyr, D. D., Merz, C. N., Shaw, L. J., Chaitman, B. R., Boden, W. E., Alexander, K. P., Rosenberg, Y. D., Bangalore, S., Stone, G. W., Held, C., Spertus, J., Goetschalckx, K., Bockeria, O., Newman, J. D., Berger, J. S., Elghamaz, A., Lopes, R. D., Min, J. K., Berman, D. S., Picard, M. H., Kwong, R. Y., Harrington, R. A., Thomas, B., O'Brien, S. M., Maron, D. J., Hochman, J. S., ISCHEMIA Research Group *, Mavromatis, K., Linefsky, J., Miller, T., Banerjee, S., Reynolds, H. R., Newman, J. D., Bangalore, S., Donnino, R. M., Phillips, L. M., Saric, M., Abdul-Nour, K., Stone, P. H., Jang, J. J., Yee, G., Weitz, S., Arnold, S., O'Keefe, J. H., Shapiro, M. D., El-Hajjar, M., Sidhu, M. S., Fein, S. A., Torosoff, M. T., Lyubarova, R., Mookherjee, S., Drzymalski, K., McFalls, E. O., Garcia, S. A., Bertog, S. C., Siddiqui, R. A., Ishani, A., Hansen, R. A., Khouri, M. G., Goldberg, J. L., Goldweit, R., Cohen, R. A., Mirrer, B., Navarro, V., Winchester, D. E., Kronenberg, M., Rogal, P., McFarren, C., Heitner, J. F., Dauber, I. M., Cannan, C., Sudarshan, S., Mehta, P. K., McDaniel, M., Lerakis, S., Quyyumi, A., Wenger, N. K., Hedgepeth, C. M., Hurlburt, H., Rosen, A., Sahul, Z., Booth, D., Leung, S., Abdel-Latif, A., Reda, H., Ziada, K., Setty, S., Barua, R. S., Hage, F., Caldeira, C., Davies, J. E., Leesar, M., Heo, J., Iskandrian, A., Al Solaiman, F., Singh, S., Dajani, K., El-Hajjar, M., Der Mesropian, P., Sacco, J., McCandless, B., Orgera, M., Sidhu, M. S., Arif, I., Kerr, H., Trejo Gutierrez, J. F., Fletcher, G., Lane, G. E., Neeson, L. M., Parikh, P. P., Pollak, P. M., Shapiro, B. P., Landolfo, K., Gemignani, A., O'Rourke, D., Meadows, J. L., Call, J. T., Hannan, J., Bojar, R., Kumar, D., Mukai, J., Martin, E. T., Vorobiof, G., Moorman, A., Kinlay, S., Hamburger, R. J., Rocco, T. P., Bhatt, D. L., Croce, K., Quin, J. A., Anumpa, J., Zenati, M., Faxon, D. P., Rayos, G., Seedhom, A., Sullenberger, L., Kumkumian, G., Sedlis, S. P., Donnino, R. M., Lorin, J., Tamis-Holland, J. E., Kornberg, R., Leber, R., Saba, S., Lee, M. W., Small, D. R., Nona, W., Alexander, P. B., Rehman, I., Badami, U., Marzo, K., Robbins, I. H., Levite, H. A., Shetty, S., Patel, M., Hamroff, G. S., Little, R. W., Zimbelman, B. D., Lui, C. Y., Smith, B. R., Vezina, D. P., Khor, L. L., Abraham, J. D., Bull, D. A., McKellar, S. H., Booth, D., Kotter, J., Abdel-Latif, A., Hu, B., Labovitz, A. J., Berlowitz, M., Rogal, P., McFarren, C., Matar, F., Caldeira, C., Maron, D. J., Rodriguez, F., Schnittger, I., Fearon, W. F., Deedwania, P., Reddy, K., Sweeny, J., Spizzieri, C., Hochberg, C. P., Salerno, W. D., Wyman, R., Zarka, A., Shah, A. V., Haldis, T., Kohn, J. A., Girotra, S., Almousalli, O., Krishnam, M. S., Milliken, J. C., Patel, P. M., Seto, A. H., Harley, K. T., Gibson, M. A., Allen, B. J., Coram, R., Thomas, S., Schwartz, R. G., Chen, W., El Shahawy, M., Stafford, J., Abernethy, W. B., Zurick, A., Meyer, T. M., Morford, R. G., Rutkin, B., Bokhari, S., Sokol, S. I., Meisner, J., Hamzeh, I., Misra, A., Wall, M., De Rosen, V. L., Alam, M., Turner, M. C., Mulhearn, T. J., Good, A. P., Shammas, N. W., Chilton, R., Nguyen, P. K., Jezior, M., Gordon, P. C., Crain, T., Stenberg, R., Pedalino, R. P., Wiesel, J., Juang, G. J., Al-Amoodi, M., Wohns, D., Lader, E. W., Mumma, M., Dharmarajan, L., McGarvey, J. F., Downes, T. R., Luckasen, G. J., Cheong, B., Potluri, S., Mastouri, R. A., Breall, J. A., Revtyak, G. E., Bazeley, J. W., Li, D., Giedd, K., Old, W., Burt, F., Sokhon, K., Gopal, D., Valeti, U. S., Kobashigawa, J., Govindan, S. C., Nair, R. G., Manjunath, C. N., Moorthy, N., Manjunath, S. C., Narayanappa, S., Pandit, N., Nath, R. K., Dwivedi, S. K., Narain, V. S., Chandra, S., Wander, G. S., Tandon, R., Ralhan, S., Aslam, N., Goyal, A., Bhargava, B., Karthikeyan, G., Ramakrishnan, S., Seth, S., Yadav, R., Singh, S., Roy, A., Parakh, N., Verma, S. K., Narang, R., Mishra, S., Naik, N., Sharma, G., Choudhary, S. K., Patel, C., Gulati, G., Sharma, S., Bahl, V. K., Mathew, A., Punnoose, E., Gadkari, M. A., Gadage, S., Pillay, T. U., Satheesh, S., Mathur, A., Kaul, U., Christopher, J., Menon, R., Kumar, N., Oomman, A., Mao, R., Solomon, H., Naik, S., Khan, S. P., Christopher, J., Kumar, N., Grant, P., Kachru, R., Ajit Kumar, V. K., Ganapathi, S., Jayakumar, K., Sivadasanpillai, H., Sasidharan, B., Kapilamoorthy, T. R., Christopher, J., Polamuri, P., Kaul, U., Senior, R., Elghamaz, A., Gurunathan, S., Karogiannis, N., Shah, B. N., Trimlett, R. H., Rubens, M. B., Nicol, E. D., Mittal, T. K., Hampson, R., Gamma, R. A., de Belder, M. A., Thambyrajah, J., Nageh, T., Davies, J. R., Lindsay, S. J., Kurian, J., Jamil, H., Raheem, O., Hoye, A., Donnelly, P., Valecka, B., Chauhan, A., Barr, C., Alfakih, K., Byrne, J., Webb, I., Henriksen, P., OKane, P., de Silva, R., Conway, D. S., Sirker, A. A., Hoole, S. P., Witherow, F. N., Johnston, N., Harbinson, M., Walsh, S., Douglas, H., Luckie, M., Sobolewska, J., Jeetley, P., Patel, N., Kotecha, T., Travill, C., Karimullah, I., Al-Bustami, M., Braganza, D., Henderson, R., Pointon, K., Naik, S., Mathew, T., Berry, C., Collison, D., Roditi, G., Moriarty, A. J., Glover, J. D., Pradhan, J., Mikhail, G., Francis, D. P., Gosselin, G., Diaz, A., Rheault, P., Barrero, M., Gagne, C., Pepin-Dubois, Y., Costa, R., Sia, Y. T., Lemay, C., Gisbert, A., Gervais, P., Rheault, A., Phaneuf, D. C., Gosselin, G., Garg, P., Chow, B. J., Hessian, R. C., Beanlands, R. S., Davies, R. F., Bainey, K. R., Cheema, A. N., Bagai, A., Wald, R., Goodman, S., Graham, J. J., Peterson, M., Chow, C., Abramson, B., Cheema, A. N., Vakani, M. T., Cha, J., Howarth, A. G., Wong, G., Uxa, A., Galiwango, P., Kassam, S., Mukherjee, A., Ricci, A. J., Lam, A., Mehta, S., Udell, J., Genereux, P., Hameed, A., Daba, L., Hueb, W., Rezende, P. C., Silva, E. E., Hueb, A. C., Smanio, P. E., de Quadros, A. S., Kalil, R. A., da Costa Vieira, J. L., Grossmann, G., de Oliveira, P. P., Bridi, L., Savaris, S., Vitola, J. V., Cerci, R. J., Farias, F. R., Fernandes, M. M., Marin-Neto, J. A., Schmidt, A., de Oliveira Lima Filho, M., Oliveira, R. M., Chierice, J. R., Polanczyk, C. A., Furtado, M. V., Smidt, L. F., Carvalho, A. C., Pucci, G., Lyra, F., Junior, A. R., Dracoulakis, M. D., Lima, R. G., Figueiredo, E., Caramori, P. R., Tumelero, R., Dall'Orto, F., Mesquita, C. T., Colafranseschi, A. S., Oliveira, A. C., Carvalho, L. A., Palazzo, I. C., Sousa, A. S., da Silva, E. E., de Barros, P. G., de Padua Silva Baptista, L., Rodrigues, M. J., de Resende, M. V., Saraiva, J. F., Costantini, C., Demkow, M., Pracon, R., Kepka, C., Teresinska, A., Kryczka, K., Henzel, J., Solecki, M., Kaczmarska, E., Mazurek, T., Drozdz, J., Czarniak, B., Frach, M., Szymczyk, K., Niedzwiecka, I., Sobczak, S., Ciurus, T., Jakubowski, P., Misztal-Teodorczyk, M., Teodorczyk, D., Fratczak, A., Szkopiak, M., Lebioda, P., Wlodarczyk, M., Plachcinska, A., Kusmierek, J., Miller, M., Marciniak, H., Wojtczak-Soska, K., Luczak, K., Tarchalski, T., Cichocka-Radwan, A., Szwed, H., Szulczyk, G. A., Witkowski, A., Kukula, K., Celinska-Spodar, M., Zalewska, J., Gajos, G., Bury, K., Pruszczyk, P., Roik, M., Loboz-Grudzien, K., Sokalski, L., Brzezinska, B., Lesiak, M., Lanocha, M., Reczuch, K. W., Kalarus, Z., Swiatkowski, A., Szulik, M., Musial, W. J., Bockeria, L., Petrosyan, K., Trifonova, T., Chernyavskiy, A. M., Kretov, E. I., Grazhdankin, I. O., Bershtein, L. L., Sayganov, S. A., Kuzmina-Krutetskaya, A. M., Zbyshevskaya, E. V., Katamadze, N. O., Demchenko, E. A., Kozlov, P. S., Kozulin, V. Y., Lubinskaya, E. I., Lopez-Sendon, J., Castro, A., Salicio, E. R., Guzman, G., Galeote, G., Valbuena, S., Peteiro, J., Martinez-Ruiz, M. D., Perez-Fernandez, R., Cuenca-Castillo, J. J., Flores-Rios, X., Prada-Delgado, O., Barge-Caballero, G., Juanatey, J. R., Bayarri, M. S., Nunez, V. P., Sanchez, R. O., Alvarez, B. C., Gil, C. P., Monzonis, A. M., Sionis, A., Perales, M. V., Padro, J. M., Penaranda, A. S., Picart, J. G., Iglesias, A. G., Marimon, X. G., Llado, G. P., Costa, F. C., Miro, V., Diez, J. L., Calvillo, P., Ortuno, F. M., Chavarri, M. V., Montolliu, A. T., Bermudez, E. P., De La Morena, G., Blancas, M. G., Luena, J. E., Fernandez-Aviles, F., Chen, J., Wu, Y., Ma, Y., Yang, Y., Ji, Z., Yang, X., Lin, W., Zeng, H., Fu, X., Yang, B., Wang, S., Cheng, G., Zhao, Y., Fang, X., Zeng, Q., Su, X., Li, Q., Nie, S., Yu, Q., Wang, J., Zhang, S., Liu, Z., Perna, G. P., Marini, M., Gabrielli, G., Provasoli, S., Verna, E., Monti, L., Nardi, B., Di Chiara, A., Mortara, A., Galvani, M., Ottani, F., Sicuro, M., Calabro, P., Formisano, T., Tarantini, G., Cucchini, U., Andres, A. L., Racca, E., Briguori, C., Amati, R., Vergoni, W., Russo, A., Fanelli, R., Poh, K., Chai, P., Lau, T., Loh, J. P., Tay, E. L., Teoh, K., Teo, L. L., Ong, C., Wong, R. C., Loh, P., Kofidis, T., Chan, W. X., Chan, K. H., Foo, D., Kong, J. L., Er, C. M., Jafary, F. H., Chua, T., Doerr, R., Stumpf, J., Matschke, K., Simonis, G., Kadalie, C. T., Sechtem, U., Ong, P., Schulze, P. C., Goebel, B., Lenk, K., Nickenig, G., Schuchlenz, H., Weikl, S., Lang, I. M., Huber, K., Jakl-Kotauschek, G., Vertes, A., Varga, A., Fontos, G., Merkely, B., Kerecsen, G., Hinic, S., Zdravkovic, M., Mudrenovic, V., Crnokrak, B., Beleslin, B. D., Boskovic, N. N., Petrovic, M. T., Dobric, M. R., Markovic, Z. Z., Mladenovic, A. S., Cemerlic-Adjic, N., Davidovic, G., Vucic, R., Dekleva, M. N., Stankovic, G., Apostolovic, S., Escobedo, J., Baleon-Espinosa, R., Campos-Santaolalla, A. S., Duran-Cortes, E., Flores-Palacios, J. M., Garcia-Rincon, A., Jimenez-Santos, M., Penafiel, J. V., Ortega-Ramirez, J. A., Valdespino-Estrada, A., Rosas, E. A., Selvanayagam, J. B., Joseph, M. X., Thambar, S. T., Beltrame, J. F., Hillis, G. S., Thuaire, C., Dutoiu, T., Steg, P. G., Juliard, J., Slama, M. S., El Mahmoud, R., Nicollet, E., Goube, P., Barone-Rochette, G., Furber, A., Biere, L., Laucevicius, A., Celutkiene, J., Kedhi, E., Timmer, J., Hermanides, R., Kaplan, E., Riezebos, R. K., Samadi, P., van Dongen, E., Niehe, S. R., Suryapranata, H., van Vugt, S., Ramos, R., Cacela, D., Santana, A., Fiarresga, A., Sousa, L., Marques, H., Patricio, L., Bernanrdes, L., Rio, P., Carvalho, R., Ferreira, R., Silva, T., Rodrigues, I., Modas, P., Portugal, G., Fragata, J., Pinto, F. J., Menezes, M. N., Lopes, G. C., Almeida, A. G., Silva, P. C., Nobre, A., Francisco, A. R., Ferreira, N., Lopes, R. L., Guzman, L., Figal, J. C., Mendiz, O., Cortes, C., Favaloro, R. R., Alvarez, C., Courtis, J., Zeballos, G., Schiavi, L., Rubio, M., Devlin, G. P., Fisher, R., Stewart, R. A., White, H. D., Benatar, J., Kedev, S., Mitevska, I. P., Kostovska, E. S., Pejkov, H., Held, C., Eggers, K., Frostfelt, G., Johnston, N., Olsowka, M., Akerblom, A., Soveri, I., Aspberg, J., Sharir, T., Elian, D., Kerner, A., Massalha, S., Fukuda, K., Kohsaka, S., Yasuda, S., Nishimura, S., Goetschalckx, K., Van de Werf, F., Claes, K., Hung, C., Yun, C., Hou, C. J., Kuo, J., Yeh, H., Hung, T., Li, J., Chien, C., Tsai, C., Liu, C., Yu, F., Lin, Y., Lan, W., Yen, C., Tsai, J., Sung, K., Ntsekhe, M., Pandie, S., Viljoen, C. A., De Andrade, M., Moccetti, T., Rossi, M. G., Abdelhamid, M., Adel, A., Kamal, A., Mahrous, H., El Kaffas, S., El Fishawy, H., Pop, C., Claudia, M., Popescu, B. A., Ginghina, C., Deleanu, D., Iliescu, V. A., Al-Mallah, M. H., Aljzeeri, A., Najm, H., Alghamdi, A., Ramos, W. E., Kuanprasert, S., Prommintikul, A., Nawarawong, W., Woragidpoonpol, S., Tepsuwan, T., Taksaudom, N., Rimsukcharoenchai, C., Euathrongchit, J., Wannasopha, Y., Yamwong, S., Sritara, P., Aramcharoen, S., Meemuk, K., Khairuddin, A., Hadi, H. A., Yahaya, S. A. 2024: e029850

  Abstract

  BACKGROUND: Women with chronic coronary disease are generally older than men and have more comorbidities but less atherosclerosis. We explored sex differences in revascularization, guideline-directed medical therapy, and outcomes among patients with chronic coronary disease with ischemia on stress testing, with and without invasive management.METHODS AND RESULTS: The ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial randomized patients with moderate or severe ischemia to invasive management with angiography, revascularization, and guideline-directed medical therapy, or initial conservative management with guideline-directed medical therapy alone. We evaluated the primary outcome (cardiovascular death, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest) and other end points, by sex, in 1168 (22.6%) women and 4011 (77.4%) men. Invasive group catheterization rates were similar, with less revascularization among women (73.4% of invasive-assigned women revascularized versus 81.2% of invasive-assigned men; P<0.001). Women had less coronary artery disease: multivessel in 60.0% of invasive-assigned women and 74.8% of invasive-assigned men, and no ≥50% stenosis in 12.3% versus 4.5% (P<0.001). In the conservative group, 4-year catheterization rates were 26.3% of women versus 25.6% of men (P=0.72). Guideline-directed medical therapy use was lower among women with fewer risk factor goals attained. There were no sex differences in the primary outcome (adjusted hazard ratio [HR] for women versus men, 0.93 [95% CI, 0.77-1.13]; P=0.47) or the major secondary outcome of cardiovascular death/myocardial infarction (adjusted HR, 0.93 [95% CI, 0.76-1.14]; P=0.49), with no significant sex-by-treatment-group interactions.CONCLUSIONS: Women had less extensive coronary artery disease and, therefore, lower revascularization rates in the invasive group. Despite lower risk factor goal attainment, women with chronic coronary disease experienced similar risk-adjusted outcomes to men in the ISCHEMIA trial.REGISTRATION: URL: http://wwwclinicaltrials.gov. Unique identifier: NCT01471522.

  View details for DOI 10.1161/JAHA.122.029850

  View details for PubMedID 38410945

• Prevalence of frequent premature ventricular contractions and nonsustained ventricular tachycardia in older women screened for atrial fibrillation in the Women's Health Initiative. Heart rhythm Gomez, S. E., Larson, J., Hlatky, M. A., Rodriguez, F., Wheeler, M., Greenland, P., LaMonte, M., Froelicher, V., Stefanick, M. L., Wallace, R., Kooperberg, C., Tinker, L. F., Schoenberg, J., Soliman, E. Z., Vitolins, M. Z., Saquib, N., Nuño, T., Haring, B., Perez, M. V. 2024

  Abstract

  Frequent premature ventricular contractions (PVCs) and nonsustained ventricular tachycardia (NSVT) have been associated with cardiovascular disease and mortality. Their prevalence, especially in ambulatory populations, is under-studied and limited by few female participants and the use of short-duration (24-48 hour) monitoring.Report the prevalence of frequent PVCs and NSVT in a community-based population of women likely to undergo ECG screening using sequential patch monitoring.Participants from the Women's Health Initiative Strong and Healthy (WHISH) trial with no history of atrial fibrillation (AF) but 5-year predicted risk of incident AF ≥ 5% by CHARGE-AF score were randomly selected to undergo screening with 7-day ECG patch monitors at baseline, 6 months, and 12 months. Recordings were reviewed for PVCs and NSVT (> 5 beats); data was analyzed using multivariate regression models.There were 1,067 participants who underwent ECG screening at baseline, 866 at 6-months and 777 at 12-months. Frequent PVCs were found on at least one patch from 4.3% of participants and one or more episodes of NSVT was found in 12 (1.1%) women. PVC frequency directly correlated with CHARGE-AF score and NSVT on any patch. Detection of frequent PVCs increased with sequential monitoring.Among postmenopausal women at high risk for AF, frequent PVCs were relatively common (4.3%), and correlated with higher CHARGE-AF score. As strategies for AF screening continue to evolve, particularly in those individuals at high risk of AF, the prevalence of incidental ventricular arrhythmias is an important benchmark to guide clinical decision-making.

  View details for DOI 10.1016/j.hrthm.2024.02.040

  View details for PubMedID 38403238

• Coronary artery calcium and cardiovascular outcomes in patients with lymphoma undergoing autologous hematopoietic cell transplantation. Cancer Wu, S., Rhee, J. W., Iukuridze, A., Bosworth, A., Chen, S., Atencio, L., Manubolu, V., Bhandari, R., Jamal, F., Mei, M., Herrera, A., Rodriguez, F., Forman, S., Nakamura, R., Wong, F. L., Budoff, M., Armenian, S. H. 2024

  Abstract

  Patients undergoing autologous hematopoietic cell transplantation (HCT) have a >2-fold risk of developing cardiovascular disease (CVD; heart failure, myocardial infarction, and stroke), compared to the general population. Coronary artery calcium (CAC) is predictive of CVD in nononcology patients but is not as well studied in patients who underwent HCT and survivors of HCT.The objective of this study was to examine the association between CAC and CVD risk and outcomes after HCT in patients with lymphoma.This was a retrospective cohort study of 243 consecutive patients who underwent a first autologous HCT for lymphoma between 2009 and 2014. CAC (Agatston score) was determined from chest computed tomography obtained <60 days from HCT. Multivariable Cox regression analysis was used to calculate hazard ratio (HR) estimates and 95% confidence intervals (CIs), adjusted for covariates (age, conventional risk factors [e.g., hypertension and dyslipidemia], and cancer treatment).The median age at HCT was 55.7 years (range, 18.5-75.1 years), 59% were male, and 60% were non-Hispanic White. The prevalence of CAC was 37%. The 5-year CVD incidence for the cohort was 12%, and there was an incremental increase in the incidence according to CAC score: 0 (6%), 1-100 (20%), and >100 (32%) (p = .001). CAC was significantly associated with CVD risk (HR, 3.0; 95% CI, 1.2-7.5) and worse 5-year survival (77% vs. 50%; p < .001; HR, 2.0; 95% CI, 1.1-3.4), compared to those without CAC.CAC is independently associated with CVD and survival after HCT. This highlights the importance of integrating readily available imaging information in risk stratification and decision-making in patients undergoing HCT, which sets the stage for strategies to optimize outcomes after HCT.

  View details for DOI 10.1002/cncr.35252

  View details for PubMedID 38358333

• Racial and ethnic disparities in cardiovascular disease - analysis across major US national databases. Journal of the National Medical Association Minhas, A. M., Talha, K. M., Abramov, D., Johnson, H. M., Antoine, S., Rodriguez, F., Fudim, M., Michos, E. D., Misra, A., Abushamat, L., Nambi, V., Fonarow, G. C., Ballantyne, C. M., Virani, S. S. 2024

  Abstract

  There are several studies that have analyzed disparities in cardiovascular disease (CVD) health using a variety of different administrative databases; however, a unified analysis of major databases does not exist. In this analysis of multiple publicly available datasets, we sought to examine racial and ethnic disparities in different aspects of CVD, CVD-related risk factors, CVD-related morbidity and mortality, and CVD trainee representation in the US.We used National Health and Nutrition Examination Survey, National Ambulatory Medical Care Survey, National Inpatient Sample, Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research, United Network for Organ Sharing, and American Commission for Graduate Medical Education data to evaluate CVD-related disparities among Non-Hispanic (NH) White, NH Black and Hispanic populations.The prevalence of most CVDs and associated risk factors was higher in NH Black adults compared to NH White adults, except for dyslipidemia and ischemic heart disease (IHD). Statins were underutilized in IHD in NH Black and Hispanic patients. Hospitalizations for HF and stroke were higher among Black patients compared to White patients. All-cause, CVD, heart failure, acute myocardial infarction, IHD, diabetes mellitus, hypertension and cerebrovascular disease related mortality was highest in NH Black or African American individuals. The number of NH Black and Hispanic trainees in adult general CVD fellowship programs was disproportionately lower than NH White trainees.Racial disparities are pervasive across the spectrum of CVDs with NH Black adults at a significant disadvantage compared to NH White adults for most CVDs.

  View details for DOI 10.1016/j.jnma.2024.01.022

  View details for PubMedID 38342731

• Patient Representativeness With Virtual Enrollment in the PRO-HF Trial. Journal of the American Heart Association Gupta, A., Skye, M., Calma, J., Din, N., Azizi, Z., Hernandez, M. F., Zheng, J., Kalwani, N. M., Malunjkar, S., Schirmer, J., Wang, P., Rodriguez, F., Heidenreich, P., Sandhu, A. T. 2024; 13 (2): e030903

  View details for DOI 10.1161/JAHA.123.030903

  View details for PubMedID 38226522

• Design and Implementation of an Electronic Health Record-Integrated Hypertension Management Application. Journal of the American Heart Association Funes Hernandez, M., Babakhanian, M., Chen, T. P., Sarraju, A., Seninger, C., Ravi, V., Azizi, Z., Tooley, J., Chang, T. I., Lu, Y., Downing, N. L., Rodriguez, F., Li, R. C., Sandhu, A. T., Turakhia, M., Bhalla, V., Wang, P. J. 2024; 13 (2): e030884

  Abstract

  High blood pressure affects approximately 116 million adults in the United States. It is the leading risk factor for death and disability across the world. Unfortunately, over the past decade, hypertension control rates have decreased across the United States. Prediction models and clinical studies have shown that reducing clinician inertia alone is sufficient to reach the target of ≥80% blood pressure control. Digital health tools containing evidence-based algorithms that are able to reduce clinician inertia are a good fit for turning the tide in blood pressure control, but careful consideration should be taken in the design process to integrate digital health interventions into the clinical workflow.We describe the development of a provider-facing hypertension management platform. We enumerate key steps of the development process, including needs finding, clinical workflow analysis, treatment algorithm creation, platform design and electronic health record integration. We interviewed and surveyed 5 Stanford clinicians from primary care, cardiology, and their clinical care team members (including nurses, advanced practice providers, medical assistants) to identify needs and break down the steps of clinician workflow analysis. The application design and development stage were aided by a team of approximately 15 specialists in the fields of primary care, hypertension, bioinformatics, and software development.Digital monitoring holds immense potential for revolutionizing chronic disease management. Our team developed a hypertension management platform at an academic medical center to address some of the top barriers to adoption and achieving clinical outcomes. The frameworks and processes described in this article may be used for the development of a diverse range of digital health tools in the cardiovascular space.

  View details for DOI 10.1161/JAHA.123.030884

  View details for PubMedID 38226516

• Digital Health Interventions for Heart Failure Management in Underserved Rural Areas of the United States: A Systematic Review of Randomized Trials. Journal of the American Heart Association Azizi, Z., Broadwin, C., Islam, S., Schenk, J., Din, N., Hernandez, M. F., Wang, P., Longenecker, C. T., Rodriguez, F., Sandhu, A. T. 2024; 13 (2): e030956

  Abstract

  Heart failure disproportionately affects individuals residing in rural areas, leading to worse health outcomes. Digital health interventions have been proposed as a promising approach for improving heart failure management. This systematic review aims to identify randomized trials of digital health interventions for individuals living in underserved rural areas with heart failure.We conducted a systematic review by searching 6 databases (CINAHL, EMBASE, MEDLINE, Web of Science, Scopus, and PubMed; 2000-2023). A total of 30 426 articles were identified and screened. Inclusion criteria consisted of digital health randomized trials that were conducted in underserved rural areas of the United States based on the US Census Bureau's classification. Two independent reviewers screened the studies using the National Heart, Lung, and Blood Institute tool to evaluate the risk of bias. The review included 5 trials from 6 US states, involving 870 participants (42.9% female). Each of the 5 studies employed telemedicine, 2 studies used remote monitoring, and 1 study used mobile health technology. The studies reported improvement in self-care behaviors in 4 trials, increased knowledge in 2, and decreased cardiovascular mortality in 1 study. However, 3 trials revealed no change or an increase in health care resource use, 2 showed no change in cardiac biomarkers, and 2 demonstrated an increase in anxiety.The results suggest that digital health interventions have the potential to enhance self-care and knowledge of patients with heart failure living in underserved rural areas. However, further research is necessary to evaluate their impact on clinical outcomes, biomarkers, and health care resource use.URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42022366923.

  View details for DOI 10.1161/JAHA.123.030956

  View details for PubMedID 38226517

• Clinician use of the Statin Choice Shared Decision-making Encounter Tool in a Major Health System. Journal of general internal medicine Martinez, K. A., Montori, V. M., Rodriguez, F., Tereshchenko, L. G., Kovach, J. D., Hurwitz, H. M., Rothberg, M. B. 2024

  Abstract

  Effective shared decision-making (SDM) tools for use during clinical encounters are available, but, outside of study settings, little is known about clinician use of these tools in practice.To describe real-world use of an SDM encounter tool for statin prescribing, Statin Choice, embedded into the workflow of an electronic health record.Cross-sectional study.Clinicians and their statin-eligible patients who had outpatient encounters between January 2020 and June 2021 in Cleveland Clinic Health System.Clinician use of Statin Choice was recorded within the Epic record system. We categorized each patient's 10-year atherosclerotic cardiovascular disease risk into low (< 5%), borderline (5-7.5%), intermediate (7.5-20%), and high (≥ 20%). Other patient factors included age, sex, insurance, and race. We used mixed effects logistic regression to assess the odds of using Statin Choice for statin-eligible patients, accounting for clustering by clinician and site. We generated a residual intraclass correlation coefficient (ICC) to characterize the impact of the clinician on Statin Choice use.Statin Choice was used in 7% of 68,505 eligible patients. Of 1047 clinicians, 48% used Statin Choice with ≥ 1 patient, and these clinicians used it with a median 9% of their patients (interquartile range: 3-22%). In the mixed effects logistic regression model, patient age (adjusted OR per year: 1.04; 95%CI 1.03-1.04) and 10-year ASVCD risk (aOR for 5-7.5% versus < 5% risk: 1.28; 95%CI: 1.14-1.44) were associated with use of Statin Choice. Black versus White race was associated with a lower odds of Statin Choice use (aOR: 0.83; 95%CI: 0.73-0.95), as was female versus male sex (aOR: 0.83; 95%CI: 0.76-0.90). The model ICC demonstrated that 53% of the variation in use of Statin Choice was clinician-driven.Patient factors, including race and sex, were associated with clinician use of Statin Choice; half the variation in use was attributable to individual clinicians.

  View details for DOI 10.1007/s11606-023-08597-3

  View details for PubMedID 38191974

• Evidence Of Genetic Testing In A Large, Real -world DCM Cohort And Association With Heart Failure Risk Bhasin, K., Longoni, M., Ward, A., Nisson, M., White, B., Lee, D., Bhatt, S., Rodriguez, F., Dash, R. CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS. 2024: 128

  View details for Web of Science ID 001162343100023

• Underrepresentation of Women in Reduced Ejection Heart Failure Clinical Trials With Improved Mortality or Hospitalization. JACC. Advances Ekpo, E., Balla, S., Ngo, S., Witting, C., Sarraju, A., Furst, A., Rodriguez, F. 2024; 3 (1)

  Abstract

  BACKGROUND: There are established sex-specific differences in heart failure with reduced ejection fraction (HFrEF) outcomes. Randomized clinical trials (RCTs) based on cardiovascular outcome benefits, typically either reduced cardiovascular mortality or hospitalization for heart failure (HHF), influence current guidelines for therapy.OBJECTIVES: The authors evaluate the representation of women in HFrEF RCTs that observed reduced all-cause or cardiovascular mortality or HHF.METHODS: We queried Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica dataBASE, Medical Literature Analysis and Retrieval System Online, and PubMed for HFrEF RCTs that reported a statistically significant benefit of intervention resulting in improved mortality or HHF published from 1980 to 2021. We estimated representation using the participation-to-prevalence ratio (PPR). A PPR of 0.8 to 1.2 was considered representative.RESULTS: The final analysis included 33 RCTs. Women represented only 23.2% of all enrolled participants (n = 24,366/104,972), ranging from 11.4% to 40.1% per trial. Overall PPR was 0.58, with per-trial PPR estimates ranging from 0.29 to 1.00. Only 5 trials (15.2%) had a PPR of women representative of the disease population. Representation did not change significantly over time. The proportion of women in North American trials was significantly greater than trials conducted in Europe (P = 0.03). The proportion of women was greater in industry trials compared to government-funded trials (P = 0.05).CONCLUSIONS: Women are underrepresented in HFrEF RCTs that have demonstrated mortality or HHF benefits and influence current guidelines. Representation is key to further delineation of sex-specific differences in major trial results. Sustained efforts are warranted to ensure equitable and appropriate inclusion of women in HFrEF trials.

  View details for DOI 10.1016/j.jacadv.2023.100743

  View details for PubMedID 38405270

• Drivers of telemedicine in primary care clinics at a large academic medical centre. Journal of telemedicine and telecare Parameswaran, V., Koos, H., Kalwani, N., Qureshi, L., Rosengaus, L., Dash, R., Scheinker, D., Rodriguez, F., Johnson, C. B., Stange, K., Aron, D., Lyytinen, K., Sharp, C. 2023: 1357633X231219311

  Abstract

  COVID-19 disrupted healthcare routines and prompted rapid telemedicine implementation. We investigated the drivers of visit modality selection (telemedicine versus in-person) in primary care clinics at an academic medical centre.We used electronic medical record data from March 2020 to May 2022 from 13 primary care clinics (N = 21,031 new, N = 207,292 return visits), with 55% overall telemedicine use. Hierarchical logistic regression and cross-validation methods were used to estimate the variation in visit modality explained by the patient, clinician and visit factors as measured by the mean-test area under the curve (AUC).There was significant variation in telemedicine use across clinicians (ranging from 0-100%) for the same visit diagnosis. The strongest predictors of telemedicine were the clinician seen for new visits (mean AUC of 0.79) and the primary visit diagnosis for return visits (0.77). Models based on all patient characteristics combined accounted for relatively little variation in modality selection, 0.54 for new and 0.58 for return visits, respectively. Amongst patient characteristics, males, patients over 65 years, Asians and patient's with non-English language preferences used less telemedicine; however, those using interpreter services used significantly more telemedicine.Clinician seen and primary visit diagnoses were the best predictors of visit modality. The distinction between new and return visits and the minimal impact of patient characteristics on visit modality highlights the complexity of clinical care and warrants research approaches that go beyond linear models to uncover the emergent causal effects of specific technology features mediated by tasks, people and organisations.

  View details for DOI 10.1177/1357633X231219311

  View details for PubMedID 38130140

• Opportunities to Increase Science of Diversity and Inclusion in Clinical Trials: Equity and a Lack of a Control. Journal of the American Heart Association Igwe, J., Wangdak Yuthok, T. Y., Cruz, E., Mueller, A., Lan, R. H., Brown-Johnson, C., Idris, M., Rodriguez, F., Clark, K., Palaniappan, L., Echols, M., Wang, P., Onwuanyi, A., Pemu, P., Lewis, E. F. 2023: e030042

  Abstract

  The United States witnessed a nearly 4-fold increase in personal health care expenditures between 1980 and 2010. Despite innovations and obvious benefits to health, participants enrolled in clinical trials still do not accurately represent the racial and ethnic composition of patients nationally or globally. This lack of diversity in cohorts limits the generalizability and significance of results among all populations and has deep repercussions for patient equity. To advance diversity in clinical trials, robust evidence for the most effective strategies for recruitment of diverse participants is needed. A major limitation of previous literature on clinical trial diversity is the lack of control or comparator groups for different strategies. To date, interventions have focused primarily on (1) community-based interventions, (2) institutional practices, and (3) digital health systems. This review article outlines prior intervention strategies across these 3 categories and considers health policy and ethical incentives for substantiation before US Food and Drug Administration approval. There are no current studies that comprehensively compare these interventions against one another. The American Heart Association Strategically Focused Research Network on the Science of Diversity in Clinical Trials represents a multicenter, collaborative network between Stanford School of Medicine and Morehouse School of Medicine created to understand the barriers to diversity in clinical trials by contemporaneous head-to-head interventional strategies accessing digital, institutional, and community-based recruitment strategies to produce informed recruitment strategies targeted to improve underrepresented patient representation in clinical trials.

  View details for DOI 10.1161/JAHA.123.030042

  View details for PubMedID 38108253

• National Trends in Racial and Ethnic Disparities in Use of Recommended Therapies in Adults with Atherosclerotic Cardiovascular Disease, 1999-2020. JAMA network open Lu, Y., Liu, Y., Dhingra, L. S., Caraballo, C., Mahajan, S., Massey, D., Spatz, E. S., Sharma, R., Rodriguez, F., Watson, K. E., Masoudi, F. A., Krumholz, H. M. 2023; 6 (12): e2345964

  Abstract

  Despite efforts to improve the quality of care for patients with atherosclerotic cardiovascular disease (ASCVD), it is unclear whether the US has made progress in reducing racial and ethnic differences in utilization of guideline-recommended therapies for secondary prevention.To evaluate 21-year trends in racial and ethnic differences in utilization of guideline-recommended pharmacological medications and lifestyle modifications among US adults with ASCVD.This cross-sectional study includes data from the National Health and Nutrition Examination Survey between 1999 and 2020. Eligible participants were adults aged 18 years or older with a history of ASCVD. Data were analyzed between March 2022 and May 2023.Self-reported race and ethnicity.Rates and racial and ethnic differences in the use of guideline-recommended pharmacological medications and lifestyle modifications.The study included 5218 adults with a history of ASCVD (mean [SD] age, 65.5 [13.2] years, 2148 women [weighted average, 44.2%]), among whom 1170 (11.6%) were Black, 930 (7.7%) were Hispanic or Latino, and 3118 (80.7%) were White in the weighted sample. Between 1999 and 2020, there was a significant increase in total cholesterol control and statin use in all racial and ethnic subgroups, and in angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) utilization in non-Hispanic White individuals and Hispanic and Latino individuals (Hispanic and Latino individuals: 17.12 percentage points; 95% CI, 0.37-37.88 percentage points; P = .046; non-Hispanic White individuals: 12.14 percentage points; 95% CI, 6.08-18.20 percentage points; P < .001), as well as smoking cessation within the Hispanic and Latino population (-27.13 percentage points; 95% CI, -43.14 to -11.12 percentage points; P = .002). During the same period, the difference in smoking cessation between Hispanic and Latino individuals and White individuals was reduced (-24.85 percentage points; 95% CI, -38.19 to -11.51 percentage points; P < .001), but racial and ethnic differences for other metrics did not change significantly. Notably, substantial gaps persisted between current care and optimal care throughout the 2 decades of data analyzed. In the period of 2017 to 2020, optimal regimens were observed in 47.4% (95% CI, 39.3%-55.4%), 48.7% (95% CI, 36.7%-60.6%), and 53.0% (95% CI, 45.6%-60.4%) of Black, Hispanic and Latino, and White individuals, respectively.In this cross-sectional study of US adults with ASCVD, significant disparities persisted between current care and optimal care, surpassing any differences observed among demographic groups. These findings highlight the critical need for sustained efforts to bridge these gaps and achieve better outcomes for all patients, regardless of their racial and ethnic backgrounds.

  View details for DOI 10.1001/jamanetworkopen.2023.45964

  View details for PubMedID 38039001

• Readability and reliability of online patient education materials about statins. American journal of preventive cardiology Ngo, S., Asirvatham, R., Baird, G. L., Sarraju, A., Maron, D. J., Rodriguez, F. 2023; 16: 100594

  Abstract

  Statins are the cornerstone for the prevention and treatment of cardiovascular disease. Patients often consult online patient education materials (OPEMs) to inform medical decision-making. We therefore aimed to assess the readability and reliability of OPEMs related to statins.A total of 17 statin-related terms were queried using an online search engine to identify the top 20 search results for each statin-related term. Each OPEM was then grouped into the following categories based on 2 independent reviewers: government OPEMs (national, state, or local government agencies); healthcare/nonprofit OPEMs (major health systems and nonprofit organizations with a specific cardiovascular health focus); industry/commercial OPEMs (pharmaceutical manufacturers and online pharmacies); lay press OPEMs (healthcare-oriented news organizations); and dictionary/encyclopedia OPEMs. Grade-level readability for each OPEM was calculated using 5 standard readability metrics and compared with AMA-recommended readability recommendations. Reliability of each OPEM was evaluated using the JAMA benchmark criteria for online health information and certification from Health on the Net (HONCode).A total of 340 websites were identified across the 17 statin search terms. There were 211 statin OPEMs after excluding non-OPEM results; 172 OPEMs had unique content. Statin OPEM readability exceeded the recommended 6th grade AMA reading level (average reading grade level of 10.9). The average JAMA benchmark criteria score was 2.13 (on a scale of 0-4, with higher scores indicating higher reliability), and only 60% of statin OPEMs were HONCode-certified. There was an inverse association between readability and reliability. The most readable results were from industry and commercial sources, while the most reliable sites were from lay press sources.Statin OPEMs are written at an overall averaging reading grade level of 10.9. There was an inverse association between readability and reliability. Lack of accessible, high-quality online health information may contribute to statin nonadherence.

  View details for DOI 10.1016/j.ajpc.2023.100594

  View details for PubMedID 37822580

  View details for PubMedCentralID PMC10562660

• Opportunistic assessment of ischemic heart disease risk using abdominopelvic computed tomography and medical record data: a multimodal explainable artificial intelligence approach. Scientific reports Zambrano Chaves, J. M., Wentland, A. L., Desai, A. D., Banerjee, I., Kaur, G., Correa, R., Boutin, R. D., Maron, D. J., Rodriguez, F., Sandhu, A. T., Rubin, D., Chaudhari, A. S., Patel, B. N. 2023; 13 (1): 21034

  Abstract

  Current risk scores using clinical risk factors for predicting ischemic heart disease (IHD) events-the leading cause of global mortality-have known limitations and may be improved by imaging biomarkers. While body composition (BC) imaging biomarkers derived from abdominopelvic computed tomography (CT) correlate with IHD risk, they are impractical to measure manually. Here, in a retrospective cohort of 8139 contrast-enhanced abdominopelvic CT examinations undergoing up to 5 years of follow-up, we developed multimodal opportunistic risk assessment models for IHD by automatically extracting BC features from abdominal CT images and integrating these with features from each patient's electronic medical record (EMR). Our predictive methods match and, in some cases, outperform clinical risk scores currently used in IHD risk assessment. We provide clinical interpretability of our model using a new method of determining tissue-level contributions from CT along with weightings of EMR features contributing to IHD risk. We conclude that such a multimodal approach, which automatically integrates BC biomarkers and EMR data, can enhance IHD risk assessment and aid primary prevention efforts for IHD. To further promote research, we release the Opportunistic L3 Ischemic heart disease (OL3I) dataset, the first public multimodal dataset for opportunistic CT prediction of IHD.

  View details for DOI 10.1038/s41598-023-47895-y

  View details for PubMedID 38030716

  View details for PubMedCentralID 7734661

• Trends and Site-level Variation of Novel Cardiovascular Medication Utilization among Patients Admitted for Heart Failure or Coronary Artery Disease in the US Veterans Affairs System: 2017-2021. American heart journal Salahuddin, T., Hebbe, A., Daus, M., Essien, U. R., Waldo, S. W., Rodriguez, F., Ho, P. M., Simons, C., Gilmartin, H. M., Doll, J. A. 2023

  Abstract

  We assessed trends in novel cardiovascular medication utilization in US Veterans Affairs (VA) for angiotensin receptor-neprilysin inhibitors (ARNI), sodium-glucose cotransporter-2 Inhibitors (SGLT2i), and glucagon-like peptide-1 receptor agonists (GLP-1 RA).We retrospectively identified cohorts from 114 VA hospitals with admission for prevalent 1) systolic heart failure (HF, N=82,375) or 2) coronary artery disease and diabetes (CAD+T2D, N=74,209). Site-level data for prevalent filled prescriptions were assessed at hospital admission, discharge, or within 6 months of discharge. Variability among sites was estimated with median odds ratios (mOR), and within-site Pearson correlations of utilization of each medication class were calculated. Site- and patient-level characteristics were compared by high-, mixed-, and low-utilizing sites.ARNI and SGTL2i use for HF increased from <5% to 20% and 21% respectively, while SGTL2i or GLP-1 RA use for CAD+T2D increased from <5% to 30% from 2017-2021. Adjusted mOR and 95% confidence intervals for ARNI, SGTL2i for HF, and SGTL2i or GLP-1 RA for CAD+T2D were 1.73 (1.64-1.91), 1.72 (1.59-1.81), and 1.53 (1.45-1.62), respectively. Utilization of each medication class correlated poorly with use of other novel classes (Pearson <0.38 for all). Higher patient volume, number of beds, and hospital complexity correlated with high-utilizing sites.Utilization of novel medications has increased over time but remains suboptimal for US Veterans with HF and CAD+T2D, with substantial site-level heterogeneity despite a universal medication formulary and low out-of-pocket costs for patients. Future work should include further characterization of hospital- and clinician-level practice patterns to serve as targets to increase implementation.

  View details for DOI 10.1016/j.ahj.2023.11.009

  View details for PubMedID 37956920

• Eligibility for Cardiovascular Risk Reduction Therapy in the U.S. Based on SELECT Trial Criteria: Insights from the National Health and Nutrition Examination Survey. Circulation. Cardiovascular quality and outcomes Lu, Y., Liu, Y., Jastreboff, A. M., Khera, R., Ndumele, C. D., Rodriguez, F., Watson, K. E., Krumholz, H. M. 2023

  View details for DOI 10.1161/CIRCOUTCOMES.123.010640

  View details for PubMedID 37950677

• Who Are We Missing? Reporting of Transgender and Gender-Expansive Populations in Clinical Trials. Journal of the American Heart Association Rice, E. N., Lan, R. H., Nunes, J. C., Shah, R., Clark, K., Periyakoil, V. S., Chen, J. H., Lin, B., Echols, M., Awad, C., Idris, M. Y., Cruz, E. R., Poullos, P. D., Lewis, E. F., Brown-Johnson, C., Igwe, J., Shen, S., Palaniappan, L., Stefanick, M. L., Ritter, V., Pemu, P., Rodriguez, F., Deb, B., Pundi, K., Wang, P. J. 2023: e030209

  View details for DOI 10.1161/JAHA.123.030209

  View details for PubMedID 37947088

• Leveraging Digital Health to Improve the Cardiovascular Health of Women. Current cardiovascular risk reports Azizi, Z., Adedinsewo, D., Rodriguez, F., Lewey, J., Merchant, R. M., Brewer, L. C. 2023; 17 (11): 205-214

  Abstract

  In this review, we present a comprehensive discussion on the population-level implications of digital health interventions (DHIs) to improve cardiovascular health (CVH) through sex- and gender-specific prevention strategies among women.Over the past 30 years, there have been significant advancements in the diagnosis and treatment of cardiovascular diseases, a leading cause of morbidity and mortality among men and women worldwide. However, women are often underdiagnosed, undertreated, and underrepresented in cardiovascular clinical trials, which all contribute to disparities within this population. One approach to address this is through DHIs, particularly among racial and ethnic minoritized groups. Implementation of telemedicine has shown promise in increasing adherence to healthcare visits, improving BP monitoring, weight control, physical activity, and the adoption of healthy behaviors. Furthermore, the use of mobile health applications facilitated by smart devices, wearables, and other eHealth (defined as electronically delivered health services) modalities has also promoted CVH among women in general, as well as during pregnancy and the postpartum period. Overall, utilizing a digital health approach for healthcare delivery, decentralized clinical trials, and incorporation into daily lifestyle activities has the potential to improve CVH among women by mitigating geographical, structural, and financial barriers to care.Leveraging digital technologies and strategies introduces novel methods to address sex- and gender-specific health and healthcare disparities and improve the quality of care provided to women. However, it is imperative to be mindful of the digital divide in specific populations, which may hinder accessibility to these novel technologies and inadvertently widen preexisting inequities.

  View details for DOI 10.1007/s12170-023-00728-z

  View details for PubMedID 37868625

  View details for PubMedCentralID PMC10587029

• Leveraging Digital Health to Improve the Cardiovascular Health of Women CURRENT CARDIOVASCULAR RISK REPORTS Azizi, Z., Adedinsewo, D., Rodriguez, F., Lewey, J., Merchant, R. M., Brewer, L. C. 2023

  View details for DOI 10.1007/s12170-023-00728

  View details for Web of Science ID 001073191000001

• Association of Coronary Artery Calcium Detected by Routine Ungated CT Imaging With Cardiovascular Outcomes. Journal of the American College of Cardiology Peng, A. W., Dudum, R., Jain, S. S., Maron, D. J., Patel, B. N., Khandwala, N., Eng, D., Chaudhari, A. S., Sandhu, A. T., Rodriguez, F. 2023; 82 (12): 1192-1202

  Abstract

  Coronary artery calcium (CAC) is a strong predictor of cardiovascular events across all racial and ethnic groups. CAC can be quantified on nonelectrocardiography (ECG)-gated computed tomography (CT) performed for other reasons, allowing for opportunistic screening for subclinical atherosclerosis.The authors investigated whether incidental CAC quantified on routine non-ECG-gated CTs using a deep-learning (DL) algorithm provided cardiovascular risk stratification beyond traditional risk prediction methods.Incidental CAC was quantified using a DL algorithm (DL-CAC) on non-ECG-gated chest CTs performed for routine care in all settings at a large academic medical center from 2014 to 2019. We measured the association between DL-CAC (0, 1-99, or ≥100) with all-cause death (primary outcome), and the secondary composite outcomes of death/myocardial infarction (MI)/stroke and death/MI/stroke/revascularization using Cox regression. We adjusted for age, sex, race, ethnicity, comorbidities, systolic blood pressure, lipid levels, smoking status, and antihypertensive use. Ten-year atherosclerotic cardiovascular disease risk was calculated using the pooled cohort equations.Of 5,678 adults without ASCVD (51% women, 18% Asian, 13% Hispanic/Latinx), 52% had DL-CAC >0. Those with DL-CAC ≥100 had an average 10-year ASCVD risk of 24%; yet, only 26% were on statins. After adjustment, patients with DL-CAC ≥100 had increased risk of death (HR: 1.51; 95% CI: 1.28-1.79), death/MI/stroke (HR: 1.57; 95% CI: 1.33-1.84), and death/MI/stroke/revascularization (HR: 1.69; 95% CI: 1.45-1.98) compared with DL-CAC = 0.Incidental CAC ≥100 was associated with an increased risk of all-cause death and adverse cardiovascular outcomes, beyond traditional risk factors. DL-CAC from routine non-ECG-gated CTs identifies patients at increased cardiovascular risk and holds promise as a tool for opportunistic screening to facilitate earlier intervention.

  View details for DOI 10.1016/j.jacc.2023.06.040

  View details for PubMedID 37704309

• Artificial intelligence in clinical workflow processes in vascular surgery and beyond. Seminars in vascular surgery Dossabhoy, S. S., Ho, V. T., Ross, E. G., Rodriguez, F., Arya, S. 2023; 36 (3): 401-412

  Abstract

  In the past decade, artificial intelligence (AI)-based applications have exploded in health care. In cardiovascular disease, and vascular surgery specifically, AI tools such as machine learning, natural language processing, and deep neural networks have been applied to automatically detect underdiagnosed diseases, such as peripheral artery disease, abdominal aortic aneurysms, and atherosclerotic cardiovascular disease. In addition to disease detection and risk stratification, AI has been used to identify guideline-concordant statin therapy use and reasons for nonuse, which has important implications for population-based cardiovascular disease health. Although many studies highlight the potential applications of AI, few address true clinical workflow implementation of available AI-based tools. Specific examples, such as determination of optimal statin treatment based on individual patient risk factors and enhancement of intraoperative fluoroscopy and ultrasound imaging, demonstrate the potential promise of AI integration into clinical workflow. Many challenges to AI implementation in health care remain, including data interoperability, model bias and generalizability, prospective evaluation, privacy and security, and regulation. Multidisciplinary and multi-institutional collaboration, as well as adopting a framework for integration, will be critical for the successful implementation of AI tools into clinical practice.

  View details for DOI 10.1053/j.semvascsurg.2023.07.002

  View details for PubMedID 37863612

• 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Arnold, S. V., Bittner, V., Brewer, L. C., Demeter, S., Dixon, D. L., Fearon, W. F., Hess, B., Johnson, H. M., Kazi, D. S., Kolte, D., Kumbhani, D. J., Lofaso, J., Mahtta, D., Mark, D. B., Minissian, M., Navar, A., Patel, A. R., Piano, M. R., Rodriguez, F., Talbot, A. W., Taqueti, V. R., Thomas, R. J., van Diepen, S., Wiggins, B., Williams, M. S. 2023; 82 (9): 833-955

  View details for DOI 10.1016/j.jacc.2023.04.003

  View details for Web of Science ID 001068846800001

• Response by Sandhu et al to Letter Regarding Article, "Incidental Coronary Artery Calcium: Opportunistic Screening of Previous Nongated Chest Computed Tomography Scans to Improve Statin Rates (NOTIFY-1 Project)". Circulation Sandhu, A. T., Rodriguez, F., Maron, D. J. 2023; 148 (5): 441

  View details for DOI 10.1161/CIRCULATIONAHA.123.065360

  View details for PubMedID 37523759

• Cardiovascular Disease Prevention Recommendations From an Online Chat-Based AI Reply JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Sarraju, A., Rodriguez, F., Laffin, L. 2023; 330 (1): 83

  View details for Web of Science ID 001058995600028

  View details for PubMedID 37395774

• Cardiovascular Disease Prevention Recommendations From an Online Chat-Based AI Model-Reply. JAMA Sarraju, A., Rodriguez, F., Laffin, L. 2023; 330 (1): 83

  View details for DOI 10.1001/jama.2023.8181

  View details for PubMedID 37395774

• Sociodemographic disparities in the use of cardiovascular ambulatory care and telemedicine during the COVID-19 pandemic. American heart journal Osmanlliu, E., Kalwani, N. M., Parameswaran, V., Qureshi, L., Dash, R., Scheinker, D., Rodriguez, F. 2023

  Abstract

  The COVID-19 pandemic accelerated adoption of telemedicine in cardiology clinics. Early in the pandemic, there were sociodemographic disparities in telemedicine use. It is unknown if these disparities persisted and whether they were associated with changes in the population of patients accessing care.We examined all adult cardiology visits at an academic and an affiliated community practice in Northern California from March 2019 to February 2020 (pre-COVID) and March 2020 to February 2021 (COVID). We compared patient sociodemographic characteristics between these periods. We used logistic regression to assess the association of patient/visit characteristics with visit modality (in-person vs telemedicine and video- vs phone-based telemedicine) during the COVID period.There were 54,948 pre-COVID and 58,940 COVID visits. Telemedicine use increased from <1% to 70.7% of visits (49.7% video, 21.0% phone) during the COVID period. Patient sociodemographic characteristics were similar during both periods. In adjusted analyses, visits for patients from some sociodemographic groups were less likely to be delivered by telemedicine, and when delivered by telemedicine, were less likely to be delivered by video versus phone. The observed disparities in the use of video-based telemedicine were greatest for patients aged ≥80 years (vs age <60, OR 0.24, 95% CI 0.21, 0.28), Black patients (vs non-Hispanic White, OR 0.64, 95% CI 0.56, 0.74), patients with limited English proficiency (vs English proficient, OR 0.52, 95% CI 0.46-0.59), and those on Medicaid (vs privately insured, OR 0.47, 95% CI 0.41-0.54).During the first year of the pandemic, the sociodemographic characteristics of patients receiving cardiovascular care remained stable, but the modality of care diverged across groups. There were differences in the use of telemedicine vs in-person care and most notably in the use of video- vs phone-based telemedicine. Future studies should examine barriers and outcomes in digital healthcare access across diverse patient groups.

  View details for DOI 10.1016/j.ahj.2023.06.011

  View details for PubMedID 37369269

  View details for PubMedCentralID PMC10290766

• Evaluating Recommendations About Atrial Fibrillation for Patients and Clinicians Obtained From Chat-Based Artificial Intelligence Algorithms. Circulation. Arrhythmia and electrophysiology Azizi, Z., Alipour, P., Gomez, S., Broadwin, C., Islam, S., Sarraju, A., Rogers, A. J., Sandhu, A. T., Rodriguez, F. 2023: e012015

  View details for DOI 10.1161/CIRCEP.123.012015

  View details for PubMedID 37334705

• Testing the Appropriateness of Diabetes Prevention and Care Information Given by the Online Conversational AI ChatGPT. Clinical diabetes : a publication of the American Diabetes Association Hong, J., Kikuta, N. T., Simos, A., Tsai, S., Lin, B., Rodriguez, F., Palaniappan, L. 2023; 41 (4): 549-552

  View details for DOI 10.2337/cd23-0026

  View details for PubMedID 37849522

  View details for PubMedCentralID PMC10577494

• Natural language processing to identify reasons for sex disparity in statin prescriptions. American journal of preventive cardiology Witting, C., Azizi, Z., Gomez, S. E., Zammit, A., Sarraju, A., Ngo, S., Hernandez-Boussard, T., Rodriguez, F. 2023; 14: 100496

  Abstract

  Background: Statins are the cornerstone of treatment of patients with atherosclerotic cardiovascular disease (ASCVD). Despite this, multiple studies have shown that women with ASCVD are less likely to be prescribed statins than men. The objective of this study was to use Natural Language Processing (NLP) to elucidate factors contributing to this disparity.Methods: Our cohort included adult patients with two or more encounters between 2014 and 2021 with an ASCVD diagnosis within a multisite electronic health record (EHR) in Northern California. After reviewing structured EHR prescription data, we used a benchmark deep learning NLP approach, Clinical Bidirectional Encoder Representations from Transformers (BERT), to identify and interpret discussions of statin prescriptions documented in clinical notes. Clinical BERT was evaluated against expert clinician review in 20% test sets.Results: There were 88,913 patients with ASCVD (mean age 67.8±13.1 years) and 35,901 (40.4%) were women. Women with ASCVD were less likely to be prescribed statins compared with men (56.6%vs 67.6%, p <0.001), and, when prescribed, less likely to be prescribed guideline-directed high-intensity dosing (41.4%vs 49.8%, p <0.001). These disparities were more pronounced among younger patients, patients with private insurance, and those for whom English is their preferred language. Among those not prescribed statins, women were less likely than men to have statins mentioned in their clinical notes (16.9%vs 19.1%, p <0.001). Women were less likely than men to have statin use reported in clinical notes despite absence of recorded prescription (32.8%vs 42.6%, p <0.001). Women were slightly more likely than men to have statin intolerance documented in structured data or clinical notes (6.0%vs 5.3%, p=0.003).Conclusions: Women with ASCVD were less likely to be prescribed guideline-directed statins compared with men. NLP identified additional sex-based statin disparities and reasons for statin non-prescription in clinical notes of patients with ASCVD.

  View details for DOI 10.1016/j.ajpc.2023.100496

  View details for PubMedID 37128554

• Cardiovascular Health in Hispanic/Latino Patients: From Research to Practice. Journal of the American College of Cardiology Rodriguez, F., Blumer, V. 2023; 81 (15): 1521-1523

  View details for DOI 10.1016/j.jacc.2023.02.025

  View details for PubMedID 37045522

• How Low Can You Go? New Evidence Supports No Lower Bound to Low-Density Lipoprotein Cholesterol Level in Secondary Prevention. Circulation Rodriguez, F., Khera, A. 2023; 147 (16): 1204-1207

  View details for DOI 10.1161/CIRCULATIONAHA.123.064041

  View details for PubMedID 37068134

• Clinical Trial Technologies for Improving Equity and Inclusion in Cardiovascular Clinical Research. Cardiology and therapy Broadwin, C., Azizi, Z., Rodriguez, F. 2023

  Abstract

  Approximately one-third of clinical trials fail to meet their recruitment goals, which can cause costly delays to sponsors and compromise the scientific integrity and generalizability of a trial. Inadequate recruitment and retention of patient groups who have the disease under investigation may produce insufficient medical knowledge about the therapeutic effects of drugs or products for the population at large. It is essential to address these issues to ensure that certain groups are not unduly subjected to disproportionate risks or denied the benefits of research. This commentary will present opportunities for clinical trialists to use emerging technologies and decentralized approaches to improve clinical trial recruitment, mitigate disparities, and improve individual and population-level outcomes within cardiovascular medicine.

  View details for DOI 10.1007/s40119-023-00311-y

  View details for PubMedID 37043079

  View details for PubMedCentralID 9072305

• Clinical Trial Technologies for Improving Equity and Inclusion in Cardiovascular Clinical Research Cardiology and Therapy Broadwin, C., Azizi, Z., Rodriguez, F. 2023

  Abstract

  Approximately one-third of clinical trials fail to meet their recruitment goals, which can cause costly delays to sponsors and compromise the scientific integrity and generalizability of a trial. Inadequate recruitment and retention of patient groups who have the disease under investigation may produce insufficient medical knowledge about the therapeutic effects of drugs or products for the population at large. It is essential to address these issues to ensure that certain groups are not unduly subjected to disproportionate risks or denied the benefits of research. This commentary will present opportunities for clinical trialists to use emerging technologies and decentralized approaches to improve clinical trial recruitment, mitigate disparities, and improve individual and population-level outcomes within cardiovascular medicine.

  View details for DOI 10.1007/s40119-023-00311-y

  View details for PubMedCentralID 9072305

• Longitudinal Trends in Cardiovascular Risk Factor Profiles and Complications Among Patients Hospitalized for COVID-19 Infection: Results From the American Heart Association COVID-19 Cardiovascular Disease Registry. Circulation. Cardiovascular quality and outcomes Hall, E. J., Ayers, C. R., Kolkailah, A. A., Rutan, C., Walchok, J., Williams, J. H., Wang, T. Y., Rodriguez, F., Bradley, S. M., Stevens, L., Hall, J. L., Mallya, P., Roth, G. A., Morrow, D. A., Elkind, M. S., Das, S. R., de Lemos, J. A. 2023: e009652

  Abstract

  The COVID-19 pandemic has evolved through multiple phases characterized by new viral variants, vaccine development, and changes in therapies. It is unknown whether rates of cardiovascular disease (CVD) risk factor profiles and complications have changed over time.We analyzed the American Heart Association COVID-19 CVD registry, a national multicenter registry of hospitalized adults with active COVID-19 infection. The time period from April 2020 to December 2021 was divided into 3-month epochs, with March 2020 analyzed separately as a potential outlier. Participating centers varied over the study period. Trends in all-cause in-hospital mortality, CVD risk factors, and in-hospital CVD outcomes, including a composite primary outcome of cardiovascular death, cardiogenic shock, new heart failure, stroke, and myocardial infarction, were evaluated across time epochs. Risk-adjusted analyses were performed using generalized linear mixed-effects models.A total of 46 007 patient admissions from 134 hospitals were included (mean patient age 61.8 years, 53% male, 22% Black race). Patients admitted later in the pandemic were younger, more likely obese, and less likely to have existing CVD (Ptrend ≤0.001 for each). The incidence of the primary outcome increased from 7.0% in March 2020 to 9.8% in October to December 2021 (risk-adjusted Ptrend=0.006). This was driven by an increase in the diagnosis of myocardial infarction and stroke (Ptrend<0.0001 for each). The overall rate of in-hospital mortality was 14.2%, which declined over time (20.8% in March 2020 versus 10.8% in the last epoch; adjusted Ptrend<0.0001). When the analysis was restricted to July 2020 to December 2021, no temporal change in all-cause mortality was seen (adjusted Ptrend=0.63).Despite a shifting risk factor profile toward a younger population with lower rates of established CVD, the incidence of diagnosed cardiovascular complications of COVID increased from the onset of the pandemic through December 2021. All-cause mortality decreased during the initial months of the pandemic and thereafter remained consistently high through December 2021.

  View details for DOI 10.1161/CIRCOUTCOMES.122.009652

  View details for PubMedID 37017087

• Artificial Intelligence-Enabled Analysis of Statin-Related Topics and Sentiments on Social Media. JAMA network open Somani, S., van Buchem, M. M., Sarraju, A., Hernandez-Boussard, T., Rodriguez, F. 2023; 6 (4): e239747

  Abstract

  Despite compelling evidence that statins are safe, are generally well tolerated, and reduce cardiovascular events, statins are underused even in patients with the highest risk. Social media may provide contemporary insights into public perceptions about statins.To characterize and classify public perceptions about statins that were gleaned from more than a decade of statin-related discussions on Reddit, a widely used social media platform.This qualitative study analyzed all statin-related discussions on the social media platform that were dated between January 1, 2009, and July 12, 2022. Statin- and cholesterol-focused communities, were identified to create a list of statin-related discussions. An artificial intelligence (AI) pipeline was developed to cluster these discussions into specific topics and overarching thematic groups. The pipeline consisted of a semisupervised natural language processing model (BERT [Bidirectional Encoder Representations from Transformers]), a dimensionality reduction technique, and a clustering algorithm. The sentiment for each discussion was labeled as positive, neutral, or negative using a pretrained BERT model.Statin-related posts and comments containing the terms statin and cholesterol.Statin-related topics and thematic groups.A total of 10 233 unique statin-related discussions (961 posts and 9272 comments) from 5188 unique authors were identified. The number of statin-related discussions increased by a mean (SD) of 32.9% (41.1%) per year. A total of 100 discussion topics were identified and were classified into 6 overarching thematic groups: (1) ketogenic diets, diabetes, supplements, and statins; (2) statin adverse effects; (3) statin hesitancy; (4) clinical trial appraisals; (5) pharmaceutical industry bias and statins; and (6) red yeast rice and statins. The sentiment analysis revealed that most discussions had a neutral (66.6%) or negative (30.8%) sentiment.Results of this study demonstrated the potential of an AI approach to analyze large, contemporary, publicly available social media data and generate insights into public perceptions about statins. This information may help guide strategies for addressing barriers to statin use and adherence.

  View details for DOI 10.1001/jamanetworkopen.2023.9747

  View details for PubMedID 37093597

• Underutilization Of Guideline-directed Genetic Testing In Cardiomyopathies: A Missed Opportunity Longoni, M., Ward, A., Bhasin, K., Lee, D., Bhatt, S., Rodriguez, F., Dash, R. CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS. 2023: 704-705

  View details for Web of Science ID 001009258900393

• Identifying Reasons for Statin Nonuse in Patients With Diabetes Using Deep Learning of Electronic Health Records. Journal of the American Heart Association Sarraju, A., Zammit, A., Ngo, S., Witting, C., Hernandez-Boussard, T., Rodriguez, F. 2023: e028120

  Abstract

  Background Statins are guideline-recommended medications that reduce cardiovascular events in patients with diabetes. Yet, statin use is concerningly low in this high-risk population. Identifying reasons for statin nonuse, which are typically described in unstructured electronic health record data, can inform targeted system interventions to improve statin use. We aimed to leverage a deep learning approach to identify reasons for statin nonuse in patients with diabetes. Methods and Results Adults with diabetes and no statin prescriptions were identified from a multiethnic, multisite Northern California electronic health record cohort from 2014 to 2020. We used a benchmark deep learning natural language processing approach (Clinical Bidirectional Encoder Representations from Transformers) to identify statin nonuse and reasons for statin nonuse from unstructured electronic health record data. Performance was evaluated against expert clinician review from manual annotation of clinical notes and compared with other natural language processing approaches. Of 33 461 patients with diabetes (mean age 59±15 years, 49% women, 36% White patients, 24% Asian patients, and 15% Hispanic patients), 47% (15 580) had no statin prescriptions. From unstructured data, Clinical Bidirectional Encoder Representations from Transformers accurately identified statin nonuse (area under receiver operating characteristic curve [AUC] 0.99 [0.98-1.0]) and key patient (eg, side effects/contraindications), clinician (eg, guideline-discordant practice), and system reasons (eg, clinical inertia) for statin nonuse (AUC 0.90 [0.86-0.93]) and outperformed other natural language processing approaches. Reasons for nonuse varied by clinical and demographic characteristics, including race and ethnicity. Conclusions A deep learning algorithm identified statin nonuse and actionable reasons for statin nonuse in patients with diabetes. Findings may enable targeted interventions to improve guideline-directed statin use and be scaled to other evidence-based therapies.

  View details for DOI 10.1161/JAHA.122.028120

  View details for PubMedID 36974740

• Locking the Revolving Door: Racial Disparities in Cardiovascular Disease. Journal of the American Heart Association Velarde, G., Bravo-Jaimes, K., Brandt, E. J., Wang, D., Douglass, P., Castellanos, L. R., Rodriguez, F., Palaniappan, L., Ibebuogu, U., Bond, R., Ferdinand, K., Lundberg, G., Thaman, R., Vijayaraghavan, K., Watson, K. 2023: e025271

  Abstract

  Racial disparities in cardiovascular disease are unjust, systematic, and preventable. Social determinants are a primary cause of health disparities, and these include factors such as structural and overt racism. Despite a number of efforts implemented over the past several decades, disparities in cardiovascular disease care and outcomes persist, pervading more the outpatient rather than the inpatient setting, thus putting racial and ethnic minority groups at risk for hospital readmissions. In this article, we discuss differences in care and outcomes of racial and ethnic minority groups in both of these settings through a review of registries. Furthermore, we explore potential factors that connote a revolving door phenomenon for those whose adverse outpatient environment puts them at risk for hospital readmissions. Additionally, we review promising strategies, as well as actionable items at the policy, clinical, and educational levels aimed at locking this revolving door.

  View details for DOI 10.1161/JAHA.122.025271

  View details for PubMedID 36942617

• SOCIAL DETERMINANTS OF HEALTH AND CORONARY ARTERY CALCIUM: RESULTS FROM THE PROJECT BASELINE HEALTH STUDY Dudum, R., Ling, A., Short, S., Koweek, L. H., Carroll, M., Daubert, M. A., Haddad, F., Hernandez, A. F., Shah, S., Mahaffey, K. W., Douglas, P. S., Mega, J., Maron, D., Rodriguez, F. ELSEVIER SCIENCE INC. 2023: 1843

  View details for Web of Science ID 000990866101855

• READABILITY AND RELIABILITY OF ONLINE PATIENT EDUCATIONAL MATERIALS ON STATINS Asirvatham, R., Ngo, S., Baird, G., Sarraju, A., Rodriguez, F. ELSEVIER SCIENCE INC. 2023: 1762

  View details for Web of Science ID 000990866101774

• OPPORTUNISTIC SCREENING OF INCIDENTAL CORONARY ARTERY CALCIUM WITH DEEP-LEARNING ALGORITHM ON NON-ECG GATED CHEST CT IMAGING AND ASSOCIATION WITH CARDIOVASCULAR EVENTS AND MORTALITY Peng, A., Dudum, R., Maron, D., Sandhu, A., Rodriguez, F. ELSEVIER SCIENCE INC. 2023: 2123

  View details for Web of Science ID 000990866102135

• TOPICS AND SENTIMENTS AROUND STATINS ON REDDIT USING ARTIFICIAL INTELLIGENCE Somani, S., Van Buchem, M., Sarraju, A., Hernandez-Boussard, T., Rodriguez, F. ELSEVIER SCIENCE INC. 2023: 1637

  View details for Web of Science ID 000990866101649

• PERSISTENT SOCIODEMOGRAPHIC DISPARITIES IN CARDIOVASCULAR TELEMEDICINE USE DURING THE COVID-19 PANDEMIC Kalwani, N., Osmanlliu, E., Parameswaran, V., Qureshi, L., Dash, R., Scheinker, D., Rodriguez, F. ELSEVIER SCIENCE INC. 2023: 2287

  View details for Web of Science ID 000990866102298

• ANTIRACIST AI: A MACHINE LEARNING MODEL USING ELECTROCARDIOGRAMS AND ECHOCARDIOGRAMS CAN DETECT TRANSTHYRETIN CARDIAC AMYLOIDOSIS AND DECREASE RACIAL BIAS IN DIAGNOSTIC TESTING Jain, S. S., Sun, T., Brown, K., Ramlall, V., Tatonetti, N., Elhadad, N., Rodriguez, F., Witteles, R., Maurer, M. S., Poterucha, T., Elias, P. ELSEVIER SCIENCE INC. 2023: 338

  View details for Web of Science ID 000990866100339

• PATTERNS AND GAPS IN GUIDELINE-DIRECTED STATIN USE FOR ATHEROSCLEROTIC CARDIOVASCULAR DISEASE IN DISAGGREGATED HISPANIC AND ASIAN SUBGROUPS Sarraju, A., Yan, S., Huang, Q., Dudum, R., Palaniappan, L. P., Rodriguez, F. ELSEVIER SCIENCE INC. 2023: 1785

  View details for Web of Science ID 000990866101797

• Circulating ketone bodies and cardiovascular outcomes: the MESA study. European heart journal Shemesh, E., Chevli, P. A., Islam, T., German, C. A., Otvos, J., Yeboah, J., Rodriguez, F., deFilippi, C., Lima, J. A., Blaha, M., Pandey, A., Vaduganathan, M., Shapiro, M. D. 2023

  Abstract

  AIMS: Ketone bodies (KB) are an important alternative metabolic fuel source for the myocardium. Experimental and human investigations suggest that KB may have protective effects in patients with heart failure. This study aimed to examine the association between KB and cardiovascular outcomes and mortality in an ethnically diverse population free from cardiovascular disease (CVD).METHODS AND RESULTS: This analysis included 6796 participants (mean age 62 ± 10 years, 53% women) from the Multi-Ethnic Study of Atherosclerosis. Total KB was measured by nuclear magnetic resonance spectroscopy. Multivariable-adjusted Cox proportional hazard models were used to examine the association of total KB with cardiovascular outcomes. At a mean follow-up of 13.6 years, after adjusting for traditional CVD risk factors, increasing total KB was associated with a higher rate of hard CVD, defined as a composite of myocardial infarction, resuscitated cardiac arrest, stroke, and cardiovascular death, and all CVD (additionally included adjudicated angina) [hazard ratio, HR (95% confidence interval, CI): 1.54 (1.12-2.12) and 1.37 (1.04-1.80) per 10-fold increase in total KB, respectively]. Participants also experienced an 87% (95% CI: 1.17-2.97) increased rate of CVD mortality and an 81% (1.45-2.23) increased rate of all-cause mortality per 10-fold increase in total KB. Moreover, a higher rate of incident heart failure was observed with increasing total KB [1.68 (1.07-2.65), per 10-fold increase in total KB].CONCLUSION: The study found that elevated endogenous KB in a healthy community-based population is associated with a higher rate of CVD and mortality. Ketone bodies could serve as a potential biomarker for cardiovascular risk assessment.

  View details for DOI 10.1093/eurheartj/ehad087

  View details for PubMedID 36881667

• Sociodemographic determinants of oral anticoagulant prescription in patients with atrial fibrillations: findings from the PINNACLE registry using machine learning. Heart rhythm O2 Azizi, Z., Ward, A. T., Lee, D. J., Gad, S. S., Bhasin, K., Beetel, R. J., Ferreira, T., Shankar, S., Rumsfeld, J. S., Harrington, R. A., Virani, S. S., Gluckman, T. J., Dash, R., Rodriguez, F. 2023; 4 (3): 158-168

  Abstract

  Current risk scores that are solely based on clinical factors have shown modest predictive ability for understanding of factors associated with gaps in real-world prescription of oral anticoagulation (OAC) in patients with atrial fibrillation (AF).In this study, we sought to identify the role of social and geographic determinants, beyond clinical factors associated with variation in OAC prescriptions using a large national registry of ambulatory patients with AF.Between January 2017 and June 2018, we identified patients with AF from the American College of Cardiology PINNACLE (Practice Innovation and Clinical Excellence) Registry. We examined associations between patient and site-of-care factors and prescription of OAC across U.S. counties. Several machine learning (ML) methods were used to identify factors associated with OAC prescription.Among 864,339 patients with AF, 586,560 (68%) were prescribed OAC. County OAC prescription rates ranged from 26.8% to 93%, with higher OAC use in the Western United States. Supervised ML analysis in predicting likelihood of OAC prescriptions and identified a rank order of patient features associated with OAC prescription. In the ML models, in addition to clinical factors, medication use (aspirin, antihypertensives, antiarrhythmic agents, lipid modifying agents), and age, household income, clinic size, and U.S. region were among the most important predictors of an OAC prescription.In a contemporary, national cohort of patients with AF underuse of OAC remains high, with notable geographic variation. Our results demonstrated the role of several important demographic and socioeconomic factors in underutilization of OAC in patients with AF.

  View details for DOI 10.1016/j.hroo.2022.11.004

  View details for PubMedID 36993910

  View details for PubMedCentralID PMC10041076

• Sex Disparities in Prevention of Atherosclerotic Cardiovascular Disease Across the Life Course. Circulation Rodriguez, F. 2023; 147 (7): 523-525

  View details for DOI 10.1161/CIRCULATIONAHA.122.063148

  View details for PubMedID 36780384

• Appropriateness of Cardiovascular Disease Prevention Recommendations Obtained From a Popular Online Chat-Based Artificial Intelligence Model. JAMA Sarraju, A., Bruemmer, D., Van Iterson, E., Cho, L., Rodriguez, F., Laffin, L. 2023

  Abstract

  This study examines the appropriateness of artificial intelligence model responses to fundamental cardiovascular disease prevention questions.

  View details for DOI 10.1001/jama.2023.1044

  View details for PubMedID 36735264

• The leaky pipeline of diverse race and ethnicity representation in academic science and technology training in the United States, 2003-2019. PloS one Sarraju, A., Ngo, S., Rodriguez, F. 2023; 18 (4): e0284945

  Abstract

  INTRODUCTION: Diverse race and ethnicity representation remains lacking in science and technology (S&T) careers in the United States (US). Due to systematic barriers across S&T training stages, there may be sequential loss of diverse representation leading to low representation, often conceptualized as a leaky pipeline. We aimed to quantify the contemporary leaky pipeline of S&T training in the US.METHODS: We analyzed US S&T degree data, stratified by sex and then by race or ethnicity, obtained from survey data the National Science Foundation and the National Center for Science and Engineering Statistics. We assessed changes in race and ethnicity representation in 2019 at two major S&T transition points: bachelor to doctorate degrees (2003-2019) and doctorate degrees to postdoctoral positions (2010-2019). We quantified representation changes at each point as the ratio of representation in the later stage to earlier stage (representation ratio [RR]). We assessed secular trends in the representation ratio through univariate linear regression.RESULTS: For 2019, the survey data included for bachelor degrees, 12,714,921 men and 10.612,879 women; for doctorate degrees 14,259 men and 12,860 women; and for postdoctoral data, 11,361 men and 8.672 women. In 2019, we observed that Black, Asian, and Hispanic women had comparable loss of representation among women in the bachelor to doctorate transition (RR 0.86, 95% confidence interval [CI] 0.81-0.92; RR 0.85, 95% CI 0.81-0.89; and RR 0.82, 95% CI 0.77-0.87, respectively), while among men, Black and Asian men had the greatest loss of representation (Black men RR 0.72, 95% CI 0.66-0.78; Asian men RR 0.73, 95% CI 0.70-0.77)]. We observed that Black men (RR 0.60, 95% CI 0.51-0.69) and Black women (RR 0.56, 95% CI 0.49-0.63) experienced the greatest loss of representation among men and women, respectively, in the doctorate to postdoctoral transition. Black women had a statistically significant decrease in their representation ratio in the doctorate to postdoctoral transition from 2010 to 2019 (p-trend = 0.02).CONCLUSION: We quantified diverse race and ethnicity representation in contemporary US S&T training and found that Black men and women experienced the most consistent loss in representation across the S&T training pipeline. Findings should spur efforts to mitigate the structural racism and systemic barriers underpinning such disparities.

  View details for DOI 10.1371/journal.pone.0284945

  View details for PubMedID 37099545

• Real-world utilization of guideline-directed genetic testing in inherited cardiovascular diseases. Frontiers in cardiovascular medicine Longoni, M., Bhasin, K., Ward, A., Lee, D., Nisson, M., Bhatt, S., Rodriguez, F., Dash, R. 2023; 10: 1272433

  Abstract

  Background: Cardiovascular disease continues to be the leading cause of death globally. Clinical practice guidelines aimed at improving disease management and positively impacting major cardiac adverse events recommend genetic testing for inherited cardiovascular conditions such as dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), long QT syndrome (LQTS), hereditary amyloidosis, and familial hypercholesterolemia (FH); however, little is known about how consistently practitioners order genetic testing for these conditions in routine clinical practice. This study aimed to assess the adoption of guideline-directed genetic testing for patients diagnosed with DCM, HCM, LQTS, hereditary amyloidosis, or FH.Methods: This retrospective cohort study captured real-world evidence of genetic testing from ICD-9-CM and ICD-10-CM codes, procedure codes, and structured text fields of de-identified patient records in the Veradigm Health Insights Ambulatory EHR Research Database linked with insurance claims data. Data analysis was conducted using an automated electronic health record analysis engine. Patient records in the Veradigm database were sourced from more than 250,000 clinicians serving over 170 million patients in outpatient primary care and specialty practice settings in the United States and linked insurance claims data from public and private insurance providers. The primary outcome measure was evidence of genetic testing within six months of condition diagnosis.Results: Between January 1, 2017, and December 31, 2021, 224,641 patients were newly diagnosed with DCM, HCM, LQTS, hereditary amyloidosis, or FH and included in this study. Substantial genetic testing care gaps were identified. Only a small percentage of patients newly diagnosed with DCM (827/101,919; 0.8%), HCM (253/15,507; 1.6%), LQTS (650/56,539; 1.2%), hereditary amyloidosis (62/1,026; 6.0%), or FH (718/49,650; 1.5%) received genetic testing.Conclusions: Genetic testing is underutilized across multiple inherited cardiovascular conditions. This real-world data analysis provides insights into the delivery of genomic healthcare in the United States and suggests genetic testing guidelines are rarely followed in practice.

  View details for DOI 10.3389/fcvm.2023.1272433

  View details for PubMedID 37915745

• Disparities in Adoption of New Diabetic Therapies with Cardiovascular Benefits. Diabetes research and clinical practice Vasti, E. C., Basina, M., Calma, J., Maron, D. J., Rodriguez, F., Sandhu, A. T. 2022: 110233

  Abstract

  Sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 agonists (GLP1a) have cardiovascular benefit, but adoption into clinical practice has been lagging. We aim to evaluate use of SGLT2i and GLP1a across socioeconomic strata (SES), medical risk as well as provider type.We conducted a retrospective cohort study of the prescription of SGLT2i or GLP1a within 12 months of clinic visit between January 1, 2018 and January 1, 2019 using de-identified claims data. The primary outcome was the composite of a medication fill of either an SGLT2i and/or GLP1a within 180 days of the index visit.Of the total cohort, 125,636 (15.8%) received either a GLP-1a or SGLT2i.The odds of prescription of either medication was 0.64 [p=0.006)] in patients with heart failure. Patients who identified as Black, Hispanic or Asian had lower odds of the primary outcome [Black: (AOR 0.81, p<0.000); Hispanic: (AOR 0.87, p<0.000); Asian: (AOR 0.83, p<0.000). The odds was higher for those treated by an endocrinologist versus primary care clinician [AOR 2.12, p<0.000)].Prescriptionof SGLT2i or GLP1a was lower among patients with cardiovascular co-morbidities and those who identified as Black, Hispanic or Asian. Further efforts to minimize these disparities should be pursued.

  View details for DOI 10.1016/j.diabres.2022.110233

  View details for PubMedID 36581144

• Incidental Coronary Artery Calcium: Opportunistic Screening of Prior Non-Gated Chest Cts to Improve Statin Rates Sandhu, A. T., Rodriguez, F., Ngo, S., Patel, B., Mastrodicasa, D., Eng, D. T., Khandwala, N., Balla, S., Sousa, D., Maron, D. J. LIPPINCOTT WILLIAMS & WILKINS. 2022: E601-E602

  View details for Web of Science ID 000928164500084

• Use of lipid-lowering therapy preceding first hospitalization for acute myocardial infarction or stroke. American journal of preventive cardiology Sandhu, A. T., Rodriguez, F., Maron, D. J., Heidenreich, P. A. 2022; 12: 100426

  View details for DOI 10.1016/j.ajpc.2022.100426

  View details for PubMedID 36304918

• Health Techequity: Opportunities for Digital Health Innovations to Improve Equity and Diversity in Cardiovascular Care. Current cardiovascular risk reports Hernandez, M. F., Rodriguez, F. 2022: 1-20

  Abstract

  In this review, we define health equity, disparities, and social determinants of health; the different components of digital health; the barriers to digital health equity; and cardiovascular digital health trials and possible solutions to improve health equity through digital health.Digital health interventions show incredible potential to improve cardiovascular diseases by obtaining longitudinal, continuous, and actionable patient data; increasing access to care; and by decreasing delivery barriers and cost. However, certain populations have experienced decreased access to digital health innovations and decreased representation in cardiovascular digital health trials.Special efforts will need to be made to expand access to the different elements of digital health, ensuring that the digital divide does not exacerbate health disparities. As the expansion of digital health technologies continues, it is vital to increase representation of minoritized groups in all stages of the process: product development (needs findings and screening, concept generation, product creation, and testing), clinical research (pilot studies, feasibility studies, and randomized control trials), and finally health services deployment.

  View details for DOI 10.1007/s12170-022-00711-0

  View details for PubMedID 36465151

  View details for PubMedCentralID PMC9703416

• Incidental Coronary Artery Calcium: Opportunistic Screening of Prior Non-gated Chest CTs to Improve Statin Rates (NOTIFY-1 Project). Circulation Sandhu, A. T., Rodriguez, F., Ngo, S., Patel, B. N., Mastrodicasa, D., Eng, D., Khandwala, N., Balla, S., Sousa, D., Maron, D. J. 2022

  Abstract

  BACKGROUND: Coronary artery calcium (CAC) can be identified on non-gated chest CTs, but this finding is not consistently incorporated into care. A deep learning algorithm enables opportunistic CAC screening of non-gated chest CTs. Our objective was to evaluate the impact of notifying clinicians and patients of incidental CAC on statin initiation.METHODS: NOTIFY-1 was a randomized quality improvement project in the Stanford healthcare system. Patients without known atherosclerotic cardiovascular disease (ASCVD) or prior statin prescription were screened for CAC on a prior non-gated chest CT from 2014-2019 using a validated deep learning algorithm with radiologist confirmation. Patients with incidental CAC were randomized to notification of the primary care clinician and patient versus usual care. Notification included a patient-specific image of CAC and guideline recommendations regarding statin use. The primary outcome was statin prescription within 6 months.RESULTS: Among 2,113 patients who met initial clinical inclusion criteria, CAC was identified by the algorithm in 424 patients. After additional exclusions following chart review, a radiologist confirmed CAC among 173 of 194 patients (89.2%) who were randomized to notification or usual care. At 6 months, the statin prescription rate was 51.2% (44/86) in the notification arm versus 6.9% (6/87) with usual care (p<0.001). There was also more coronary artery disease testing in the notification arm (15.1% [13/86] vs. 2.3% [2/87], p=0.008).CONCLUSIONS: Opportunistic CAC screening of prior non-gated chest CTs followed by clinician and patient notification led to a significant increase in statin prescriptions. Further research is needed to determine whether this approach can reduce ASCVD events.

  View details for DOI 10.1161/CIRCULATIONAHA.122.062746

  View details for PubMedID 36342823

• Association of Race and Ethnicity With Oral Anticoagulation and Associated Outcomes in Patients With Atrial Fibrillation: Findings From the Get With The Guidelines-Atrial Fibrillation Registry. JAMA cardiology Essien, U. R., Chiswell, K., Kaltenbach, L. A., Wang, T. Y., Fonarow, G. C., Thomas, K. L., Turakhia, M. P., Benjamin, E. J., Rodriguez, F., Fang, M. C., Magnani, J. W., Yancy, C. W., Piccini, J. P. 2022

  Abstract

  Oral anticoagulation (OAC) is underprescribed in underrepresented racial and ethnic group individuals with atrial fibrillation (AF). Little is known of how differential OAC prescribing relates to inequities in AF outcomes.To compare OAC use at discharge and AF-related outcomes by race and ethnicity in the Get With The Guidelines-Atrial Fibrillation (GWTG-AFIB) registry.This retrospective cohort analysis used data from the GWTG-AFIB registry, a national quality improvement initiative for hospitalized patients with AF. All registry patients hospitalized with AF from 2014 to 2020 were included in the study. Data were analyzed from November 2021 to July 2022.Self-reported race and ethnicity assessed in GWTG-AFIB registry.The primary outcome was prescription of direct-acting OAC (DOAC) or warfarin at discharge. Secondary outcomes included cumulative 1-year incidence of ischemic stroke, major bleeding, and mortality postdischarge. Outcomes adjusted for patient demographic, clinical, and socioeconomic characteristics as well as hospital factors.Among 69 553 patients hospitalized with AF from 159 sites between 2014 and 2020, 863 (1.2%) were Asian, 5062 (7.3%) were Black, 4058 (5.8%) were Hispanic, and 59 570 (85.6%) were White. Overall, 34 113 (49.1%) were women; the median (IQR) age was 72 (63-80) years, and the median (IQR) CHA2DS2-VASc score (calculated as congestive heart failure, hypertension, age 75 years and older, diabetes, stroke or transient ischemic attack, vascular disease, age 65 to 74 years, and sex category) was 4 (2-5). At discharge, 56 385 patients (81.1%) were prescribed OAC therapy, including 41 760 (74.1%) receiving DOAC. OAC prescription at discharge was lowest in Hispanic patients (3010 [74.2%]), followed by Black patients (3935 [77.7%]) Asian patients (691 [80.1%]), and White patients (48 749 [81.8%]). Black patients were less likely than White patients to be discharged while taking any anticoagulant (adjusted odds ratio, 0.75; 95% CI, 0.68-0.84) and DOACs (adjusted odds ratio, 0.73; 95% CI, 0.65-0.82). In 16 307 individuals with 1-year follow up data, bleeding risks (adjusted hazard ratio [aHR], 2.08; 95% CI, 1.53-2.83), stroke risks (aHR, 2.07; 95% CI, 1.34-3.20), and mortality risks (aHR, 1.22; 95% CI, 1.02-1.47) were higher in Black patients than White patients. Hispanic patients had higher stroke risk (aHR, 2.02; 95% CI, 1.38-2.95) than White patients.In a national registry of hospitalized patients with AF, compared with White patients, Black patients were less likely to be discharged while taking anticoagulant therapy and DOACs in particular. Black and Hispanic patients had higher risk of stroke compared with White patients; Black patients had a higher risk of bleeding and mortality. There is an urgent need for interventions to achieve pharmacoequity in guideline-directed AF management to improve overall outcomes.

  View details for DOI 10.1001/jamacardio.2022.3704

  View details for PubMedID 36287545

• Racial, ethnic, and sex disparities in atrial fibrillation management: rate and rhythm control. Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing Gomez, S. E., Fazal, M., Nunes, J. C., Shah, S., Perino, A. C., Narayan, S. M., Tamirisa, K. P., Han, J. K., Rodriguez, F., Baykaner, T. 2022

  Abstract

  BACKGROUND: Atrial fibrillation (AF) affects around 6 million Americans. AF management involves pharmacologic therapy and/or interventional procedures to control rate and rhythm, as well as anticoagulation for stroke prevention. Different populations may respond differently to distinct management strategies. This review will describe disparities in rate and rhythm control and their impact on outcomes among women and historically underrepresented racial and/or ethnic groups.METHODS: This is a narrative review exploring the topic of sex and racial and/or ethnic disparities in rate and rhythm management of AF. We describe basic terminology, summarize AF epidemiology, discuss diversity in clinical research, and review landmark clinical trials.RESULTS: Despite having higher rates of traditional AF risk factors, Black and Hispanic adults have lower risk of AF than non-Hispanic White (NHW) patients, although those with AF experience more severe symptoms and report lower quality-of-life scores than NHW patients with AF. NHW patients receive antiarrhythmic drugs, cardioversions, and invasive therapies more frequently than Black and Hispanic patients. Women have lower rates of AF than men, but experience more severe symptoms, heart failure, stroke, and death after AF diagnosis. Women and people from diverse racial and ethnic backgrounds are inadequately represented in AF trials; prevalence findings may be a result of underdetection.CONCLUSION: Race, ethnicity, and gender are social determinants of health that may impact the prevalence, evolution, and management of AF. This impact reflects differences in biology as well as disparities in treatment and representation in clinical trials.

  View details for DOI 10.1007/s10840-022-01383-x

  View details for PubMedID 36224481

• Drivers of variation in telemedicine use during the COVID-19 pandemic: The experience of a large academic cardiovascular practice. Journal of telemedicine and telecare Koos, H., Parameswaran, V., Claire, S., Chen, C., Kalwani, N., Osmanlliu, E., Qureshi, L., Dash, R., Scheinker, D., Rodriguez, F. 2022: 1357633X221130288

  Abstract

  BACKGROUND: COVID-19 spurred rapid adoption and expansion of telemedicine. We investigated the factors driving visit modality (telemedicine vs. in-person) for outpatient visits at a large cardiovascular center.METHODS: We used electronic health record data from March 2020 to February 2021 from four cardiology subspecialties (general cardiology, electrophysiology, heart failure, and interventional cardiology) at a large academic health system in Northern California. There were 21,912 new and return visits with 69% delivered by telemedicine. We used hierarchical logistic regression and cross-validation methods to estimate the variation in visit modality explained by patient, clinician, and visit factors as measured by the mean area under the curve.RESULTS: Across all subspecialties, the clinician seen was the strongest predictor of telemedicine usage, while primary visit diagnosis was the next most predictive. In general cardiology, the model based on clinician seen had a mean area under the curve of 0.83, the model based on the primary diagnosis had a mean area under the curve of 0.69, and the model based on all patient characteristics combined had a mean area under the curve of 0.56. There was significant variation in telemedicine use across clinicians within each subspecialty, even for visits with the same primary visit diagnosis.CONCLUSION: Individual clinician practice patterns had the largest influence on visit modality across subspecialties in a large cardiovascular medicine practice, while primary diagnosis was less predictive, and patient characteristics even less so. Cardiovascular clinics should reduce variability in visit modality selection through standardized processes that integrate clinical factors and patient preference.

  View details for DOI 10.1177/1357633X221130288

  View details for PubMedID 36214200

• Association between remnant lipoprotein cholesterol, high-sensitivity C-reactive protein, and risk of atherosclerotic cardiovascular disease events in the Multi-Ethnic Study of Atherosclerosis (MESA). Journal of clinical lipidology Chevli, P. A., Islam, T., Pokharel, Y., Rodriguez, F., Virani, S. S., Blaha, M. J., Bertoni, A. G., Budoff, M., Otvos, J. D., Shapiro, M. D. 2022

  Abstract

  BACKGROUND: Elevated remnant-lipoprotein (RLP)-cholesterol (RLP-C) and high-sensitivity C-reactive protein (hsCRP) are each individually associated with atherosclerotic cardiovascular disease (ASCVD).OBJECTIVE: To evaluate the interplay of nuclear magnetic resonance (NMR)-derived RLP-C and hsCRP and their association with ASCVD in the Multi-Ethnic Study of Atherosclerosis (MESA).METHODS: Lipoprotein particles were measured using NMR spectroscopic analysis at baseline. RLP-C includes very-low-density lipoprotein cholesterol and intermediate-density lipoprotein cholesterol. Four groups were created as follows: Group 1: RLP-C ≤ median (≤29.14 mg/dL) and hsCRP < 2 mg/L; Group 2: RLP-C ≤ median and hsCRP≥ 2 mg/L; Group 3: RLP-C > median and hsCRP level < 2 mg/L; and Group 4: RLP-C > median and hsCRP level ≥ 2 mg/L. Kaplan-Meier survival curves and multivariable-adjusted Cox proportional hazard models were used to examine the relationship between RLP-C and hsCRP with incident ASCVD.RESULTS: A total of 6,720 MESA participants (mean age 62.2 y, 53% female) with a median follow-up of 15.6 years were included. In the fully adjusted model, compared to those in the reference group (Group 1), participants in Group 2, Group 3, and Group 4 demonstrated a 20% (95% CI, -2%-48%), 18% (-4%-44%), and 43% (18%-76%) increased risk of incident ASCVD events, respectively (p<0.01). An additive and multiplicative interaction between RLP-C and hsCRP was not statistically significant.CONCLUSION: NMR-derived RLP-C and hsCRP showed a similar independent association with incident ASCVD. Notably, the combination of increased RLP-C and hsCRP was associated with an increased risk of future ASCVD events.

  View details for DOI 10.1016/j.jacl.2022.09.005

  View details for PubMedID 36180367

• Association between Obesity and Length of COVID-19 Hospitalization: Unexpected Insights from the American Heart Association National COVID-19 Registry. Journal of obesity & metabolic syndrome Collins, W. J., Chang, A. Y., Weng, Y., Dahlen, A., O'Brien, C. G., Hom, J., Ahuja, N., Rodriguez, F., Rohatgi, N. 2022

  Abstract

  Background: Observational analyses have noted an association between obesity and poor clinical outcome from Coronavirus Disease 2019 (COVID-19). The mechanism for this finding remains unclear.Methods: We analyzed data from 22,915 COVID-19 patients hospitalized in non-intensive care units using the American Heart Association National COVID Registry of adult COVID-19 admissions from March 2020 to April 2021. A multivariable Poisson model adjusted for age, sex, medical history, admission respiratory status, hospitalization characteristics, and select laboratory findings was used to calculate length of stay (LOS) as a function of body mass index (BMI) category. Additionally, 5,327 patients admitted to intensive care units were similarly analyzed for comparison.Results: Relative to normal BMI subjects, overweight, class I obese, and class II obese patients had approximately half-day reductions in LOS (-0.469 days, P<0.01; -0.480 days, P<0.01; -0.578 days, P<0.01, respectively).Conclusion: The model identified a dose-dependent, inverse relationship between BMI category and LOS for COVID-19, which was not seen when the model was applied to critically ill patients.

  View details for DOI 10.7570/jomes22042

  View details for PubMedID 36058896

• LDL-C target attainment in secondary prevention of ASCVD in the United States: barriers, consequences of nonachievement, and strategies to reach goals. Postgraduate medicine Underberg, J., Toth, P. P., Rodriguez, F. 2022

  Abstract

  Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in the United States. Elevated low-density lipoprotein cholesterol (LDL-C) is a major causal risk factor for ASCVD. Current evidence overwhelmingly demonstrates that lowering LDL-C reduces the risk of secondary cardiovascular events in patients with previous myocardial infarction or stroke. There is no lower limit for LDL-C: large, randomized studies and meta-analyses have found continuous benefit and no safety concerns in patients achieving LDL-C levels <25 mg/dL. As 'Time is plaque' in patients with ASCVD, early, sustained reductions in LDL-C are critical to slow or halt disease progression. However, despite use of lipid-lowering medications, <30% of patients with ASCVD achieve guideline-recommended reductions in LDL-C, resulting in a substantial societal burden of preventable cardiovascular events and early mortality. LDL-C goals are not met due to several factors: lipid-lowering therapy is not initiated and intensified as directed by clinical guidelines (clinical inertia); most patients do not adhere to prescribed medications; and high-risk patients are frequently denied access to add-on therapies by their insurance providers. Promoting patient and clinician education, multidisciplinary collaboration, and other interventions may help to overcome these barriers. Ultimately, achieving population-level guideline-recommended reductions in LDL-C will require a collaborative effort from patients, clinicians, relevant professional societies, drug manufacturers, and payers.

  View details for DOI 10.1080/00325481.2022.2117498

  View details for PubMedID 36004573

• Trends in Lipid Concentrations and Lipid Control Among US Adults, 2007-2018. JAMA Aggarwal, R., Bhatt, D. L., Rodriguez, F., Yeh, R. W., Wadhera, R. K. 2022; 328 (8): 737-745

  Abstract

  Importance: High lipid concentrations are a modifiable risk factor for cardiovascular disease. Little is known about how population-level lipid concentrations, as well as trends in lipid control, have changed over the past decade among US adults.Objective: To determine whether lipid concentrations and rates of lipid control changed among US adults and whether these trends differed by sex and race and ethnicity, from 2007 to 2018.Design, Setting, and Participants: Serial cross-sectional analysis of 33 040 US adults aged 20 years or older, weighted to be nationally representative, from the National Health and Nutrition Examination Surveys (2007-2008 to 2017-2018).Main Outcomes and Measures: Lipid concentrations among US adults and rates of lipid control among adults receiving statin therapy. Lipid control was defined as a total cholesterol concentration of 200 mg/dL or less.Results: The mean age of the study population was 47.4 years, and 51.4% were women; of the 33 040 participants, 12.0% were non-Hispanic Black; 10.3%, Mexican American; 6.4%, other Hispanic American; 62.7%, non-Hispanic White; and 8.5%, other race and ethnicities (including non-Hispanic Asian. Among all US adults, age-adjusted total cholesterol improved significantly in the overall population from 197 mg/dL in 2007-2008 to 189 mg/dL in 2017-2018 (difference, -8.6 mg/dL [95% CI, -12.2 to -4.9 mg/dL]; P for trend <.001), with similar patterns for men and women. Black, Mexican American, other Hispanic, and White adults experienced significant improvements in total cholesterol, but no significant change was observed for Asian adults. Among adults receiving statin therapy, age-adjusted lipid control rates did not significantly change from 78.5% in 2007-2008 to 79.5% in 2017-2018 (difference, 1.1% [95% CI, -3.7% to 5.8%]; P for trend=.27), and these patterns were similar for men and women. Across all racial and ethnic groups, only Mexican Americans experienced a significant improvement in age-adjusted lipid control (P for trend=.008). In 2015-2018, age-adjusted rates of lipid control were significantly lower for women than for men (OR, 0.54 [95% CI, 0.40 to 0.72]). In addition, when compared with White adults, rates of lipid control while taking statins were significantly lower among Black adults (OR, 0.66 [95% CI, 0.47 to 0.94]) and other Hispanic adults (OR, 0.59 [95% CI, 0.37 to 0.95]); no significant differences were observed for other racial and ethnic groups.Conclusions and Relevance: In this serial cross-sectional study, lipid concentrations improved in the US adult population from 2007-2008 through 2017-2018. These patterns were observed across all racial and ethnic subgroups, with the exception of non-Hispanic Asian adults.

  View details for DOI 10.1001/jama.2022.12567

  View details for PubMedID 35997731

• Association Between Social Vulnerability Index and Cardiovascular Disease: ABehavioral Risk Factor Surveillance System Study. Journal of the American Heart Association Jain, V., Al Rifai, M., Khan, S. U., Kalra, A., Rodriguez, F., Samad, Z., Pokharel, Y., Misra, A., Sperling, L. S., Rana, J. S., Ullah, W., Medhekar, A., Virani, S. S. 2022: e024414

  Abstract

  Background Social and environmental factors play an important role in the rising health care burden of cardiovascular disease. The Centers for Disease Control and Prevention developed the Social Vulnerability Index (SVI) from US census data as a tool for public health officials to identify communities in need of support in the setting of a hazardous event. SVI (ranging from a least vulnerable score of 0 to a most vulnerable score of 1) ranks communities on 15 social factors including unemployment, minoritized groups status, and disability, and groups them under 4 broad themes: socioeconomic status, housing and transportation, minoritized groups, and household composition. We sought to assess the association of SVI with self-reported prevalent cardiovascular comorbidities and atherosclerotic cardiovascular disease (ASCVD). Methods and Results We performed a retrospective cohort analysis of adults (≥18years) in the Behavioral Risk Factor Surveillance System 2016 to 2019. Data regarding self-reported prevalent cardiovascular comorbidities (including diabetes, hypertension, hyperlipidemia, smoking, substance use), and ASCVD was captured using participants' response to a structured telephonic interview. We divided states on the basis of the tertile of SVI (first-participant lives in the least vulnerable group of states, 0-0.32; to third-participant lives in the most vulnerable group of states, 0.54-1.0). Multivariable logistic regression models adjusting for age, race and ethnicity, sex, employment, income, health care coverage, and association with federal poverty line were constructed to assess the association of SVI with cardiovascular comorbidities. Our study sample consisted of 1745999 participants ≥18years of age. States in the highest (third) tertile of social vulnerability had predominantly Black and Hispanic adults, lower levels of education, lower income, higher rates of unemployment, and higher rates of prevalent comorbidities including hypertension, diabetes, chronic kidney disease, hyperlipidemia, substance use, and ASCVD. In multivariable logistic regression models, individuals living in states in the third tertile of SVI had higher odds of having hypertension (odds ratio (OR), 1.14 [95% CI, 1.11-1.17]), diabetes (OR, 1.12 [95% CI, 1.09-1.15]), hyperlipidemia (OR, 1.09 [95% CI, 1.06-1.12]), chronic kidney disease (OR, 1.17 [95% CI, 1.12-1.23]), smoking (OR, 1.05 [95% CI, 1.03-1.07]), and ASCVD (OR, 1.15 [95% CI, 1.12-1.19]), compared with those living in the first tertile of SVI. Conclusions SVI varies across the US states and is associated with prevalent cardiovascular comorbidities and ASCVD, independent of age, race and ethnicity, sex, employment, income, and health care coverage. SVI may be a useful assessment tool for health policy makers and health systems researchers examining multilevel influences on cardiovascular-related health behaviors and identifying communities for targeted interventions pertaining to social determinants of health.

  View details for DOI 10.1161/JAHA.121.024414

  View details for PubMedID 35904206

• Persistent Racial/Ethnic Disparities in Cardiology Trainees in the United States. Journal of the American College of Cardiology Minhas, A. M., Sagheer, S., Ijaz, S. H., Nazir, S., Khan, M. S., Zaidi, S. H., Fudim, M., Rodriguez, F., Johnson, H. M., Virani, S. S. 2022; 80 (3): 276-279

  View details for DOI 10.1016/j.jacc.2022.05.014

  View details for PubMedID 35835499

• Toward a Broader Conceptualization of Disparities and Solutions CIRCULATION Carnethon, M. R., Rodriguez, F., Watson, K. E. 2022; 146 (3): 145-146

  View details for DOI 10.1161/CIRCULATIONAHA.122.061209

  View details for Web of Science ID 000823965300001

• Multi-dimensional characterization of prediabetes in the Project Baseline Health Study. Cardiovascular diabetology Chatterjee, R., Kwee, L. C., Pagidipati, N., Koweek, L. H., Mettu, P. S., Haddad, F., Maron, D. J., Rodriguez, F., Mega, J. L., Hernandez, A., Mahaffey, K., Palaniappan, L., Shah, S. H., Project Baseline Health Study 2022; 21 (1): 134

  Abstract

  BACKGROUND: We examined multi-dimensional clinical and laboratory data in participants with normoglycemia, prediabetes, and diabetes to identify characteristics of prediabetes and predictors of progression from prediabetes to diabetes or reversion to no diabetes.METHODS: The Project Baseline Health Study (PBHS) is a multi-site prospective cohort study of 2502 adults that conducted deep clinical phenotyping through imaging, laboratory tests, clinical assessments, medical history, personal devices, and surveys. Participants were classified by diabetes status (diabetes [DM], prediabetes [preDM], or no diabetes [noDM]) at each visit based on glucose, HbA1c, medications, and self-report. Principal component analysis (PCA) was performed to create factors that were compared across groups cross-sectionally using linear models. Logistic regression was used to identify factors associated with progression from preDM to DM and for reversion from preDM to noDM.RESULTS: At enrollment, 1605 participants had noDM; 544 had preDM; and 352 had DM. Over 4 years of follow-up, 52 participants with preDM developed DM and 153 participants reverted to noDM. PCA identified 33 factors composed of clusters of clinical variables; these were tested along with eight individual variables identified a priori as being of interest. Six PCA factors and six a priori variables significantly differed between noDM and both preDM and DM after false discovery rate adjustment for multiple comparisons (q<0.05). Of these, two factors (one comprising glucose measures and one of anthropometry and physical function) demonstrated monotonic/graded relationships across the groups, as did three a priori variables: ASCVD risk, coronary artery calcium, and triglycerides (q<10-21 for all). Four factors were significantly different between preDM and noDM, but concordant or similar between DM and preDM: red blood cell indices (q=8*10-10), lung function (q=2*10-6), risks of chronic diseases (q=7*10-4), and cardiac function (q=0.001), along with a priori variables of diastolic function (q=1*10-10), sleep efficiency (q=9*10-6) and sleep time (q=6*10-5). Two factors were associated with progression from prediabetes to DM: anthropometry and physical function (OR [95% CI]: 0.6 [0.5, 0.9], q=0.04), and heart failure and c-reactive protein (OR [95% CI]: 1.4 [1.1, 1.7], q=0.02). The anthropometry and physical function factor was also associated with reversion from prediabetes to noDM: (OR [95% CI]: 1.9 [1.4, 2.7], q=0.02) along with a factor of white blood cell indices (OR [95% CI]: 0.6 [0.4, 0.8], q=0.02), and the a priori variables ASCVD risk score (OR [95% CI]: 0.7 [0.6, 0.9] for each 0.1 increase in ASCVD score, q=0.02) and triglycerides (OR [95% CI]: 0.9 [0.8, 1.0] for each 25mg/dl increase, q=0.05).CONCLUSIONS: PBHS participants with preDM demonstrated pathophysiologic changes in cardiac, pulmonary, and hematology measures and declines in physical function and sleep measures that precede DM; some changes predicted an increased risk of progression to DM. A factor with measures of anthropometry and physical function was the most important factor associated with progression to DM and reversion to noDM. Future studies may determine whether these changes elucidate pathways of progression to DM and related complications and whether they can be used to identify individuals at higher risk of progression to DM for targeted preventive interventions. Trial registration ClinicalTrials.gov NCT03154346.

  View details for DOI 10.1186/s12933-022-01565-x

  View details for PubMedID 35850765

• County-Level Social Vulnerability is Associated With In-Hospital Death and Major Adverse Cardiovascular Events in Patients Hospitalized With COVID-19: An Analysis of the American Heart Association COVID-19 Cardiovascular Disease Registry. Circulation. Cardiovascular quality and outcomes Islam, S. J., Malla, G., Yeh, R. W., Quyyumi, A. A., Kazi, D. S., Tian, W., Song, Y., Nayak, A., Mehta, A., Ko, Y., de Lemos, J. A., Rodriguez, F., Goyal, A., Wadhera, R. K. 2022: 101161CIRCOUTCOMES121008612

  Abstract

  BACKGROUND: The COVID-19 pandemic has disproportionately affected low-income and racial/ethnic minority populations in the United States. However, it is unknown whether hospitalized patients with COVID-19 from socially vulnerable communities experience higher rates of death and/or major adverse cardiovascular events (MACEs). Thus, we evaluated the association between county-level social vulnerability and in-hospital mortality and MACE in a national cohort of hospitalized COVID-19 patients.METHODS: Our study population included patients with COVID-19 in the American Heart Association COVID-19 Cardiovascular Disease Registry across 107 US hospitals between January 14, 2020 to November 30, 2020. The Social Vulnerability Index (SVI), a composite measure of community vulnerability developed by Centers for Disease Control and Prevention, was used to classify the county-level social vulnerability of patients' place of residence. We fit a hierarchical logistic regression model with hospital-level random intercepts to evaluate the association of SVI with in-hospital mortality and MACE.RESULTS: Among 16939 hospitalized COVID-19 patients in the registry, 5065 (29.9%) resided in the most vulnerable communities (highest national quartile of SVI). Compared with those in the lowest quartile of SVI, patients in the highest quartile were younger (age 60.2 versus 62.3 years) and more likely to be Black adults (36.7% versus 12.2%) and Medicaid-insured (31.1% versus 23.0%). After adjustment for demographics (age, sex, race/ethnicity) and insurance status, the highest quartile of SVI (compared with the lowest) was associated with higher likelihood of in-hospital mortality (OR, 1.25 [1.03-1.53]; P=0.03) and MACE (OR, 1.26 [95% CI, 1.05-1.50]; P=0.01). These findings were not attenuated after accounting for clinical comorbidities and acuity of illness on admission.CONCLUSIONS: Patients hospitalized with COVID-19 residing in more socially vulnerable communities experienced higher rates of in-hospital mortality and MACE, independent of race, ethnicity, and several clinical factors. Clinical and health system strategies are needed to improve health outcomes for socially vulnerable patients.

  View details for DOI 10.1161/CIRCOUTCOMES.121.008612

  View details for PubMedID 35862003

• Screening for participants in the ISCHEMIA trial: Implications for clinical research. Journal of clinical and translational science Rodriguez, F., Hochman, J. S., Xu, Y., Reynolds, H. R., Berger, J. S., Mavromichalis, S., Newman, J. D., Bangalore, S., Maron, D. J. 2022; 6 (1): e90

  Abstract

  The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) found that there was no statistical difference in cardiovascular events with an initial invasive strategy as compared with an initial conservative strategy of guideline-directed medical therapy for patients with moderate to severe ischemia on noninvasive testing. In this study, we describe the reasons that potentially eligible patients who were screened for participation in the ISCHEMIA trial did not advance to enrollment, the step prior to randomization. Of those who preliminarily met clinical inclusion criteria on screening logs submitted during the enrollment period, over half did not participate due to physician or patient refusal, a potentially modifiable barrier. This analysis highlights the importance of physician equipoise when advising patients about participation in randomized controlled trials.

  View details for DOI 10.1017/cts.2022.428

  View details for PubMedID 36003207

  View details for PubMedCentralID PMC9389278

• Screening for participants in the ISCHEMIA trial: Implications for clinical research JOURNAL OF CLINICAL AND TRANSLATIONAL SCIENCE Rodriguez, F., Hochman, J. S., Xu, Y., Reynolds, H. R., Berger, J. S., Mavromichalis, S., Newman, J. D., Bangalore, S., Maron, D. J. 2022; 6 (1)

  View details for DOI 10.1017/cts.2022.428

  View details for Web of Science ID 000840421800001

• Trends in national and county-level Hispanic mortality in the United States, 2011-2020. Scientific reports Sarraju, A., Ngo, S., Ashland, M., Scheinker, D., Rodriguez, F. 2022; 12 (1): 11812

  Abstract

  Hispanic populations generally experience more adverse socioeconomic conditions yet demonstrate lower mortality compared with Non-Hispanic White (NHW) populations in the US. This finding of a mortality advantage is well-described as the "Hispanic paradox." The Coronavirus Disease 2019 (COVID-19) pandemic has disproportionately affected Hispanic populations. To quantify these effects, we evaluated US national and county-level trends in Hispanic versus NHW mortality from 2011 through 2020. We found that a previously steady Hispanic mortality advantage significantly decreased in 2020, potentiallydriven by COVID-19-attributable Hispanic mortality. Nearly 16% of US counties experienced a reversal of their pre-pandemic Hispanic mortality advantage such that their Hispanic mortality exceeded NHW mortality in 2020. An additional 50% experienced a decrease in a pre-pandemic Hispanic mortality advantage. Our work provides a quantitative understanding of the disproportionate burden of the pandemic on Hispanic health and the Hispanic paradox and provides a renewed impetus to tackle the factors driving these concerning disparities.

  View details for DOI 10.1038/s41598-022-15916-x

  View details for PubMedID 35821236

• Health Disparities Across the Continuum of ASCVD Risk. Current cardiology reports Devareddy, A., Sarraju, A., Rodriguez, F. 2022

  Abstract

  PURPOSE OF THE REVIEW: Despite marked progress in cardiovascular disease management in the last several decades, there remain significant, persistent disparities in cardiovascular health in historically marginalized racial and ethnic groups. Here, we outline current state of health disparities in cardiovascular disease, discuss the interplay between social determinants of health, structural racism, and cardiovascular outcomes, and highlight strategies to address these issues.RECENT FINDINGS: Across the continuum of atherosclerotic cardiovascular disease (ASCVD) prevention, there remain significant disparities in outcomes including morbidity and mortality by race, ethnicity, and socioeconomic status (SES). These disparities begin early in childhood (primordial prevention) and continue with a higher prevalence of cardiovascular risk factors (primary prevention), and in the uptake of evidence-based therapies (secondary prevention). These disparities are driven by social determinants of health and structural racism that disproportionately disadvantage historically marginalized populations. Structural racism and social determinants of health contribute to significant disparities in cardiovascular morbidity and mortality.

  View details for DOI 10.1007/s11886-022-01736-y

  View details for PubMedID 35788894

• Association of left ventricular diastolic function with coronary artery calcium score: A Project Baseline Health Study. Journal of cardiovascular computed tomography Haddad, F., Cauwenberghs, N., Daubert, M. A., Kobayashi, Y., Bloomfield, G. S., Fleischman, D., Koweek, L., Maron, D. J., Rodriguez, F., Liao, Y. J., Moneghetti, K., Amsallem, M., Mega, J., Hernandez, A., Califf, R., Mahaffey, K. W., Shah, S. H., Kuznetsova, T., Douglas, P. S., Project Baseline Health Study Investigators 2022

  Abstract

  BACKGROUND: Coronary artery calcium (CAC) and left ventricular diastolic dysfunction (LVDD) are strong predictors of cardiovascular events and share common risk factors. However, their independent association remains unclear.METHODS: In the Project Baseline Health Study (PBHS), 2082 participants underwent cardiac-gated, non-contrast chest computed tomography (CT) and echocardiography. The association between left ventricular (LV) diastolic function and CAC was assessed using multidimensional network and multivariable-adjusted regression analyses. Multivariable analysis was conducted on continuous LV diastolic parameters and categorical classification of LVDD and adjusted for traditional cardiometabolic risk factors. LVDD was defined using reference limits from a low-risk reference group without established cardiovascular disease, cardiovascular risk factors or evidence of CAC, (n​=​560). We also classified LVDD using the American Society of Echocardiography recommendations.RESULTS: The mean age of the participants was 51​±​17 years with 56.6% female and 62.6% non-Hispanic White. Overall, 38.1% had hypertension; 13.7% had diabetes; and 39.9% had CAC >0. An intertwined network was observed between diastolic parameters, CAC score, age, LV mass index, and pulse pressure. In the multivariable-adjusted analysis, e', E/e', and LV mass index were independently associated with CAC after adjustment for traditional risk factors. For both e' and E/e', the effect size and statistical significance were higher across increasing CAC tertiles. Other independent correlates of e' and E/e' included age, female sex, Black race, height, weight, pulse pressure, hemoglobin A1C, and HDL cholesterol. The independent association with CAC was confirmed using categorical analysis of LVDD, which occurred in 554 participants (26.6%) using population-derived thresholds.CONCLUSION: In the PBHS study, the subclinical coronary atherosclerotic disease burden detected using CAC scoring was independently associated with diastolic function.CLINICALTRIALS: GOV IDENTIFIER: NCT03154346.

  View details for DOI 10.1016/j.jcct.2022.06.003

  View details for PubMedID 35872137

• Race/ethnicity reporting and representation in US clinical trials: a cohort study. Lancet Regional Health. Americas Turner, B. E., Steinberg, J. R., Weeks, B. T., Rodriguez, F., Cullen, M. R. 2022; 11

  Abstract

  Background: Systemic progress in improving trial representation is uncertain, and previous analyses of minority trial participation have been limited to small cohorts with limited exploration of driving factors.Methods: We analyzed detailed trial records from all US clinical trials registered in ClinicalTrials.gov from March 2000 to March 2020. Minority enrollment was compared to 2010 US Census demographic estimates using Wilcoxon test. We utilized logistic regression and generalized linear regression with a logit link to assess the association of possible drivers (including trials' funding source, size, phase, and design) with trials' disclosure of and amount of minority enrollment respectively.Findings: Among 20,692 US-based trials with reported results (representing ~4·76 million enrollees), only 43% (8,871/20,692) reported any race/ethnicity data. The majority of enrollees were White (median 79·7%; interquartile range [IQR] 61·9-90·0%), followed by Black (10·0%; IQR 2·5-23·5%), Hispanic/Latino (6·0%; IQR 0·43-15·4%), Asian (1·0%; IQR 0·0-4·1%), and American Indian (0·0%; IQR 0·0-0·2%). Median combined enrollment of minority race/ethnicity groups (Black, Hispanic/Latino, Asian, American Indian, Other/Multi) was below census estimates (27·6%) (p<0·001) however increased at an annual rate of 1·7%. Industry and Academic funding were negatively associated with race/ethnicity reporting (Industry adjusted odds ratio [aOR]: 0·42, 95% confidence interval [CI]: 0·38 to 0·46, p<0.0001; Academic aOR: 0·45, CI: 0·41 to 0·50, p<0.0001). Industry also had a negative association with the proportion of minority ethnicity enrollees (aOR: 0·69, CI: 0·60 to 0·79) compared to US Government-funded trials.Interpretation: Over the past two decades, the majority of US trials in ClinicalTrials.gov do not report race/ethnicity enrollment data, and minorities are underrepresented in trials with modest improvement over time.Funding: Stanford Medical Scholars Research Funding, the National Heart, Lung, and Blood Institute, NIH (1K01HL144607) and the American Heart Association/Robert Wood Johnson Medical Faculty Development Program.

  View details for DOI 10.1016/j.lana.2022.100252

  View details for PubMedID 35875251

• Unique Cardiovascular Disease Risk Factors in Hispanic Individuals. Current cardiovascular risk reports Gomez, S., Blumer, V., Rodriguez, F. 2022: 1-9

  Abstract

  Purpose of Review: This review summarizes contemporary data on unique cardiovascular disease (CVD) risk factors in Hispanic individuals in the USA, and how addressing these factors is important in addressing health equity.Recent Findings: Recent studies have shown high rates of traditional CVD risk factors in Hispanic individuals such as obesity, hypertension, diabetes, hyperlipidemia, and emerging CVD risk factors like hypertensive disorders of pregnancy, psychological stress, and occupational exposures. However, most studies fail to consider the significant heterogeneity in risk factor burden and outcomes in atherosclerotic CVD by Hispanic subgroup. Heart failure and rhythm disorders are less well studied in Hispanic adults, making risk assessment for these conditions difficult. High levels of CVD risk factors in Hispanic youth given an aging Hispanic population overall highlight the importance of risk mitigation among these individuals.Summary: In brief, these data highlight the significant, unique burden of CVD risk among Hispanic individuals in the USA and predict a rising burden of disease among this growing and aging population. Future CVD research should focus on including robust, diverse Hispanic cohorts as well as specifically delineating results for disaggregated Hispanic groups across CVDs. This will allow for better risk assessment, prevention, and treatment decisions to promote health equity for Hispanic patients.

  View details for DOI 10.1007/s12170-022-00692-0

  View details for PubMedID 35669678

• Review of Lipid-Lowering Therapy in Women from Reproductive to Postmenopausal Years. Reviews in cardiovascular medicine Witting, C., Devareddy, A., Rodriguez, F. 2022; 23 (5)

  Abstract

  Although cardiovascular disease is the leading cause of death in women, cardiovascular risk factors remain underrecognized and undertreated. Hyperlipidemia is one of the leading modifiable risk factors for CVD. Statins are the mainstay of lipid lowering therapy (LLT), with additional agents such as ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors as additive or alternative therapies. Clinical trials have demonstrated that these LLTs are equally efficacious in lipid lowering and cardiovascular risk reduction in women as they are in men. Although the data on statin teratogenicity is evolving, in times of pregnancy or attempted pregnancy, most lipid-lowering agents are generally avoided due to lack of high-quality safety data. This leads to limited treatment options in pregnant women with hyperlipidemia or cardiovascular disease. During the perimenopausal period, the mainstay of lipid management remains consistent with guidelines across all ages. Hormone replacement therapy for cardiovascular risk reduction is not recommended. Future research is warranted to target sex-based disparities in LLT initiation and persistence across the life course.

  View details for DOI 10.31083/j.rcm2305183

  View details for PubMedID 38031574

  View details for PubMedCentralID PMC10686310

• Sex-Specific Risk Factors Associated With First Acute Myocardial Infarction in Young Adults. JAMA network open Lu, Y., Li, S., Liu, Y., Rodriguez, F., Watson, K. E., Dreyer, R. P., Khera, R., Murugiah, K., D'Onofrio, G., Spatz, E. S., Nasir, K., Masoudi, F. A., Krumholz, H. M. 2022; 5 (5): e229953

  Abstract

  Importance: An increasing proportion of people in the US hospitalized for acute myocardial infarction (AMI) are younger than 55 years, with the largest increase in young women. Effective prevention requires an understanding of risk factors associated with risk of AMI in young women compared with men.Objectives: To assess the sex-specific associations of demographic, clinical, and psychosocial risk factors with first AMI among adults younger than 55 years, overall, and by AMI subtype.Design, Setting, and Participants: This study used a case-control design with 2264 patients with AMI, aged 18 to 55 years, from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study and 2264 population-based controls matched for age, sex, and race and ethnicity from the National Health and Nutrition Examination Survey from 2008 to 2012. Data were analyzed from April 2020 to November 2021.Exposures: A wide range of demographic, clinical, and psychosocial risk factors.Main Outcomes and Measures: Odds ratios (ORs) and population attributable fractions (PAF) for first AMI associated with demographic, clinical, and psychosocial risk factors.Results: Of the 4528 case patients and matched controls, 3122 (68.9%) were women, and the median (IQR) age was 48 (44-52) years. Seven risk factors (diabetes [OR, 3.59 (95% CI, 2.72-4.74) in women vs 1.76 (1.19-2.60) in men], depression [OR, 3.09 (95% CI, 2.37-4.04) in women vs 1.77 (1.15-2.73) in men], hypertension [OR, 2.87 (95% CI, 2.31-3.57) in women vs 2.19 (1.65-2.90) in men], current smoking [OR, 3.28 (95% CI, 2.65-4.07) in women vs 3.28 (2.65-4.07) in men], family history of premature myocardial infarction [OR, 1.48 (95% CI, 1.17-1.88) in women vs 2.42 (1.71-3.41) in men], low household income [OR, 1.79 (95% CI, 1.28-2.50) in women vs 1.35 (0.82-2.23) in men], hypercholesterolemia [OR, 1.02 (95% CI, 0.81-1.29) in women vs 2.16 (1.49-3.15) in men]) collectively accounted for the majority of the total risk of AMI in women (83.9%) and men (85.1%). There were significant sex differences in risk factor associations: hypertension, depression, diabetes, current smoking, and family history of diabetes had stronger associations with AMI in young women, whereas hypercholesterolemia had a stronger association in young men. Risk factor profiles varied by AMI subtype, and traditional cardiovascular risk factors had higher prevalence and stronger ORs for type 1 AMI compared with other AMI subtypes.Conclusions and Relevance: In this case-control study, 7 risk factors, many potentially modifiable, accounted for 85% of the risk of first AMI in young women and men. Significant differences in risk factor profiles and risk factor associations existed by sex and by AMI subtype. These findings suggest the need for sex-specific strategies in risk factor modification and prevention of AMI in young adults. Further research is needed to improve risk assessment of AMI subtypes.

  View details for DOI 10.1001/jamanetworkopen.2022.9953

  View details for PubMedID 35503221

• Review of Lipid-Lowering Therapy in Women from Reproductive to Postmenopausal Years REVIEWS IN CARDIOVASCULAR MEDICINE Witting, C., Devareddy, A., Rodriguez, F. 2022; 23 (5)

  View details for DOI 10.31083/j.rcm2305183

  View details for Web of Science ID 000809900700002

• Cardiovascular Disease Mortality Among Hispanic Versus Non-Hispanic White Adults in the United States, 1999 to 2018. Journal of the American Heart Association Khan, S. U., Lone, A. N., Yedlapati, S. H., Dani, S. S., Khan, M. Z., Watson, K. E., Parwani, P., Rodriguez, F., Cainzos-Achirica, M., Michos, E. D. 2022: e022857

  Abstract

  Background Life expectancy has been higher for Hispanic versus non-Hispanic White (NHW) individuals; however, data are limited on cardiovascular disease (CVD) mortality. Method and Results Using the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research death certificate database (1999-2018), we compared age-adjusted mortality rates for total CVD and its subtypes (ischemic heart disease, stroke, heart failure, hypertensive heart disease, other CVD), and average annual percentage changes among Hispanic and NHW adults. The age-adjusted mortality rate per 100000 was lower for Hispanic than NHW adults for total CVD (186.4 versus 254.6; P<0.001) and its subtypes. Between 1999 and 2018, mortality decline was higher in Hispanic than NHW adults for total CVD (average annual percentage change [AAPC], -2.90 versus -2.41) and ischemic heart disease (AAPC: -4.44 versus -3.82) (P<0.001). In contrast, stroke mortality decline was slower in Hispanic versus NHW adults (AAPC: -2.05 versus -2.60; P<0.05). Stroke mortality increased in Hispanic but stalled in NHW adults since 2011 (AAPC: 0.79 versus -0.09). For ischemic heart disease (AAPC: -0.80 versus -1.85) and stroke (AAPC: -1.32 versus -1.43) mortality decline decelerated more for Hispanic than NHW adults aged <45years (P<0.05). For heart failure, Hispanic adults aged <45 (3.55 versus 2.16) and 45 to 64 (1.88 versus 1.54) showed greater rise in age-adjusted mortality rate than NHW individuals (P<0.05). Age-adjusted heart failure mortality rate also accelerated in Hispanic versus NHW men (1.00 versus 0.67; P<0.001). Conclusions Disaggregating data by CVD subtype and demographics unmasked heterogeneities in CVD mortality between Hispanic and NHW adults. NHW adults had greater CVD mortality rates and slower decline than Hispanic adults, whereas marked demographic differences in mortality signaled concerning trends among the Hispanic versus NHW population.

  View details for DOI 10.1161/JAHA.121.022857

  View details for PubMedID 35362334

• DRIVERS OF VARIATION IN TELEMEDICINE USE AT AN ACADEMIC CARDIOVASCULAR CENTER DURING THE COVID-19 PANDEMIC Koos, H., Parameswaran, V., Claire, S., Chen, C., Kalwani, N., Osmanlliu, E., Dash, R., Scheinker, D., Rodriguez, F. ELSEVIER SCIENCE INC. 2022: 2046

  View details for Web of Science ID 000781026602247

• Corrigendum to "Risk Factor Control Across the Spectrum of Cardiovascular Risk: Findings from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)" [American Journal of Preventive Cardiology, Volume 5, March 2021, 100147]. American journal of preventive cardiology Rodriguez, F., Lee, U. J., Barone, N., Swett, K., Lopez, L., Cheng, S., Daviglus, M. L., Hanna, D. B., Giacinto, R. A., Arguelles, W., Cai, J., Talavera, G. A., Rodriguez, C. J. 2022; 9: 100302

  Abstract

  [This corrects the article DOI: 10.1016/j.ajpc.2021.100147.].

  View details for DOI 10.1016/j.ajpc.2021.100302

  View details for PubMedID 35399739

• Racial and Ethnic Group Underrepresentation in Studies of Adverse Pregnancy Outcomes and Cardiovascular Risk. Journal of the American Heart Association Gomez, S. E., Sarraju, A., Rodriguez, F. 2022: e024776

  View details for DOI 10.1161/JAHA.121.024776

  View details for PubMedID 35191322

• Changes in telemedicine use and ambulatory visit volumes at a multispecialty cardiovascular center during the COVID-19 pandemic. Journal of telemedicine and telecare Kalwani, N. M., Osmanlliu, E., Parameswaran, V., Qureshi, L., Dash, R., Heidenreich, P. A., Scheinker, D., Rodriguez, F. 1800: 1357633X211073428

  Abstract

  Early in the COVID-19 pandemic, cardiology clinics rapidly implemented telemedicine to maintain access to care. Little is known about subsequent trends in telemedicine use and visit volumes across cardiology subspecialties. We conducted a retrospective cohort study including all patients with ambulatory visits at a multispecialty cardiovascular center in Northern California from March 2019 to February 2020 (pre-COVID) and March 2020 to February 2021 (COVID). Telemedicine use increased from 3.5% of visits (1200/33,976) during the pre-COVID period to 63.0% (21,251/33,706) during the COVID period. Visit volumes were below pre-COVID levels from March to May 2020 but exceeded pre-COVID levels after June 2020, including when local COVID-19 cases peaked. Telemedicine use was above 75% of visits in all cardiology subspecialties in April 2020 and stabilized at rates ranging from over 95% in electrophysiology to under 25% in heart transplant and vascular medicine. From June 2020 to February 2021, subspecialties delivering a greater percentage of visits through telemedicine experienced larger increases in new patient visits (r=0.81, p=0.029). Telemedicine can be used to deliver a significant proportion of outpatient cardiovascular care though utilization varies across subspecialties. Higher rates of telemedicine adoption may increase access to care in cardiology clinics.

  View details for DOI 10.1177/1357633X211073428

  View details for PubMedID 35108126

• Online Patient Education Materials Related to Lipoprotein(a): Readability Assessment. Journal of medical Internet research Pearson, K., Ngo, S., Ekpo, E., Sarraju, A., Baird, G., Knowles, J., Rodriguez, F. 1800; 24 (1): e31284

  Abstract

  BACKGROUND: Lipoprotein(a) (Lp(a)) is a highly proatherogenic lipid fraction that is a clinically significant risk modifier. Patients wanting to learn more about Lp(a) are likely to use online patient educational materials (OPEMs). However, the readability of OPEMs may exceed the health literacy of the public.OBJECTIVE: This study aims to assess the readability of OPEMs related to Lp(a). We hypothesized that the readability of these online materials would exceed the sixth grade level recommended by the American Medical Association.METHODS: Using an online search engine, we queried the top 20 search results from 10 commonly used Lp(a)-related search terms to identify a total of 200 websites. We excluded duplicate websites, advertised results, research journal articles, or non-patient-directed materials, such as those intended only for health professionals or researchers. Grade level readability was calculated using 5 standard readability metrics (automated readability index, SMOG index, Coleman-Liau index, Gunning Fog score, Flesch-Kincaid score) to produce robust point (mean) and interval (CI) estimates of readability. Generalized estimating equations were used to model grade level readability by each search term, with the 5 readability scores nested within each OPEM.RESULTS: A total of 27 unique websites were identified for analysis. The average readability score for the aggregated results was a 12.2 (95% CI 10.9798-13.3978) grade level. OPEMs were grouped into 6 categories by primary source: industry, lay press, research foundation and nonprofit organizations, university or government, clinic, and other. The most readable category was OPEMs published by universities or government agencies (9.0, 95% CI 6.8-11.3). The least readable OPEMs on average were the ones published by the lay press (13.0, 95% CI 11.2-14.8). All categories exceeded the sixth grade reading level recommended by the American Medical Association.CONCLUSIONS: Lack of access to readable OPEMs may disproportionately affect patients with low health literacy. Ensuring that online content is understandable by broad audiences is a necessary component of increasing the impact of novel therapeutics and recommendations regarding Lp(a).

  View details for DOI 10.2196/31284

  View details for PubMedID 35014955

• The Gig Economy Worker-A New Social Determinant of Health? JAMA cardiology Rodriguez, F., Sarraju, A., Turakhia, M. P. 1800

  View details for DOI 10.1001/jamacardio.2021.5435

  View details for PubMedID 34985492

• Evaluation of Factors Underlying Sex-Based Disparities in Cardiovascular Care in Adults With Self-reported Premature Atherosclerotic Cardiovascular Disease. JAMA cardiology Jain, V., Al Rifai, M., Turpin, R., Eken, H. N., Agrawal, A., Mahtta, D., Samad, Z., Coulter, S., Rodriguez, F., Petersen, L. A., Virani, S. S. 1800

  Abstract

  Importance: There are limited data regarding sex-based differences in physical and mental health domains and health care access in adults with premature atherosclerotic cardiovascular disease (ASCVD).Objective: To study the association of sex with physical and mental health domains as well as health care access-related factors among adults with self-reported premature ASCVD.Design, Setting, and Participants: Retrospective cohort analysis of 748 090 adults aged 18 to 55 years in the Behavioral Risk Factor Surveillance System 2016 to 2019 in the US. Data were analyzed from June to July 2021.Exposures: Self-reported ASCVD, defined as having a history of coronary artery disease, myocardial infarction, or stroke.Main Outcomes and Measures: Self-reported physical and mental health and measures of health care access, including self-reported cost-related medication nonadherence and inability to see a physician due to cost.Results: Between 2016 and 2019, 748 090 adults aged 18-55 years were identified, of whom 28 522 (3.3%) had self-reported premature ASCVD. Of these, 14 358 (47.0%) were women. Compared with men, women with premature ASCVD were more likely to report being clinically depressed (odds ratio [OR], 1.73; 95% CI, 1.41-2.14; P<.001), have cost-related medication nonadherence (OR, 1.42; 95% CI, 1.11-1.82; P=.005), have not seen a physician due to cost-related issues (OR, 4.52; 95% CI, 2.24-9.13; P<.001), and were more likely to report overall poor physical health (OR, 1.39; 95% CI, 1.09-1.78; P=.008) despite being more likely to have health care coverage (85.3% vs 80.8%; P=.04) and a primary care physician (84.2% vs 75.7%; P<.001).Conclusions and Relevance: Results from this study indicate that women with premature ASCVD were more likely to report worse overall physical and mental health, inability to see a physician due to cost, and cost-related medical nonadherence. Interventions addressing mental health and out-of-pocket costs are needed in adults with premature ASCVD.

  View details for DOI 10.1001/jamacardio.2021.5430

  View details for PubMedID 34985497

• Biological and clinical correlates of the patient health questionnaire-9: exploratory cross-sectional analyses of the baseline health study. BMJ open Califf, R. M., Wong, C., Doraiswamy, P. M., Hong, D. S., Miller, D. P., Mega, J. L. 2022; 12 (1): e054741

  Abstract

  We assessed the relationship between the Patient Health Questionnaire-9 (PHQ-9) at intake and other measurements intended to assess biological factors, markers of disease and health status.We performed a cross-sectional analysis of 2365 participants from the Baseline Health Study, a prospective cohort of adults selected to represent major demographic groups in the USA. Participants underwent deep phenotyping on demographic, clinical, laboratory, functional and imaging findings.Despite extensive research on the clinical implications of the PHQ-9, data are limited on the relationship between PHQ-9 scores and other measures of health and disease; we sought to better understand this relationship.None.Cross-sectional measures of medical illnesses, gait, balance strength, activities of daily living, imaging and laboratory tests.Compared with lower PHQ-9 scores, higher scores were associated with female sex (46.9%-66.7%), younger participants (53.6-42.4 years) and compromised physical status (higher resting heart rates (65 vs 75 bpm), larger body mass index (26.5-30 kg/m2), greater waist circumference (91-96.5 cm)) and chronic conditions, including gastro-oesophageal reflux disease (13.2%-24.7%) and asthma (9.5%-20.4%) (p<0.0001). Increasing PHQ-9 score was associated with a higher frequency of comorbidities (migraines (6%-20.4%)) and active symptoms (leg cramps (6.4%-24.7%), mood change (1.2%-47.3%), lack of energy (1.2%-57%)) (p<0.0001). After adjustment for relevant demographic, socioeconomic, behavioural and medical characteristics, we found that memory change, tension, shortness of breath and indicators of musculoskeletal symptoms (backache and neck pain) are related to higher PHQ-9 scores (p<0.0001).Our study highlights how: (1) even subthreshold depressive symptoms (measured by PHQ-9) may be indicative of several individual- and population-level concerns that demand more attention; and (2) depression should be considered a comorbidity in common disease.NCT03154346.

  View details for DOI 10.1136/bmjopen-2021-054741

  View details for PubMedID 34983769

• Using deep learning-based natural language processing to identify reasons for statin nonuse in patients with atherosclerotic cardiovascular disease. Communications medicine Sarraju, A., Coquet, J., Zammit, A., Chan, A., Ngo, S., Hernandez-Boussard, T., Rodriguez, F. 2022; 2: 88

  Abstract

  Background: Statins conclusively decrease mortality in atherosclerotic cardiovascular disease (ASCVD), the leading cause of death worldwide, and are strongly recommended by guidelines. However, real-world statin utilization and persistence are low, resulting in excess mortality. Identifying reasons for statin nonuse at scale across health systems is crucial to developing targeted interventions to improve statin use.Methods: We developed and validated deep learning-based natural language processing (NLP) approaches (Clinical Bidirectional Encoder Representations from Transformers [BERT]) to classify statin nonuse and reasons for statin nonuse using unstructured electronic health records (EHRs) from a diverse healthcare system.Results: We present data from a cohort of 56,530 ASCVD patients, among whom 21,508 (38%) lack guideline-directed statin prescriptions and statins listed as allergies in structured EHR portions. Of these 21,508 patients without prescriptions, only 3,929 (18%) have any discussion of statin use or nonuse in EHR documentation. The NLP classifiers identify statin nonuse with an area under the curve (AUC) of 0.94 (95% CI 0.93-0.96) and reasons for nonuse with a weighted-average AUC of 0.88 (95% CI 0.86-0.91) when evaluated against manual expert chart review in a held-out test set. Clinical BERT identifies key patient-level reasons (side-effects, patient preference) and clinician-level reasons (guideline-discordant practices) for statin nonuse, including differences by type of ASCVD and patient race/ethnicity.Conclusions: Our deep learning NLP classifiers can identify crucial gaps in statin nonuse and reasons for nonuse in high-risk populations to support education, clinical decision support, and potential pathways for health systems to address ASCVD treatment gaps.

  View details for DOI 10.1038/s43856-022-00157-w

  View details for PubMedID 35856080

• COVID-19 is associated with higher risk of venous thrombosis, but not arterial thrombosis, compared with influenza: Insights from a large US cohort. PloS one Ward, A., Sarraju, A., Lee, D., Bhasin, K., Gad, S., Beetel, R., Chang, S., Bonafede, M., Rodriguez, F., Dash, R. 2022; 17 (1): e0261786

  Abstract

  Infection with SARS-CoV-2 is typically compared with influenza to contextualize its health risks. SARS-CoV-2 has been linked with coagulation disturbances including arterial thrombosis, leading to considerable interest in antithrombotic therapy for Coronavirus Disease 2019 (COVID-19). However, the independent thromboembolic risk of SARS-CoV-2 infection compared with influenza remains incompletely understood. We evaluated the adjusted risks of thromboembolic events after a diagnosis of COVID-19 compared with influenza in a large retrospective cohort.We used a US-based electronic health record (EHR) dataset linked with insurance claims to identify adults diagnosed with COVID-19 between April 1, 2020 and October 31, 2020. We identified influenza patients diagnosed between October 1, 2018 and April 31, 2019. Primary outcomes [venous composite of pulmonary embolism (PE) and acute deep vein thrombosis (DVT); arterial composite of ischemic stroke and myocardial infarction (MI)] and secondary outcomes were assessed 90 days post-diagnosis. Propensity scores (PS) were calculated using demographic, clinical, and medication variables. PS-adjusted hazard ratios (HRs) were calculated using Cox proportional hazards regression.There were 417,975 COVID-19 patients (median age 57y, 61% women), and 345,934 influenza patients (median age 47y, 66% women). Compared with influenza, patients with COVID-19 had higher venous thromboembolic risk (HR 1.53, 95% CI 1.38-1.70), but not arterial thromboembolic risk (HR 1.02, 95% CI 0.95-1.10). Secondary analyses demonstrated similar risk for ischemic stroke (HR 1.11, 95% CI 0.98-1.25) and MI (HR 0.93, 95% CI 0.85-1.03) and higher risk for DVT (HR 1.36, 95% CI 1.19-1.56) and PE (HR 1.82, 95% CI 1.57-2.10) in patients with COVID-19.In a large retrospective US cohort, COVID-19 was independently associated with higher 90-day risk for venous thrombosis, but not arterial thrombosis, as compared with influenza. These findings may inform crucial knowledge gaps regarding the specific thromboembolic risks of COVID-19.

  View details for DOI 10.1371/journal.pone.0261786

  View details for PubMedID 35020742

• Opportunistic Incidence Prediction of Multiple Chronic Diseases from Abdominal CT Imaging Using Multi-task Learning Blankemeier, L., Gallegos, I., Chaves, J., Maron, D., Sandhu, A., Rodriguez, F., Rubin, D., Patel, B., Willis, M., Boutin, R., Chaudhari, A. S., Wang, L., Dou, Q., Fletcher, P. T., Speidel, S., Li, S. SPRINGER INTERNATIONAL PUBLISHING AG. 2022: 309-318

  View details for DOI 10.1007/978-3-031-16449-1_30

  View details for Web of Science ID 000867568000030

• Personalizing cholesterol treatment recommendations for primary cardiovascular disease prevention. Scientific reports Sarraju, A., Ward, A., Li, J., Valencia, A., Palaniappan, L., Scheinker, D., Rodriguez, F. 2022; 12 (1): 23

  Abstract

  Statin therapy is the cornerstone of preventing atherosclerotic cardiovascular disease (ASCVD), primarily by reducing low density lipoprotein cholesterol (LDL-C) levels. Optimal statin therapy decisions rely on shared decision making and may be uncertain for a given patient. In areas of clinical uncertainty, personalized approaches based on real-world data may help inform treatment decisions. We sought to develop a personalized statin recommendation approach for primary ASCVD prevention based on historical real-world outcomes in similar patients. Our retrospective cohort included adults from a large Northern California electronic health record (EHR) aged 40-79 years with no prior cardiovascular disease or statin use. The cohort was split into training and test sets. Weighted-K-nearest-neighbor (wKNN) regression models were used to identify historical EHR patients similar to a candidate patient. We modeled four statin decisions for each patient: none, low-intensity, moderate-intensity, and high-intensity. For each candidate patient, the algorithm recommended the statin decision that was associated with the greatest percentage reduction in LDL-C after 1 year in similar patients. The overall cohort consisted of 50,576 patients (age 54.6 ± 9.8 years) with 55% female, 48% non-Hispanic White, 32% Asian, and 7.4% Hispanic patients. Among 8383 test-set patients, 52%, 44%, and 4% were recommended high-, moderate-, and low-intensity statins, respectively, for a maximum predicted average 1-yr LDL-C reduction of 16.9%, 20.4%, and 14.9%, in each group, respectively. Overall, using aggregate EHR data, a personalized statin recommendation approach identified the statin intensity associated with the greatest LDL-C reduction in historical patients similar to a candidate patient. Recommendations included low- or moderate-intensity statins for maximum LDL-C lowering in nearly half the test set, which is discordant with their expected guideline-based efficacy. A data-driven personalized statin recommendation approach may inform shared decision making in areas of uncertainty, and highlight unexpected efficacy-effectiveness gaps.

  View details for DOI 10.1038/s41598-021-03796-6

  View details for PubMedID 34996943

• N-Terminal Pro-B-Type Natriuretic Peptide as a Biomarker for the Severity and Outcomes With COVID-19 in a Nationwide Hospitalized Cohort. Journal of the American Heart Association O'Donnell, C., Ashland, M. D., Vasti, E. C., Lu, Y., Chang, A. Y., Wang, P., Daniels, L. B., de Lemos, J. A., Morrow, D. A., Rodriguez, F., O'Brien, C. G. 2021: e022913

  Abstract

  Background Currently, there is limited research on the prognostic value of NT-proBNP (N-terminal pro-B-type natriuretic peptide) as a biomarker in COVID-19. We proposed the a priori hypothesis that an elevated NT-proBNP concentration at admission is associated with increased in-hospital mortality. Methods and Results In this prospective, observational cohort study of the American Heart Association's COVID-19 Cardiovascular Disease Registry, 4675 patients hospitalized with COVID-19 were divided into normal and elevated NT-proBNP cohorts by standard age-adjusted heart failure thresholds, as well as separated by quintiles. Patients with elevated NT-proBNP (n=1344; 28.7%) were older, with more cardiovascular risk factors, and had a significantly higher rate of in-hospital mortality (37% versus 16%; P<0.001) and shorter median time to death (7 versus 9days; P<0.001) than those with normal values. Analysis by quintile of NT-proBNP revealed a steep graded relationship with mortality (7.1%-40.2%; P<0.001). NT-proBNP was also associated with major adverse cardiac events, intensive care unit admission, intubation, shock, and cardiac arrest (P<0.001 for each). In subgroup analyses, NT-proBNP, but not prior heart failure, was associated with increased risk of in-hospital mortality. Adjusting for cardiovascular risk factors with presenting vital signs, an elevated NT-proBNP was associated with 2-fold higher adjusted odds of death (adjusted odds ratio [OR], 2.23; 95% CI, 1.80-2.76), and the log-transformed NT-proBNP with other biomarkers projected a 21% increased risk of death for each 2-fold increase (adjusted OR, 1.21; 95% CI, 1.08-1.34). Conclusions Elevated NT-proBNP levels on admission for COVID-19 are associated with an increased risk of in-hospital mortality and other complications in patients with and without heart failure.

  View details for DOI 10.1161/JAHA.121.022913

  View details for PubMedID 34889112

• Major disparities in COVID-19 test positivity for patients with non-English preferred language even after accounting for race and social factors in the United States in 2020. BMC public health Cohen-Cline, H., Li, H., Gill, M., Rodriguez, F., Hernandez-Boussard, T., Wolberg, H., Lippa, J., Vartanian, K. 2021; 21 (1): 2121

  Abstract

  BACKGROUND: The COVID-19 pandemic has further exposed inequities in our society, demonstrated by disproportionate COVID-19 infection rate and mortality in communities of color and low-income communities. One key area of inequity that has yet to be explored is disparities based on preferred language.METHODS: We conducted a retrospective cohort study of 164,368 adults tested for COVID-19 in a large healthcare system across Washington, Oregon, and California from March - July 2020. Using electronic health records, we constructed multi-level models that estimated the odds of testing positive for COVID-19 by preferred language, adjusting for age, race/ethnicity, and social factors. We further investigated interaction between preferred language and both race/ethnicity and state. Analysis was performed from October-December 2020.RESULTS: Those whose preferred language was not English had higher odds of having a COVID-19 positive test (OR 3.07, p<0.001); this association remained significant after adjusting for age, race/ethnicity, and social factors. We found significant interaction between language and race/ethnicity and language and state, but the odds of COVID-19 test positivity remained greater for those whose preferred language was not English compared to those whose preferred language was English within each race/ethnicity and state.CONCLUSIONS: People whose preferred language is not English are at greater risk of testing positive for COVID-19 regardless of age, race/ethnicity, geography, or social factors - demonstrating a significant inequity. Research demonstrates that our public health and healthcare systems are centered on English speakers, creating structural and systemic barriers to health. Addressing these barriers are long overdue and urgent for COVID-19 prevention.

  View details for DOI 10.1186/s12889-021-12171-z

  View details for PubMedID 34794421

• National Trends and Disparities in Hospitalization for Acute Hypertension Among Medicare Beneficiaries (1999-2019). Circulation Lu, Y., Wang, Y., Spatz, E. S., Onuma, O., Nasir, K., Rodriguez, F., Watson, K. E., Krumholz, H. M. 2021

  View details for DOI 10.1161/CIRCULATIONAHA.121.057056

  View details for PubMedID 34743531

• Association of human immunodeficiency virus infection with outcomes among adults hospitalized with COVID-19. AIDS (London, England) Durstenfeld, M. S., Sun, K., Ma, Y., Rodriguez, F., Secemsky, E. A., Parikh, R. V., Hsue, P. Y. 2021

  Abstract

  OBJECTIVE: To evaluate the association of HIV infection with outcomes among people hospitalized with COVID-19.DESIGN: Prospectively-planned analysis of the American Heart Association's COVID-19 Cardiovascular Disease Registry.SETTING: 107 academic and community hospitals in the United States from March through December 2020.PARTICIPANTS: Consecutive sample of 21,528 adults hospitalized with COVID-19 at participating hospitals.MAIN OUTCOME AND MEASURE: Primary outcome was pre-defined as in-hospital mortality. We used hierarchical mixed effects models to assess the association of HIV with in-hospital mortality accounting for patient demographics, comorbidities and clustering by hospital. Secondary outcomes included major adverse cardiac events (MACE), severity of illness, and length of stay (LOS).RESULTS: The registry included 220 people living with HIV (PLWH). PLWH were younger and more likely to be male, Non-Hispanic Black, on Medicaid, and active tobacco users. Of the study population, 36 PLWH (16.4%) died compared with 3,290 (15.4%) without HIV (Risk ratio 1.06; 95%CI 0.79-1.43; p = 0.71). After adjustment for age, sex, race, and insurance, HIV was not associated with in-hospital mortality (aOR 1.13; 95%CI 0.77-1.6; p = 0.54) with no change in effect after adding body mass index and comorbidities (aOR 1.15; 95%CI 0.78-1.70; p = 0.48). HIV was not associated with MACE (aOR 0.99; 95%CI 0.69-1.44, p = 0.91), COVID severity (aOR 0.96; 95%CI 0.62-1.50; p = 0.86), or LOS (aOR 1.03; 95% CI 0.76-1.66; p = 0.21).CONCLUSIONS: In the largest study of PLWH hospitalized with COVID-19 in the United States to date, we did not find significant associations between HIV and adverse outcomes including in-hospital mortality, MACE, or severity of illness.

  View details for DOI 10.1097/QAD.0000000000003129

  View details for PubMedID 34750295

• Author Correction: Genetics of 35 blood and urine biomarkers in the UK Biobank. Nature genetics Sinnott-Armstrong, N., Tanigawa, Y., Amar, D., Mars, N., Benner, C., Aguirre, M., Venkataraman, G. R., Wainberg, M., Ollila, H. M., Kiiskinen, T., Havulinna, A. S., Pirruccello, J. P., Qian, J., Shcherbina, A., FinnGen, Rodriguez, F., Assimes, T. L., Agarwala, V., Tibshirani, R., Hastie, T., Ripatti, S., Pritchard, J. K., Daly, M. J., Rivas, M. A. 2021

  View details for DOI 10.1038/s41588-021-00956-2

  View details for PubMedID 34608296

• Machine learning approaches improve risk stratification for secondary cardiovascular disease prevention in multiethnic patients. Open heart Sarraju, A., Ward, A., Chung, S., Li, J., Scheinker, D., Rodriguez, F. 2021; 8 (2)

  Abstract

  OBJECTIVES: Identifying high-risk patients is crucial for effective cardiovascular disease (CVD) prevention. It is not known whether electronic health record (EHR)-based machine-learning (ML) models can improve CVD risk stratification compared with a secondary prevention risk score developed from randomised clinical trials (Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention, TRS 2°P).METHODS: We identified patients with CVD in a large health system, including atherosclerotic CVD (ASCVD), split into 80% training and 20% test sets. A rich set of EHR patient features was extracted. ML models were trained to estimate 5-year CVD event risk (random forests (RF), gradient-boosted machines (GBM), extreme gradient-boosted models (XGBoost), logistic regression with an L2 penalty and L1 penalty (Lasso)). ML models and TRS 2°P were evaluated by the area under the receiver operating characteristic curve (AUC).RESULTS: The cohort included 32 192 patients (median age 74 years, with 46% female, 63% non-Hispanic white and 12% Asian patients and 23 475 patients with ASCVD). There were 4010 events over 5 years of follow-up. ML models demonstrated good overall performance; XGBoost demonstrated AUC 0.70 (95% CI 0.68 to 0.71) in the full CVD cohort and AUC 0.71 (95% CI 0.69 to 0.73) in patients with ASCVD, with comparable performance by GBM, RF and Lasso. TRS 2°P performed poorly in all CVD (AUC 0.51, 95% CI 0.50 to 0.53) and ASCVD (AUC 0.50, 95% CI 0.48 to 0.52) patients. ML identified nontraditional predictive variables including education level and primary care visits.CONCLUSIONS: In a multiethnic real-world population, EHR-based ML approaches significantly improved CVD risk stratification for secondary prevention.

  View details for DOI 10.1136/openhrt-2021-001802

  View details for PubMedID 34667093

• Prioritizing Equity and Diversity in Academic Medicine Faculty Recruitment and Retention JAMA HEALTH FORUM Ajayi, A. A., Rodriguez, F., de Jesus Perez, V. 2021; 2 (9)

  View details for DOI 10.1001/jamahealthforum.2021.2426

  View details for Web of Science ID 000837117200003

• Initial Outcomes of CardioClick, a Telehealth Program for Preventive Cardiac Care: Observational Study. JMIR cardio Kalwani, N. M., Johnson, A. N., Parameswaran, V., Dash, R., Rodriguez, F. 2021; 5 (2): e28246

  Abstract

  BACKGROUND: Telehealth use has increased in specialty clinics, but there is limited evidence on the outcomes of telehealth in primary cardiovascular disease (CVD) prevention.OBJECTIVE: The objective of this study was to evaluate the initial outcomes of CardioClick, a telehealth primary CVD prevention program.METHODS: In 2017, the Stanford South Asian Translational Heart Initiative (a preventive cardiology clinic focused on high-risk South Asian patients) introduced CardioClick, which is a clinical pathway replacing in-person follow-up visits with video visits. We assessed patient engagement and changes in CVD risk factors in CardioClick patients and in a historical in-person cohort from the same clinic.RESULTS: In this study, 118 CardioClick patients and 441 patients who received in-person care were included. CardioClick patients were more likely to complete the clinic's CVD prevention program (76/118, 64.4% vs 173/441, 39.2%, respectively; P<.001) and they did so in lesser time (mean, 250 days vs 307 days, respectively; P<.001) than the patients in the historical in-person cohort. Patients who completed the CardioClick program achieved reductions in CVD risk factors, including blood pressure, lipid concentrations, and BMI, which matched or exceeded those observed in the historical in-person cohort.CONCLUSIONS: Telehealth can be used to deliver care effectively in a preventive cardiology clinic setting and may result in increased patient engagement. Further studies on telehealth outcomes are needed to determine the optimal role of virtual care models across diverse preventive medicine clinics.

  View details for DOI 10.2196/28246

  View details for PubMedID 34499037

• Gender disparities in difficulty accessing healthcare and cost-related medication non-adherence: The CDC behavioral risk factor surveillance system (BRFSS) survey. Preventive medicine Daher, M., Al Rifai, M., Kherallah, R. Y., Rodriguez, F., Mahtta, D., Michos, E. D., Khan, S. U., Petersen, L. A., Virani, S. S. 2021: 106779

  Abstract

  Ensuring healthcare access is critical to maintain health and prevent illness. Studies demonstrate gender disparities in healthcare access. Less is known about how these vary with age, race/ethnicity, and atherosclerotic cardiovascular disease. We utilized cross-sectional data from 2016 to 2019 CDC Behavioral Risk Factor Surveillance System (BRFSS), a U.S. telephone-based survey of adults (≥18 years). Measures of difficulty accessing healthcare included absence of healthcare coverage, delay in healthcare access, absence of primary care physician, >1-year since last checkup, inability to see doctor due to cost, and cost-related medication non-adherence. We studied the association between gender and these variables using multivariable-adjusted logistic regression models, stratifying by age, race/ethnicity, and atherosclerotic cardiovascular disease status. Our population consisted of 1,737,397 individuals; 54% were older (≥45 years), 51% women, 63% non-Hispanic White, 12% non-Hispanic Black,17% Hispanic, 9% reported atherosclerotic cardiovascular disease. In multivariable-adjusted models, women were more likely to report delay in healthcare access: odds ratio (OR) and (95% confidence interval): 1.26 (1.11, 1.43) [p < 0.001], inability to see doctor due to cost: 1.29 (1.22, 1.36) [p < 0.001], cost-related medication non-adherence: 1.24 (1.01, 1.50) [p 0.04]. Women were less likely to report lack of healthcare coverage: 0.71 (0.66, 0.75) [p < 0.001] and not having a primary care physician: 0.50 (0.48, 0.52) [p < 0.001]. Disparities were pronounced in younger (<45 years) and Black women. Identifying these barriers, particularly among younger women and Black women, is crucial to ensure equitable healthcare access to all individuals.

  View details for DOI 10.1016/j.ypmed.2021.106779

  View details for PubMedID 34487748

• Prioritizing Equity and Diversity in Academic Medicine Faculty Recruitment and Retention. JAMA health forum Ajayi, A. A., Rodriguez, F., de Jesus Perez, V. 2021; 2 (9): e212426

  View details for DOI 10.1001/jamahealthforum.2021.2426

  View details for PubMedID 36218655

• Could Clinician Sensitivity to Cultural and Historical Considerations Help Reduce COVID-19 Deaths among Blacks? Southern medical journal Kountz, D., Rodriguez, F., Vital, V., Vora, S., Gough, R., Seyfried, J. 2021; 114 (9): 591-592

  View details for DOI 10.14423/SMJ.0000000000001288

  View details for PubMedID 34480192

• Associations of Insulin Resistance With Systolic and Diastolic Blood Pressure: A Study From the HCHS/SOL. Hypertension (Dallas, Tex. : 1979) Quesada, O., Claggett, B., Rodriguez, F., Cai, J., Moncrieft, A. E., Garcia, K., Del Rios Rivera, M., Hanna, D. B., Daviglus, M. L., Talavera, G. A., Bairey Merz, C. N., Solomon, S. D., Cheng, S., Bello, N. A. 2021; 78 (3): 716-725

  Abstract

  [Figure: see text].

  View details for DOI 10.1161/HYPERTENSIONAHA.120.16905

  View details for PubMedID 34379440

• Feasibility Of An Asynchronous, Semi-Automated Remote Patient Monitoring Blood Pressure Management System Sarraju, A., Babakhanian, M., Szeto, I., Seninger, C., Chang, T., Bhalla, V., Downing, L., Rodriguez, F., Turakhia, M., Wang, P. J. LIPPINCOTT WILLIAMS & WILKINS. 2021

  View details for DOI 10.1161/hyp.78.suppl_1.P120

  View details for Web of Science ID 000714476600150

• Disparity in the Setting of Incident Heart Failure Diagnosis. Circulation. Heart failure Sandhu, A. T., Tisdale, R. L., Rodriguez, F., Stafford, R. S., Maron, D. J., Hernandez-Boussard, T., Lewis, E., Heidenreich, P. A. 2021: CIRCHEARTFAILURE121008538

  Abstract

  BACKGROUND: Early heart failure (HF) recognition can reduce morbidity, yet HF is often initially diagnosed only after a patient clinically worsens. We sought to identify characteristics that predict diagnosis in the acute care setting versus the outpatient setting.METHODS: We estimated the proportion of incident HF diagnosed in the acute care setting (inpatient hospital or emergency department) versus outpatient setting based on diagnostic codes from a claims database covering commercial insurance and Medicare Advantage between 2003 and 2019. After excluding new-onset HF potentially caused by a concurrent acute cause (eg, acute myocardial infarction), we identified demographic, clinical, and socioeconomic predictors of diagnosis setting. Patients were linked to their primary care clinicians to evaluate diagnosis setting variation across clinicians.RESULTS: Of 959 438 patients with new HF, 38% were diagnosed in acute care. Of these, 46% had potential HF symptoms in the prior 6 months. Over time, the relative odds of acute care diagnosis increased by 3.2% annually after adjustment for patient characteristics (95% CI, 3.1%-3.3%). Acute care diagnosis setting was more likely for women compared with men (adjusted odds ratio, 1.11 [95% CI, 1.10-1.12]) and for Black patients compared with White patients (adjusted odds ratio, 1.18 [95% CI, 1.16-1.19]). The proportion of acute care diagnosis varied substantially (interquartile range: 24%-39%) among clinicians after adjusting for patient-level risk factors.CONCLUSIONS: A large proportion of first HF diagnoses occur in the acute care setting, particularly among women and Black patients, yet many had potential HF symptoms in the months before acute care visits. These results raise concerns that many HF diagnoses are missed in the outpatient setting. Earlier diagnosis could allow for timelier high-value interventions, addressing disparities and reducing the progression of HF.

  View details for DOI 10.1161/CIRCHEARTFAILURE.121.008538

  View details for PubMedID 34311559

• Repeated cross-sectional analysis of hydroxychloroquine deimplementation in the AHA COVID-19 CVD Registry. Scientific reports Bradley, S. M., Emmons-Bell, S., Mutharasan, R. K., Rodriguez, F., Gupta, D., Roth, G., Gluckman, T. J., Shah, R. U., Wang, T. Y., Khera, R., Peterson, P. N., Das, S. 2021; 11 (1): 15097

  Abstract

  There is little data describing trends in the use of hydroxychloroquine for COVID-19 following publication of randomized trials that failed to demonstrate a benefit of this therapy. We identified 13,957 patients admitted for active COVID-19 at 85 U.S. hospitals participating in a national registry between March 1 and August 31, 2020. The overall proportion of patients receiving hydroxychloroquine peaked at 55.2% in March and April and decreased to 4.8% in May and June and 0.8% in July and August. At the hospital-level, median use was 59.4% in March and April (IQR 48.5-71.5%, range 0-100%) and decreased to 0.3% (IQR 0-5.4%, range 0-100%) by May and June and 0% (IQR 0-1.3%, range 0-36.4%) by July and August. The rate and hospital-level uniformity in deimplementation of this ineffective therapy for COVID-19 reflects a rapid response to evolving clinical information and further study may offer strategies to inform deimplementation of ineffective clinical care.

  View details for DOI 10.1038/s41598-021-94203-7

  View details for PubMedID 34302004

• Real-World Diagnosis and Treatment of Diabetic Kidney Disease. Advances in therapy Rodriguez, F., Lee, D. J., Gad, S. S., Santos, M. P., Beetel, R. J., Vasey, J., Bailey, R. A., Patel, A., Blais, J., Weir, M. R., Dash, R. 2021

  Abstract

  INTRODUCTION: People with type2 diabetes mellitus (T2DM) and diabetic kidney disease (DKD) have increased morbidity and mortality risk. Angiotensin-converting enzyme inhibitors (ACEi) or angiotensinII receptor blockers (ARB) are recommended to slow kidney function decline in DKD. This representative, real-world data analysis of patients with T2DM was performed to detect onset of DKD and determine methods and timing of DKD diagnosis and time to initiation of ACEi/ARB therapy.METHODS: Patients diagnosed with T2DM before January1, 2016 who developed DKD between January1, 2017 and June30, 2019 were identified from a longitudinal ambulatory electronic health record (EHR) dataset (Veradigm Inc). Each record was analyzed using the CLinical INTelligence engine (CLINT, HealthPals, Inc.) to identify delays and gaps in diagnosing DKD. DKD was diagnosed through two reduced estimated glomerular filtration rate (eGFR; <60mL/min/1.73m2) measurements at least 90days apart, a single elevated urine albumin-to-creatinine ratio (UACR; >30mg/g) measurement, or ICD-9/10 diagnosis codes for DKD and/or albuminuria. Time to diagnose (TTD), time to treat (TTT), and diagnosis to treatment time were assessed.RESULTS: Of 6,499,409 patients with T2DM before January 2016, 245,978 developed DKD between January1, 2017 and June30, 2019. In this DKD cohort, ca. 50% were first identified through EHR diagnosis and ca. 50% by UACR or eGFR lab-based diagnosis. In patients who had UACR/eGFR assessed, more than 90% exhibited DKD-level results on the first diagnostic test. Average TTD after eGFR labs was 2years; average TTT with ACEi/ARB was 6-9months after DKD lab evidence. The majority of patients who developed DKD received ACEi/ARB therapy 6-7months after diagnosis.CONCLUSION: In a contemporary, large national cohort of patients with T2DM, progression to DKD was common but likely underrepresented. The low rate of DKD-screening labs, along with sizable delays in diagnosis of DKD and initiation of ACEi/ARB therapy, indicates that many patients who progress to DKD are not being properly treated.

  View details for DOI 10.1007/s12325-021-01777-9

  View details for PubMedID 34254257

• Prevalence and Determinants of Difficulty in Accessing Medical Care in U.S. Adults. American journal of preventive medicine Al Rifai, M., Mahtta, D., Kherallah, R., Kianoush, S., Liu, J., Rodriguez, F., Nasir, K., Valero, J., Khan, S. U., Ballantyne, C., Petersen, L. A., Virani, S. S. 2021

  Abstract

  INTRODUCTION: Ensuring adequate access to health care is essential for timely delivery of preventive services. It is important to evaluate the prevalence and determinants of difficulty in accessing medical care in the overall U.S. population and among those with high-risk chronic conditions.METHODS: The study utilized cross-sectional data from the 2016-2019 Behavioral Risk Factor Surveillance System, a nationally representative telephone-based survey of adults aged ≥18 years. The prevalence and sociodemographic characteristics associated with difficulty in receiving medical care were assessed, including regional variations across U.S. states.RESULTS: The prevalence of difficulty in accessing medical care was 14% overall, 15% among those with hypertension, 15% among those with diabetes mellitus, and 17% among those with atherosclerotic cardiovascular disease. Age 18-34 years, having less than high school education, having annual household income <$75,000, unemployment, and living in a state without Medicaid expansion were all associated with a higher risk of not accessing medical care. The prevalence of difficulty in accessing medical care was 27% among individuals with ≥3 of these sociodemographic characteristics. There was regional variation across the U.S. states in the distribution of difficulty in accessing medical care with a median of 13.6% (IQR=11.3%-15.9%) for the overall population: 16.3% (IQR=14.1%-19.0%) among those living in states without Medicaid expansion versus 12.7% (IQR=10.9%-15.6%) among those living in states with Medicaid expansion (p=0.01).CONCLUSIONS: In total, 1 in 7 adults report difficulty in accessing medical care. This prevalence is nearly 1 in 4 adults with ≥3 sociodemographic characteristics related to difficulty in accessing medical care. There are regional variations in the distribution of the difficulty in accessing medical care, especially among individuals living in states that have not undergone Medicaid expansion.

  View details for DOI 10.1016/j.amepre.2021.03.026

  View details for PubMedID 34229931

• Increases in SARS-CoV-2 Test Positivity Rates Among Hispanic People in a Northern California Health System. Public health reports (Washington, D.C. : 1974) Rodriguez, F., Coquet, J., Harrington, R., Hernandez-Boussard, T. 2021: 333549211026778

  Abstract

  Racial/ethnic minority groups are disproportionately affected by the COVID-19 pandemic. We examined ethnic differences in SARS-CoV-2 testing patterns and positivity rates in a large health care system in Northern California. The study population included patients tested for SARS-CoV-2 from March 4, 2020, through January 12, 2021, at Stanford Health Care. We used adjusted hierarchical logistic regression models to identify factors associated with receiving a positive test result. During the study period, 282 916 SARS-CoV-2 tests were administered to 179 032 unique patients, 32 766 (18.3%) of whom were Hispanic. Hispanic patients were 3 times more likely to receive a positive test result than patients in other racial/ethnic groups (odds ratio = 3.16; 95% CI, 3.00-3.32). The rate of receiving a positive test result for SARS-CoV-2 among Hispanic patients increased from 5.4% in mid-March to 15.7% in mid-July, decreased to 3.9% in mid-October, and increased to 21.2% toward the end of December. Hispanic patients were more likely than non-Hispanic patients to receive a positive test result for SARS-CoV-2, with increasing trends during regional surges. The disproportionate and growing overrepresentation of Hispanic people receiving a positive test result for SARS-CoV-2 demonstrates the need to focus public health prevention efforts on these communities.

  View details for DOI 10.1177/00333549211026778

  View details for PubMedID 34161176

• Diverse Racial/Ethnic Group Underreporting and Underrepresentation in High-Impact Cholesterol Treatment Trials. Circulation Sarraju, A., Valencia, A., Knowles, J. W., Maron, D. J., Rodriguez, F. 2021; 143 (24): 2409-2411

  View details for DOI 10.1161/CIRCULATIONAHA.120.050034

  View details for PubMedID 34125567

• Analysis of Female Enrollment and Participant Sex by Burden of Disease in US Clinical Trials Between 2000 and 2020. JAMA network open Steinberg, J. R., Turner, B. E., Weeks, B. T., Magnani, C. J., Wong, B. O., Rodriguez, F., Yee, L. M., Cullen, M. R. 2021; 4 (6): e2113749

  Abstract

  Importance: Although female representation has increased in clinical trials, little is known about how clinical trial representation compares with burden of disease or is associated with clinical trial features, including disease category.Objective: To describe the rate of sex reporting (ie, the presence of clinical trial data according to sex), compare the female burden of disease with the female proportion of clinical trial enrollees, and investigate the associations of disease category and clinical trial features with the female proportion of clinical trial enrollees.Design, Setting, and Participants: This cross-sectional study included descriptive analyses and logistic and generalized linear regression analyses with a logit link. Data were downloaded from the Aggregate Analysis of ClinicalTrials.gov database for all studies registered between March 1, 2000, and March 9, 2020. Enrollment was compared with data from the 2016 Global Burden of Disease database. Of 328 452 clinical trials, 70 095 were excluded because they had noninterventional designs, 167 936 because they had recruitment sites outside the US, 69 084 because they had no reported results, 1003 because they received primary funding from the US military, and 314 because they had unclear sex categories. A total of 20 020 interventional studies enrolling approximately5.11 million participants met inclusion criteria and were divided into those with and without data on participant sex.Exposures: The primary exposure variable was clinical trial disease category. Secondary exposure variables included funding, study design, and study phase.Main Outcomes and Measures: Sex reporting and female proportion of participants in clinical trials.Results: Among 20 020 clinical trials from 2000 to 2020, 19 866 studies (99.2%) reported sex, and 154 studies (0.8%) did not. Clinical trials in the fields of oncology (46% of disability-adjusted life-years [DALYs]; 43% of participants), neurology (56% of DALYs; 53% of participants), immunology (49% of DALYs; 46% of participants), and nephrology (45% of DALYs; 42% of participants) had the lowest female representation relative to corresponding DALYs. Male participants were underrepresented in 8 disease categories, with the greatest disparity in clinical trials of musculoskeletal disease and trauma (11.3% difference between representation and proportion of DALYs). Clinical trials of preventive interventions were associated with greater female enrollment (adjusted relative difference, 8.48%; 95% CI, 3.77%-13.00%). Clinical trials in cardiology (adjusted relative difference, -18.68%; 95% CI, -22.87% to -14.47%) and pediatrics (adjusted relative difference, -20.47%; 95% CI, -25.77% to -15.16%) had the greatest negative association with female enrollment.Conclusions and Relevance: In this study, sex differences in clinical trials varied by clinical trial disease category, with male and female participants underrepresented in different medical fields. Although sex equity has progressed, these findings suggest that sex bias in clinical trials persists within medical fields, with negative consequences for the health of all individuals.

  View details for DOI 10.1001/jamanetworkopen.2021.13749

  View details for PubMedID 34143192

• Automated coronary calcium scoring using deep learning with multicenter external validation. NPJ digital medicine Eng, D., Chute, C., Khandwala, N., Rajpurkar, P., Long, J., Shleifer, S., Khalaf, M. H., Sandhu, A. T., Rodriguez, F., Maron, D. J., Seyyedi, S., Marin, D., Golub, I., Budoff, M., Kitamura, F., Takahashi, M. S., Filice, R. W., Shah, R., Mongan, J., Kallianos, K., Langlotz, C. P., Lungren, M. P., Ng, A. Y., Patel, B. N. 2021; 4 (1): 88

  Abstract

  Coronary artery disease (CAD), the most common manifestation of cardiovascular disease, remains the most common cause of mortality in the United States. Risk assessment is key for primary prevention of coronary events and coronary artery calcium (CAC) scoring using computed tomography (CT) is one such non-invasive tool. Despite the proven clinical value of CAC, the current clinical practice implementation for CAC has limitations such as the lack of insurance coverage for the test, need for capital-intensive CT machines, specialized imaging protocols, and accredited 3D imaging labs for analysis (including personnel and software). Perhaps the greatest gap is the millions of patients who undergo routine chest CT exams and demonstrate coronary artery calcification, but their presence is not often reported or quantitation is not feasible. We present two deep learning models that automate CAC scoring demonstrating advantages in automated scoring for both dedicated gated coronary CT exams and routine non-gated chest CTs performed for other reasons to allow opportunistic screening. First, we trained a gated coronary CT model for CAC scoring that showed near perfect agreement (mean difference in scores=-2.86; Cohen's Kappa=0.89, P<0.0001) with current conventional manual scoring on a retrospective dataset of 79 patients and was found to perform the task faster (average time for automated CAC scoring using a graphics processing unit (GPU) was 3.5±2.1s vs. 261s for manual scoring) in a prospective trial of 55 patients with little difference in scores compared to three technologists (mean difference in scores=3.24, 5.12, and 5.48, respectively). Then using CAC scores from paired gated coronary CT as a reference standard, we trained a deep learning model on our internal data and a cohort from the Multi-Ethnic Study of Atherosclerosis (MESA) study (total training n=341, Stanford test n=42, MESA test n=46) to perform CAC scoring on routine non-gated chest CT exams with validation on external datasets (total n=303) obtained from four geographically disparate health systems. On identifying patients with any CAC (i.e., CAC≥1), sensitivity and PPV was high across all datasets (ranges: 80-100% and 87-100%, respectively). For CAC≥100 on routine non-gated chest CTs, which is the latest recommended threshold to initiate statin therapy, our model showed sensitivities of 71-94% and positive predictive values in the range of 88-100% across all the sites. Adoption of this model could allow more patients to be screened with CAC scoring, potentially allowing opportunistic early preventive interventions.

  View details for DOI 10.1038/s41746-021-00460-1

  View details for PubMedID 34075194

• Racial and Ethnic Disparities in Cardio-Oncology: A Call to Action. JACC. CardioOncology Fazal, M., Malisa, J., Rhee, J. W., Witteles, R. M., Rodriguez, F. 2021; 3 (2): 201-204

  View details for DOI 10.1016/j.jaccao.2021.05.001

  View details for PubMedID 34308372

  View details for PubMedCentralID PMC8301207

• Health disparities in cardiometabolic risk among Black and Hispanic youth in the United States. American journal of preventive cardiology Katz, S. F., Rodriguez, F., Knowles, J. W. 2021; 6: 100175

  Abstract

  Cardiometabolic risk factors in children and adolescents track into adulthood and are associated with increased risk of atherosclerotic cardiovascular disease. The purpose of this review is to examine the pervasive race and ethnic disparities in cardiometabolic risk factors among Black and Hispanic youth in the United States. We focus on three traditional cardiometabolic risk factors (obesity, type 2 diabetes mellitus, and dyslipidemia) as well as on the emerging cardiometabolic risk factor of non-alcoholic fatty liver disease. Additionally, we highlight interventions aimed at improving cardiometabolic health among these minority pediatric populations. Finally, we advocate for continued research on effective prevention strategies to reduce cardiometabolic risk and avert further disparities in cardiovascular morbidity and mortality.

  View details for DOI 10.1016/j.ajpc.2021.100175

  View details for PubMedID 34327498

• Racial and Ethnic Disparities in Cardio-Oncology A Call to Action JACC: CARDIOONCOLOGY Fazal, M., Malisa, J., Rhee, J., Witteles, R. M., Rodriguez, F. 2021; 3 (2): 201-204

  View details for DOI 10.1016/j.jaccao.2021.05.001

  View details for Web of Science ID 000662265700003

• Racial and Ethnic Disparities in Heart and Cerebrovascular Disease Deaths During the COVID-19 Pandemic in the United States. Circulation Wadhera, R., Figueroa, J. F., Rodriguez, F., Liu, M., Tian, W., Kazi, D. S., Song, Y., Yeh, R. W., Joynt Maddox, K. E. 2021

  Abstract

  Background: Cardiovascular deaths increased during the early phase of the COVID-19 pandemic in the United States. However, it is unclear whether racial/ethnic minorities have experienced a disproportionate rise in heart disease and cerebrovascular disease deaths. Methods: We used the National Center for Health Statistics to identify heart disease and cerebrovascular disease deaths for non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, and Hispanic individuals from March-August 2020 (pandemic period), as well as for the corresponding months in 2019 (historical control). We determined the age- and sex-standardized deaths per million by race/ethnicity for each year. We then fit a modified Poisson model with robust standard errors to compare change in deaths by race/ethnicity for each condition in 2020 vs. 2019. Results: There were a total of 339,076 heart disease and 76,767 cerebrovascular disease deaths from March through August 2020, compared to 321,218 and 72,190 deaths during the same months in 2019. Heart disease deaths increased during the pandemic in 2020, compared with the corresponding period in 2019, for non-Hispanic White (age-sex standardized deaths per million, 1234.2 vs. 1208.7; risk ratio for death [RR] 1.02, 95% CI 1.02-1.03), non-Hispanic Black (1783.7 vs. 1503.8; RR 1.19, 1.17-1.20), non-Hispanic Asian (685.7 vs. 577.4; RR 1.19, 1.15-1.22), and Hispanic (968.5 vs. 820.4, RR 1.18, 1.16-1.20) populations. Cerebrovascular disease deaths also increased for non-Hispanic White (268.7 vs. 258.2; RR 1.04, 95% CI 1.03-1.05), non-Hispanic Black (430.7 vs. 379.7; RR 1.13, 95% CI 1.10-1.17), non-Hispanic Asian (236.5 vs. 207.4; RR 1.15, 1.09-1.21), and Hispanic (264.4 vs. 235.9; RR 1.12, 1.08-1.16) populations. For both heart disease and cerebrovascular disease deaths, each racial and ethnic minority group experienced a larger relative increase in deaths than the non-Hispanic White population (interaction term, p<0.001). Conclusions: During the COVID-19 pandemic in the US, Black, Hispanic, and Asian populations experienced a disproportionate rise in deaths due to heart disease and cerebrovascular disease, suggesting that racial/ethnic minorities have been most impacted by the indirect effects of the pandemic. Public health and policy strategies are needed to mitigate the short- and long-term adverse effects of the pandemic on the cardiovascular health of minority populations.

  View details for DOI 10.1161/CIRCULATIONAHA.121.054378

  View details for PubMedID 34000814

• Antithrombotic Therapy after Acute Coronary Syndromes REPLY NEW ENGLAND JOURNAL OF MEDICINE Rodriguez, F., Harrington, R. A. 2021; 384 (19): 1873-1874

  View details for Web of Science ID 000651509400029

• PREDICTORS OF SETTING OF HEART FAILURE DIAGNOSIS Tisdale, R., Stafford, R., Maron, D., Hernandez-Boussard, T., Rodriguez, F., Heidenreich, P., Sandhu, A. ELSEVIER SCIENCE INC. 2021: 676

  View details for Web of Science ID 000647487500675

• COUNTY- LEVEL RISK FACTORS ASSOCIATED WITH RACE/ETHNICITY-SPECIFIC HEART FAILURE MORTALITY Blumer, V., Parizo, J., Sarraju, A., Rodriguez, F. ELSEVIER SCIENCE INC. 2021: 545

  View details for Web of Science ID 000647487500545

• GENDER DISPARITIES IN CARDIOLOGY-RELATED COVID-19 PUBLICATIONS Vasti, E., Ouyang, D., Ngo, S., Harrington, R., Rodriguez, F. ELSEVIER SCIENCE INC. 2021: 3105

  View details for Web of Science ID 000647487503129

• IDENTIFYING REASONS FOR STATIN NONADHERENCE IN A DIVERSE, REAL-WORLD POPULATION USING ELECTRONIC HEALTH RECORDS AND NATURAL LANGUAGE PROCESSING Sarraju, A., Coquet, J., Chan, A., Ngo, S., Lossio-Ventura, J., Hernandez-Boussard, T., Rodriguez, F. ELSEVIER SCIENCE INC. 2021: 1665

  View details for Web of Science ID 000647487501671

• Trends in Patient Characteristics and COVID-19 In-Hospital Mortality in the United States During the COVID-19 Pandemic. JAMA network open Roth, G. A., Emmons-Bell, S., Alger, H. M., Bradley, S. M., Das, S. R., de Lemos, J. A., Gakidou, E., Elkind, M. S., Hay, S., Hall, J. L., Johnson, C. O., Morrow, D. A., Rodriguez, F., Rutan, C., Shakil, S., Sorensen, R., Stevens, L., Wang, T. Y., Walchok, J., Williams, J., Murray, C. 2021; 4 (5): e218828

  Abstract

  Importance: In-hospital mortality rates from COVID-19 are high but appear to be decreasing for selected locations in the United States. It is not known whether this is because of changes in the characteristics of patients being admitted.Objective: To describe changing in-hospital mortality rates over time after accounting for individual patient characteristics.Design, Setting, and Participants: This was a retrospective cohort study of 20 736 adults with a diagnosis of COVID-19 who were included in the US American Heart Association COVID-19 Cardiovascular Disease Registry and admitted to 107 acute care hospitals in 31 states from March through November 2020. A multiple mixed-effects logistic regression was then used to estimate the odds of in-hospital death adjusted for patient age, sex, body mass index, and medical history as well as vital signs, use of supplemental oxygen, presence of pulmonary infiltrates at admission, and hospital site.Main Outcomes and Measures: In-hospital death adjusted for exposures for 4 periods in 2020.Results: The registry included 20 736 patients hospitalized with COVID-19 from March through November 2020 (9524 women [45.9%]; mean [SD] age, 61.2 [17.9] years); 3271 patients (15.8%) died in the hospital. Mortality rates were 19.1% in March and April, 11.9% in May and June, 11.0% in July and August, and 10.8% in September through November. Compared with March and April, the adjusted odds ratios for in-hospital death were significantly lower in May and June (odds ratio, 0.66; 95% CI, 0.58-0.76; P<.001), July and August (odds ratio, 0.58; 95% CI, 0.49-0.69; P<.001), and September through November (odds ratio, 0.59; 95% CI, 0.47-0.73).Conclusions and Relevance: In this cohort study, high rates of in-hospital COVID-19 mortality among registry patients in March and April 2020 decreased by more than one-third by June and remained near that rate through November. This difference in mortality rates between the months of March and April and later months persisted even after adjusting for age, sex, medical history, and COVID-19 disease severity and did not appear to be associated with changes in the characteristics of patients being admitted.

  View details for DOI 10.1001/jamanetworkopen.2021.8828

  View details for PubMedID 33938933

• Impact of HIV Infection on COVID-19 Outcomes Among Hospitalized Adults in the U.S. medRxiv : the preprint server for health sciences Durstenfeld, M. S., Sun, K., Ma, Y., Rodriguez, F., Secemsky, E. A., Parikh, R. V., Hsue, P. Y. 2021

  Abstract

  Whether HIV infection is associated with differences in clinical outcomes among people hospitalized with COVID-19 is uncertain.To evaluate the impact of HIV infection on COVID-19 outcomes among hospitalized patients.Using the American Heart Association's COVID-19 Cardiovascular Disease registry, we used hierarchical mixed effects models to assess the association of HIV with in-hospital mortality accounting for patient demographics and comorbidities and clustering by hospital. Secondary outcomes included major adverse cardiac events (MACE), severity of illness, and length of stay (LOS).The registry included 21,528 hospitalization records of people with confirmed COVID-19 from 107 hospitals in 2020, including 220 people living with HIV (PLWH). PLWH were younger (56.0+/-13.0 versus 61.3+/-17.9 years old) and more likely to be male (72.3% vs 52.7%), Non-Hispanic Black (51.4% vs 25.4%), on Medicaid (44.5% vs 24.5), and active tobacco users (12.7% versus 6.5%).Of the study population, 36 PLWH (16.4%) had in-hospital mortality compared with 3,290 (15.4%) without HIV (Risk ratio 1.06, 95%CI 0.79-1.43; risk difference 0.9%, 95%CI -4.2 to 6.1%; p=0.71). After adjustment for age, sex, race, and insurance, HIV was not associated with in-hospital mortality (aOR 1.13; 95%CI 0.77-1.6; p 0.54) even after adding body mass index and comorbidities (aOR 1.15; 95%CI 0.78-1.70; p=0.48). HIV was not associated with MACE (aOR 0.99, 95%CI 0.69-1.44, p=0.91), severity of illness (aOR 0.96, 95%CI 0.62-1.50, p=0.86), or LOS (aOR 1.03; 95% CI 0.76-1.66, p=0.21).HIV was not associated with adverse outcomes of COVID-19 including in-hospital mortality, MACE, or severity of illness.

  View details for DOI 10.1101/2021.04.05.21254938

  View details for PubMedID 33851188

  View details for PubMedCentralID PMC8043485

• Racial and Ethnic Disparities in Household Contact with Individuals at Higher Risk of Exposure to COVID-19. Journal of general internal medicine Kong, S. T., Lee, R. Y., Rodriguez, F., Scheinker, D. 2021

  View details for DOI 10.1007/s11606-021-06656-1

  View details for PubMedID 33674919

• County-Level Factors Associated With Cardiovascular Mortality by Race/Ethnicity. Journal of the American Heart Association Zuma, B. Z., Parizo, J. T., Valencia, A., Spencer-Bonilla, G., Blum, M. R., Scheinker, D., Rodriguez, F. 2021: e018835

  Abstract

  Background Persistent racial/ethnic disparities in cardiovascular disease (CVD) mortality are partially explained by healthcare access and socioeconomic, demographic, and behavioral factors. Little is known about the association between race/ethnicity-specific CVD mortality and county-level factors. Methods and Results Using 2017 county-level data, we studied the association between race/ethnicity-specific CVD age-adjusted mortality rate (AAMR) and county-level factors (demographics, census region, socioeconomics, CVD risk factors, and healthcare access). Univariate and multivariable linear regressions were used to estimate the association between these factors; R2 values were used to assess the factors that accounted for the greatest variation in CVD AAMR by race/ethnicity (non-Hispanic White, non-Hispanic Black, and Hispanic/Latinx individuals). There were 659740 CVD deaths among non-Hispanic White individuals in 2698 counties; 100475 deaths among non-Hispanic Black individuals in 717 counties; and 49493 deaths among Hispanic/Latinx individuals across 267 counties. Non-Hispanic Black individuals had the highest mean CVD AAMR (320.04 deaths per 100000 individuals), whereas Hispanic/Latinx individuals had the lowest (168.42 deaths per 100000 individuals). The highest CVD AAMRs across all racial/ethnic groups were observed in the South. In unadjusted analyses, the greatest variation (R2) in CVD AAMR was explained by physical inactivity for non-Hispanic White individuals (32.3%), median household income for non-Hispanic Black individuals (24.7%), and population size for Hispanic/Latinx individuals (28.4%). In multivariable regressions using county-level factor categories, the greatest variation in CVD AAMR was explained by CVD risk factors for non-Hispanic White individuals (35.3%), socioeconomic factors for non-Hispanic Black (25.8%), and demographic factors for Hispanic/Latinx individuals (34.9%). Conclusions The associations between race/ethnicity-specific age-adjusted CVD mortality and county-level factors differ significantly. Interventions to reduce disparities may benefit from being designed accordingly.

  View details for DOI 10.1161/JAHA.120.018835

  View details for PubMedID 33653083

• Risk factor control across the spectrum of cardiovascular risk: Findings from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). American journal of preventive cardiology Rodriguez, F., Lee, U. J., Barone, N., Swett, K., Lopez, L., Cheng, S., Daviglus, M. L., Hanna, D. B., Espinoza Giacinto, R. A., Arguelles, W., Cai, J., Talavera, G. A., Rodriguez, C. J. 2021; 5: 100147

  Abstract

  Background: Presence of cardiovascular disease (CVD) risk factors (RFs) should prompt patients and their providers to work aggressively towards controlling those that are modifiable. The extent to which a greater CVD RF burden is related to CVD RF control in a contemporary and diverse Hispanic/Latino population is not well-understood.Methods: Using multicenter community-based data from the Hispanic Community Health Study/Study of Latinos, we assessed the self-reported prevalence of hypertension, hypercholesterolemia, diabetes, and prevalent CVD (ischemic heart disease or stroke). We used contemporaneous guidelines to define RF control. Multivariable logistic regression for complex survey sampling was used to examine whether having more CVD RFs was associated with CVD RF control (adjusting for age, sex, Hispanic background group, education, and health insurance).Results: Our sample included 8521 participants with at least one CVD RF or prevalent CVD. The mean age in HCHS/SOL target population was 49 (SE 0.3) years and 56% were women. Frequency of one, two, or three self-reported CVD RFs was 57%, 26%, 8%, respectively, and overall 9% of participants had prevalent CVD. After adjusting for sociodemographic factors, compared to those reporting one CVD RF, individuals with three CVD RFs were the least likely to have blood pressure, cholesterol, and glucose optimally controlled (odds ratio [OR]: 0.56; 95% confidence interval [CI]: 0.40-0.80). However, those with prevalent CVD were more likely to have all three risk factors controlled, (OR: 1.43; 95% CI: 1.01-2.01).Conclusion: Hispanic/Latino adults with three major CVD RFs represent a group with poor overall CVD RF control. Secondary CVD prevention fares better. The potential contributors to inadequate CVD RF control in this highly vulnerable group warrants further investigation.

  View details for DOI 10.1016/j.ajpc.2021.100147

  View details for PubMedID 34327490

• Wilderness Cardiology: A Case of Envenomation-Associated Cardiotoxicity Following a Rattlesnake Bite. Cardiology and therapy Slade, J., Baja, A., Al Zaki, A., Auerbach, P., Rodriguez, F. 2021

  Abstract

  Cardiac injury is infrequently described as a complication of snake bite envenomation. We present the case of a 62-year-old male with shortness of breath, right lower extremity edema, and elevated cardiac troponin 6 days after a Northern Pacific rattlesnake bite.

  View details for DOI 10.1007/s40119-021-00215-9

  View details for PubMedID 33620669

• Educational Attainment and Prevalence of Cardiovascular Health (Life's Simple 7) in Asian Americans. International journal of environmental research and public health Alam, M. T., Echeverria, S. E., DuPont-Reyes, M. J., Vasquez, E., Murillo, R., Gonzalez, T., Rodriguez, F. 2021; 18 (4)

  Abstract

  Asian Americans have a high burden of cardiovascular disease, yet little is known about the social patterning of cardiovascular health (CVH) in this population. We examined if education (10+ years, and 15.9% for the U.S.-born. All models showed that low education compared to high education was associated with lower odds of having ideal CVH. This pattern remained in adjusted models but became non-significant when controlling for nativity (odds ratio = 0.34, 95% confidence interval: 0.10, 1.13). Models stratified by time in the U.S. were less consistent but showed similar education gradients in CVH. Low education is a risk factor for attaining ideal cardiovascular health among Asian Americans, regardless of time in the U.S.

  View details for DOI 10.3390/ijerph18041480

  View details for PubMedID 33557415

• The Hispanic paradox in the prevalence of obesity at the county-level. Obesity science & practice Valencia, A., Zuma, B. Z., Spencer-Bonilla, G., López, L., Scheinker, D., Rodriguez, F. 2021; 7 (1): 14-24

  Abstract

  The percentage of Hispanics in a county has a negative association with prevalence of obesity. Because Hispanic individuals are unevenly distributed in the United States, this study examined whether this protective association persists when stratifying counties into quartiles based on the size of the Hispanic population and after adjusting for county-level demographic, socioeconomic, healthcare, and environmental factors.Data were extracted from the 2018 Robert Wood Johnson Foundation County Health Rankings. Counties were categorized into quartiles based on their percentage of Hispanics, 0%-5% (n = 1794), 5%-20% (n = 962), 20%-50% (n = 283), and >50% (n = 99). For each quartile, univariate and multivariate regression models were used to evaluate the association between prevalence of obesity and demographic, socioeconomic, healthcare, and environmental factors.Counties with the top quartile of Hispanic individuals had the lowest prevalence of obesity compared to counties at the bottom quartile (28.4 ± 3.6% vs. 32.7 ± 4.0%). There was a negative association between county-level percentage of Hispanics and prevalence of obesity in unadjusted analyses that persisted after adjusting for all county-level factors.Counties with a higher percentage of Hispanics have lower levels of obesity, even after controlling for demographic, socioeconomic, healthcare, and environmental factors. More research is needed to elucidate why having more Hispanics in a county may be protective against county-level obesity.

  View details for DOI 10.1002/osp4.461

  View details for PubMedID 33680488

  View details for PubMedCentralID PMC7909595

• Genetics of 35 blood and urine biomarkers in the UK Biobank. Nature genetics Sinnott-Armstrong, N., Tanigawa, Y., Amar, D., Mars, N., Benner, C., Aguirre, M., Venkataraman, G. R., Wainberg, M., Ollila, H. M., Kiiskinen, T., Havulinna, A. S., Pirruccello, J. P., Qian, J., Shcherbina, A., FinnGen, Rodriguez, F., Assimes, T. L., Agarwala, V., Tibshirani, R., Hastie, T., Ripatti, S., Pritchard, J. K., Daly, M. J., Rivas, M. A. 2021

  Abstract

  Clinical laboratory tests are a critical component of the continuum of care. We evaluate the genetic basis of 35 blood and urine laboratory measurements in the UK Biobank (n=363,228 individuals). We identify 1,857 loci associated with at least one trait, containing 3,374 fine-mapped associations and additional sets of large-effect (>0.1s.d.) protein-altering, human leukocyte antigen (HLA) and copy number variant (CNV) associations. Through Mendelian randomization (MR) analysis, we discover 51 causal relationships, including previously known agonistic effects of urate on gout and cystatin C on stroke. Finally, we develop polygenic risk scores (PRSs) for each biomarker and build 'multi-PRS' models for diseases using 35 PRSs simultaneously, which improved chronic kidney disease, type 2 diabetes, gout and alcoholic cirrhosis genetic risk stratification in an independent dataset (FinnGen; n=135,500) relative to single-disease PRSs. Together, our results delineate the genetic basis of biomarkers and their causal influences on diseases and improve genetic risk stratification for common diseases.

  View details for DOI 10.1038/s41588-020-00757-z

  View details for PubMedID 33462484

• Statin Use in Older Adults with Stable Atherosclerotic Cardiovascular Disease. Journal of the American Geriatrics Society Spencer-Bonilla, G., Chung, S., Sarraju, A., Heidenreich, P., Palaniappan, L., Rodriguez, F. 2021

  Abstract

  BACKGROUND/OBJECTIVES: Older adults (>75years of age) represent two-thirds of atherosclerotic cardiovascular disease (ASCVD) deaths. The 2013 and 2018 American multi-society cholesterol guidelines recommend using at least moderate intensity statins for older adults with ASCVD. We examined annual trends and statin prescribing patterns in a multiethnic population of older adults with ASCVD.DESIGN: Retrospective longitudinal study using electronic health record (EHR) data from 2007 to 2018.SETTING: A large multi-specialty health system in Northern California.PARTICIPANTS: A total of 24,651 adults older than 75years with ASCVD.MEASUREMENTS: Statin prescriptions for older adults with known ASCVD were trended over time. Multivariable regression models were used to identify predictors of statin prescription (logistic) after controlling for relevant demographic and clinical factors.RESULTS: The study cohort included 24,651 patients older than 75years; 48% were women. Although prescriptions for moderate/high intensity statins increased over time for adults over 75, fewer than half of the patients (45%) received moderate/high intensity statins in 2018. Women (odds ratio (OR) = 0.77; 95% confidence interval (CI) = 0.74, 0.80), patients who had heart failure (OR = 0.69; 95% CI = 0.65, 0.74), those with dementia (OR = 0.88; 95% CI = 0.82, 0.95) and patients who were underweight (OR = 0.64; 95% CI = 0.57, 0.73) were less likely to receive moderate/high intensity statins.CONCLUSIONS: Despite increasing prescription rates between 2007 and 2018, guideline-recommended statins remained underused in older adults with ASCVD, with more pronounced disparities among women and those with certain comorbidities. Future studies are warranted to examine reasons for statin underuse in older adults with ASCVD.

  View details for DOI 10.1111/jgs.16975

  View details for PubMedID 33410499

• Dismantling Structural Discrimination in Cardiology Fellowship Recruitment. JAMA network open Njoroge, J., Rodriguez, F., Albert, M. A. 2021; 4 (1): e2031473

  View details for DOI 10.1001/jamanetworkopen.2020.31473

  View details for PubMedID 33427879

• Management of Antithrombotic Therapy after Acute Coronary Syndromes. The New England journal of medicine Rodriguez, F. n., Harrington, R. A. 2021; 384 (5): 452–60

  View details for DOI 10.1056/NEJMra1607714

  View details for PubMedID 33534976

• Application of the Quadruple Aim to evaluate the operational impact of a telemedicine program. Healthcare (Amsterdam, Netherlands) Kalwani, N. M., Wang, K. M., Johnson, A. N., Deb, J. D., Gold, T., Maddukuri, A. K., Savage, E. G., Parameswaran, V., Dash, R., Scheinker, D., Rodriguez, F. 2021; 9 (4): 100593

  Abstract

  In response to the COVID-19 pandemic, telemedicine utilization has increased dramatically, yet most institutions lack a standardized approach to determine how much to invest in these programs.We used the Quadruple Aim to evaluate the operational impact of CardioClick, a program replacing in-person follow-up visits with video visits in a preventive cardiology clinic. We examined data for 134 patients enrolled in CardioClick with 181 video follow-up visits and 276 patients enrolled in the clinic's traditional prevention program with 694 in-person follow-up visits.Patients in CardioClick and the cohort receiving in-person care were similar in terms of age (43 vs 45 years), gender balance (74% vs 79% male), and baseline clinical characteristics. Video follow-up visits were shorter than in-person visits in terms of clinician time (median 22 vs 30 min) and total clinic time (median 22 vs 68 min). Video visits were more likely to end on time than in-person visits (71 vs 11%, p < .001). Physicians more often completed video visit documentation on the day of the visit (56 vs 42%, p = .002).Implementation of video follow-up visits in a preventive cardiology clinic was associated with operational improvements in the areas of efficiency, patient experience, and clinician experience. These benefits in three domains of the Quadruple Aim justify expanded use of telemedicine at our institution.The Quadruple Aim provides a framework to evaluate telemedicine programs recently implemented in many health systems.Level III (retrospective comparative study).

  View details for DOI 10.1016/j.hjdsi.2021.100593

  View details for PubMedID 34749227

• Heterogeneity, Nativity, and Disaggregation of Cardiovascular Risk and Outcomes in Hispanic Americans CARDIOVASCULAR DISEASE IN RACIAL AND ETHNIC MINORITY POPULATIONS, 2 EDITION Blumer, V., Rodriguez, F., Ferdinand, K. C., Taylor, J., Rodriguez, C. J. 2021: 75-87

  View details for DOI 10.1007/978-3-030-81034-4_8

  View details for Web of Science ID 000868532600009

• Statin Use in Older Adults for Primary Cardiovascular Disease Prevention Across a Spectrum of Cardiovascular Risk. Journal of general internal medicine Sarraju, A., Spencer-Bonilla, G., Chung, S., Gomez, S., Li, J., Heidenreich, P., Palaniappan, L., Rodriguez, F. 2021

  Abstract

  There remains uncertainty regarding optimal primary atherosclerotic cardiovascular disease (ASCVD) prevention practices for older adults.To assess statin treatment patterns and incident ASCVD among older patients for primary prevention across the spectrum of ASCVD risk.Retrospective cohort study of participants without ASCVD aged 65-79 years. Patients were stratified by age (65-69, 70-75, > 75 years) and 10-year ASCVD risk category (low/borderline, intermediate, high) based on the Pooled Cohort Equations. Multivariable logistic regressions were used to identify predictors of moderate- or high-intensity statin prescriptions. Cox proportional models were used to estimate hazard ratios (HRs) for incident ASCVD.Patients aged 65-79 years without ASCVD from a Northern California health system.Statin prescriptions and incident ASCVD events.There were 54,066 patients, with 10,288 (19%) aged > 75 years and 57% women. Compared with younger groups, adults > 75 years were less likely to be prescribed moderate- or high-intensity statin prescriptions across ASCVD risk groups (all p < 0.001); this persisted after multivariable adjustment including for ASCVD risk (odds ratio [OR] 0.80, 95% confidence interval [CI] 0.74-0.86). Adults > 75 years were more likely to experience incident ASCVD (HR 1.42, 95% CI 1.23-1.63). Women (OR 0.85, 95% CI 0.81-0.89) and underweight older adults (OR 0.45, 95% CI 0.33-0.61) were also less likely to receive moderate- or high-intensity statins.Among older adults aged 65-79 years without prior ASCVD, those > 75 years of age were less likely to receive moderate- or high-intensity statins regardless of ASCVD risk compared with their younger counterparts, while experiencing more incident ASCVD. Efforts are warranted to study the reasons for age-based differences in statin use in older adults, particularly those at highest ASCVD risk.

  View details for DOI 10.1007/s11606-021-07107-7

  View details for PubMedID 34505981

• Outcomes in patients hospitalized for COVID-19 among Asian, Pacific Islander, and Hispanic subgroups in the American Heart Association COVID-19 registry. American journal of medicine open Shah, N. S., Giase, G. M., Petito, L. C., Kandula, N. R., Rodriguez, F., Hsu, J. J., Wang, D. R., Khan, S. S. 1800; 1: 100003

  Abstract

  Background: Coronavirus disease 2019 (COVID-19) data from race/ethnic subgroups remain limited, potentially masking subgroup-level heterogeneity. We evaluated differences in outcomes in Asian American/Pacific Islander (AAPI) and Hispanic/Latino subgroups compared with non-Hispanic White patients hospitalized with COVID-19.Methods: In the American Heart Association COVID-19 registry including 105 US hospitals, mortality and major adverse cardiovascular events in adults age ≥18 years hospitalized with COVID-19 between March-November 2020 were evaluated. Race/ethnicity groups included AAPI overall and subgroups (Chinese, Asian Indian, Vietnamese, and Pacific Islander), Hispanic/Latino overall and subgroups (Mexican, Puerto Rican), compared with non-Hispanic White (NHW).Results: Among 13,511 patients, 7% were identified as AAPI (of whom 17% were identified as Chinese, 9% Asian Indian, 8% Pacific Islander, and 7% Vietnamese); 35% as Hispanic (of whom 15% were identified as Mexican and 1% Puerto Rican); and 59% as NHW. Mean [SD] age at hospitalization was lower in Asian Indian (60.4 [17.4] years), Pacific Islander (49.4 [16.7] years), and Mexican patients (57.4 [16.9] years), compared with NHW patients (66.9 [17.3] years, p<0.01). Mean age at death was lower in Mexican (67.7 [15.5] years) compared with NHW patients (75.5 [13.5] years, p<0.01). No differences in odds of mortality or MACE in AAPI or Hispanic patients relative to NHW patients were observed after adjustment for age.Conclusions: Pacific Islander, Asian Indian, and Mexican patients hospitalized with COVID-19 in the AHA registry were significantly younger than NHW patients. COVID-19 infection leading to hospitalization may disproportionately burden some younger AAPI and Hispanic subgroups in the US.

  View details for DOI 10.1016/j.ajmo.2021.100003

  View details for PubMedID 34918003

• Race and Ethnicity Considerations in Patients With Coronary Artery Disease and Stroke: JACC Focus Seminar 3/9. Journal of the American College of Cardiology Mital, R., Bayne, J., Rodriguez, F., Ovbiagele, B., Bhatt, D. L., Albert, M. A. 2021; 78 (24): 2483-2492

  Abstract

  Notable racial and ethnic differences and disparities exist in coronary artery disease (CAD) and stroke epidemiology and outcomes despite substantial advances in these fields. Racial and ethnic minority subgroups remain underrepresented in population data and clinical trials contributing to incomplete understanding of these disparities. Differences in traditional cardiovascular risk factors such as hypertension and diabetes play a role; however, disparities in care provision and process, social determinants of health including socioeconomic position, neighborhood environment, sociocultural factors, and racial discrimination within and outside of the health care system also drive racial and ethnic CAD and stroke disparities. Improved culturally congruent and competent communication about risk factors and symptoms is also needed. Opportunities to achieve improved and equitable outcomes in CAD and stroke must be identified and pursued.

  View details for DOI 10.1016/j.jacc.2021.05.051

  View details for PubMedID 34886970

• Gender Disparities in Cardiology-Related COVID-19 Publications. Cardiology and therapy Vasti, E. C., Ouyang, D., Ngo, S., Sarraju, A., Harrington, R. A., Rodriguez, F. 2021

  Abstract

  Female authors are underrepresented in cardiology journals, although prior work suggested improvement in reducing disparities over time. Early in the recent COVID-19 pandemic, female authorship continued to lag that of their male counterparts despite a surge in publications. The cumulative impact of the COVID-19 pandemic on authorship gender disparities remains unclear. We aimed to characterize gender disparities in COVID-19-related cardiology publications across the duration of the ongoing pandemic.We retrospectively analyzed COVID-19-related research articles published in the top 20 impact factor cardiology journals between March and June 2021. Gender representation data were extracted for any author, first authors, and senior authors.We found that 841 articles were related to COVID-19, with a total of 5586 authors and an average of 42 articles per journal. Less than a third (29.9%) of the total authors from publications were women. Women represented a smaller proportion of first authors (21.3%) and senior authors (16.4%).Female authorship has continued to lag male authorship for the duration of the ongoing COVID-19 pandemic. The pandemic may have impeded progress in reducing gender disparities in academic cardiology publications. The low proportions of first and senior female authors may reflect the impact of the pandemic on women in cardiology in leadership domains.

  View details for DOI 10.1007/s40119-021-00234-6

  View details for PubMedID 34268712

• Antithrombotic Therapy after Acute Coronary Syndromes. Reply. The New England journal of medicine Rodriguez, F. n., Harrington, R. A. 2021; 384 (19): 1873–74

  View details for DOI 10.1056/NEJMc2103789

  View details for PubMedID 33979504

• Worldwide Survey of COVID-19 Associated Arrhythmias. Circulation. Arrhythmia and electrophysiology Coromilas, E. J., Kochav, S. n., Goldenthal, I. n., Biviano, A. n., Garan, H. n., Goldbarg, S. n., Kim, J. H., Yeo, I. n., Tracy, C. n., Ayanian, S. n., Akar, J. n., Singh, A. n., Jain, S. n., Zimerman, L. n., Pimentel, M. n., Osswald, S. n., Twerenbold, R. n., Schaerli, N. n., Crotti, L. n., Fabbri, D. n., Parati, G. n., Li, Y. n., Atienza, F. n., Zatarain, E. n., Tse, G. n., Leung, K. S., Guevara-Valdivia, M. E., Rivera-Santiago, C. A., Soejima, K. n., De Filippo, P. n., Ferrari, P. n., Malanchini, G. n., Kanagaratnam, P. n., Khawaja, S. n., Mikhail, G. W., Scanavacca, M. n., Hajjar, L. A., Rizerio Gomes, B. n., Sacilotto, L. n., Mollazadeh, R. n., Eslami, M. n., Laleh Far, V. n., Mattioli, A. V., Boriani, G. n., Migliore, F. n., Cipriani, A. n., Donato, F. n., Compagnucci, P. n., Casella, M. n., Dello Russo, A. n., Coromilas, J. n., Aboyme, A. n., O'Brien, C. G., Rodriguez, F. n., Wang, P. J., Naniwadekar, A. n., Moey, M. n., Know, C. S., Cheah, W. K., Auricchio, A. n., Conte, G. n., Hwang, J. n., Han, S. n., Lazzerini, P. E., Franchi, F. n., Santoro, A. n., Capecchi, P. L., Joglar, J. A., Rosenblatt, A. G., Zardini, M. n., Bricoli, S. n., Bonura, R. n., Echarte-Morales, J. n., Benito-González, T. n., Minguito-Carazo, C. n., Fernández-Vázquez, F. n., Wan, E. Y. 2021

  Abstract

  Background - COVID-19 has led to over 1 million deaths worldwide and has been associated with cardiac complications including cardiac arrhythmias. The incidence and pathophysiology of these manifestations remain elusive. In this worldwide survey of patients hospitalized with COVID-19 who developed cardiac arrhythmias, we describe clinical characteristics associated with various arrhythmias, as well as global differences in modulations of routine electrophysiology practice during the pandemic. Methods - We conducted a retrospective analysis of patients hospitalized with COVID-19 infection worldwide with and without incident cardiac arrhythmias. Patients with documented atrial fibrillation (AF), atrial flutter (AFL), supraventricular tachycardia (SVT), non-sustained or sustained ventricular tachycardia (VT), ventricular fibrillation (VF), atrioventricular block (AVB), or marked sinus bradycardia (HR<40bpm) were classified as having arrhythmia. De-identified data was provided by each institution and analyzed. Results - Data was collected for 4,526 patients across 4 continents and 12 countries, 827 of whom had an arrhythmia. Cardiac comorbidities were common in patients with arrhythmia: 69% had hypertension, 42% diabetes mellitus, 30% had heart failure and 24% coronary artery disease. Most had no prior history of arrhythmia. Of those who did develop an arrhythmia, the majority (81.8%) developed atrial arrhythmias, 20.7% developed ventricular arrhythmias, and 22.6% had bradyarrhythmia. Regional differences suggested a lower incidence of AF in Asia compared to other continents (34% vs. 63%). Most patients in in North America and Europe received hydroxychloroquine, though the frequency of hydroxychloroquine therapy was constant across arrhythmia types. Forty-three percent of patients who developed arrhythmia were mechanically ventilated and 51% survived to hospital discharge. Many institutions reported drastic decreases in electrophysiology procedures performed. Conclusions - Cardiac arrhythmias are common and associated with high morbidity and mortality among patients hospitalized with COVID-19 infection. There were significant regional variations in the types of arrhythmias and treatment approaches.

  View details for DOI 10.1161/CIRCEP.120.009458

  View details for PubMedID 33554620

• The AHA COVID-19 Cardiovascular Disease Registry: Design, Implementation, and Initial Results De Lemos, J. A., Morrow, D., Wang, T., Rodriguez, F., Alger, H., Rutan, C., Bradley, S., Elkind, M. S., Das, S. LIPPINCOTT WILLIAMS & WILKINS. 2020: E472

  View details for Web of Science ID 000598973900021

• Racial and Ethnic Differences in Treatment and Outcomes for Patients Hospitalized with COVID-19: Findings from the American Heart Association COVID-19 Cardiovascular Disease Registry Rodriguez, F., Solomon, N., De Lemos, J., Das, S., Morrow, D., Bradley, S., Elkind, M., Williams, J., Simon, D., Matsouaka, R., Gupta, D., Gluckman, T., Abdalla, M., Albert, M., Yancy, C., Wang, T. LIPPINCOTT WILLIAMS & WILKINS. 2020: E472–E473

  View details for Web of Science ID 000639226400022

• The AHA COVID-19 Cardiovascular Disease Registry: Design, Implementation, and Initial Results De Lemos, J. A., Morrow, D., Wang, T., Rodriguez, F., Alger, H., Rutan, C., Bradley, S., Elkind, M. S., Das, S. LIPPINCOTT WILLIAMS & WILKINS. 2020: E472

  View details for Web of Science ID 000639226400021

• Call to Action: Structural Racism as a Fundamental Driver of Health Disparities: A Presidential Advisory From the American Heart Association CIRCULATION Churchwell, K., Elkind, M. V., Benjamin, R. M., Carson, A. P., Chang, E. K., Lawrence, W., Mills, A., Odom, T. M., Rodriguez, C. J., Rodriguez, F., Sanchez, E., Sharrief, A. Z., Sims, M., Williams, O., Amer Heart Assoc 2020; 142 (24): E454–E468

  Abstract

  Structural racism has been and remains a fundamental cause of persistent health disparities in the United States. The coronavirus disease 2019 (COVID-19) pandemic and the police killings of George Floyd, Breonna Taylor, and multiple others have been reminders that structural racism persists and restricts the opportunities for long, healthy lives of Black Americans and other historically disenfranchised groups. The American Heart Association has previously published statements addressing cardiovascular and cerebrovascular risk and disparities among racial and ethnic groups in the United States, but these statements have not adequately recognized structural racism as a fundamental cause of poor health and disparities in cardiovascular disease. This presidential advisory reviews the historical context, current state, and potential solutions to address structural racism in our country. Several principles emerge from our review: racism persists; racism is experienced; and the task of dismantling racism must belong to all of society. It cannot be accomplished by affected individuals alone. The path forward requires our commitment to transforming the conditions of historically marginalized communities, improving the quality of housing and neighborhood environments of these populations, advocating for policies that eliminate inequities in access to economic opportunities, quality education, and health care, and enhancing allyship among racial and ethnic groups. Future research on racism must be accelerated and should investigate the joint effects of multiple domains of racism (structural, interpersonal, cultural, anti-Black). The American Heart Association must look internally to correct its own shortcomings and advance antiracist policies and practices regarding science, public and professional education, and advocacy. With this advisory, the American Heart Association declares its unequivocal support of antiracist principles.

  View details for DOI 10.1161/CIR.0000000000000936

  View details for Web of Science ID 000598973900003

  View details for PubMedID 33170755

• Racial and Ethnic Differences in Treatment and Outcomes for Patients Hospitalized with COVID-19: Findings from the American Heart Association COVID-19 Cardiovascular Disease Registry Rodriguez, F., Solomon, N., De Lemos, J., Das, S., Morrow, D., Bradley, S., Elkind, M., Williams, J., Simon, D., Matsouaka, R., Gupta, D., Gluckman, T., Abdalla, M., Albert, M., Yancy, C., Wang, T. LIPPINCOTT WILLIAMS & WILKINS. 2020: E472–E473

  View details for Web of Science ID 000598973900022

• Racial and Ethnic Differences in Presentation and Outcomes for Patients Hospitalized with COVID-19: Findings from the American Heart Association's COVID-19 Cardiovascular Disease Registry. Circulation Rodriguez, F., Solomon, N., de Lemos, J. A., Das, S. R., Morrow, D. A., Bradley, S. M., Elkind, M. S., Williams Iv, J. H., Holmes, D., Matsouaka, R. A., Gupta, D., Gluckman, T. J., Abdalla, M., Albert, M. A., Yancy, C. W., Wang, T. Y. 2020

  Abstract

  Background: The COVID-19 pandemic has exposed longstanding racial/ethnic inequities in health risks and outcomes in the U.S.. We sought to identify racial/ethnic differences in presentation and outcomes for patients hospitalized with COVID-19. Methods: The American Heart Association COVID-19 Cardiovascular Disease Registry is a retrospective observational registry capturing consecutive patients hospitalized with COVID-19. We present data on the first 7,868 patients by race/ethnicity treated at 88 hospitals across the US between 01/17/2020 and 7/22/2020. The primary outcome was in-hospital mortality; secondary outcomes included major adverse cardiovascular events (MACE: death, myocardial infarction, stroke, heart failure) and COVID-19 cardiorespiratory ordinal severity score (worst to best: death, cardiac arrest, mechanical ventilation with mechanical circulatory support, mechanical ventilation with vasopressors/inotrope support, mechanical ventilation without hemodynamic support, and hospitalization without any of the above). Multivariable logistic regression analyses were performed to assess the relationship between race/ethnicity and each outcome adjusting for differences in sociodemographic, clinical, and presentation features, and accounting for clustering by hospital. Results: Among 7,868 patients hospitalized with COVID-19, 33.0% were Hispanic, 25.5% were non-Hispanic Black, 6.3% were Asian, and 35.2% were non-Hispanic White. Hispanic and Black patients were younger than non-Hispanic White and Asian patients and were more likely to be uninsured. Black patients had the highest prevalence of obesity, hypertension, and diabetes. Black patients also had the highest rates of mechanical ventilation (23.2%) and renal replacement therapy (6.6%) but the lowest rates of remdesivir use (6.1%). Overall mortality was 18.4% with 53% of all deaths occurring in Black and Hispanic patients. The adjusted odds ratios (ORs) for mortality were 0.93 (95% confidence interval [CI] 0.76-1.14) for Black patients, 0.90 (95% CI 0.73-1.11) for Hispanic patients, and 1.31 (95% CI 0.96-1.80) for Asian patients compared with non-Hispanic White patients. The median OR across hospitals was 1.99 (95% CI 1.74-2.48). Results were similar for MACE. Asian patients had the highest COVID-19 cardiorespiratory severity at presentation (adjusted OR 1.48, 95% CI 1.16-1.90). Conclusions: Although in-hospital mortality and MACE did not differ by race/ethnicity after adjustment, Black and Hispanic patients bore a greater burden of mortality and morbidity due to their disproportionate representation among COVID-19 hospitalizations.

  View details for DOI 10.1161/CIRCULATIONAHA.120.052278

  View details for PubMedID 33200953

• Multimethod, multidataset analysis reveals paradoxical relationships between sociodemographic factors, Hispanic ethnicity and diabetes. BMJ open diabetes research & care Knight, G. M., Spencer-Bonilla, G., Maahs, D. M., Blum, M. R., Valencia, A., Zuma, B. Z., Prahalad, P., Sarraju, A., Rodriguez, F., Scheinker, D. 2020; 8 (2)

  Abstract

  INTRODUCTION: Population-level and individual-level analyses have strengths and limitations as do 'blackbox' machine learning (ML) and traditional, interpretable models. Diabetes mellitus (DM) is a leading cause of morbidity and mortality with complex sociodemographic dynamics that have not been analyzed in a way that leverages population-level and individual-level data as well as traditional epidemiological and ML models. We analyzed complementary individual-level and county-level datasets with both regression and ML methods to study the association between sociodemographic factors and DM.RESEARCH DESIGN AND METHODS: County-level DM prevalence, demographics, and socioeconomic status (SES) factors were extracted from the 2018 Robert Wood Johnson Foundation County Health Rankings and merged with US Census data. Analogous individual-level data were extracted from 2007 to 2016 National Health and Nutrition Examination Survey studies and corrected for oversampling with survey weights. We used multivariate linear (logistic) regression and ML regression (classification) models for county (individual) data. Regression and ML models were compared using measures of explained variation (area under the receiver operating characteristic curve (AUC) and R2).RESULTS: Among the 3138 counties assessed, the mean DM prevalence was 11.4% (range: 3.0%-21.1%). Among the 12824 individuals assessed, 1688 met DM criteria (13.2% unweighted; 10.2% weighted). Age, gender, race/ethnicity, income, and education were associated with DM at the county and individual levels. Higher county Hispanic ethnic density was negatively associated with county DM prevalence, while Hispanic ethnicity was positively associated with individual DM. ML outperformed regression in both datasets (mean R2 of 0.679 vs 0.610, respectively (p<0.001) for county-level data; mean AUC of 0.737 vs 0.727 (p<0.0427) for individual-level data).CONCLUSIONS: Hispanic individuals are at higher risk of DM, while counties with larger Hispanic populations have lower DM prevalence. Analyses of population-level and individual-level data with multiple methods may afford more confidence in results and identify areas for further study.

  View details for DOI 10.1136/bmjdrc-2020-001725

  View details for PubMedID 33229378

• The Hispanic paradox in the prevalence of obesity at the county-level OBESITY SCIENCE & PRACTICE Valencia, A., Zuma, B. Z., Spencer-Bonilla, G., Lopez, L., Scheinker, D., Rodriguez, F. 2020

  View details for DOI 10.1002/osp4.461

  View details for Web of Science ID 000581091800001

• Evaluation of variation in insurance payor mix among heart transplant centers. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation Parizo, J. T., Desai, M., Rodriguez, F., Sandhu, A. T., Khush, K. K. 2020

  View details for DOI 10.1016/j.healun.2020.09.017

  View details for PubMedID 33229249

• Sex-specific genetic effects across biomarkers. European journal of human genetics : EJHG Flynn, E., Tanigawa, Y., Rodriguez, F., Altman, R. B., Sinnott-Armstrong, N., Rivas, M. A. 2020

  Abstract

  Sex differences have been shown in laboratory biomarkers; however, the extent to which this is due to genetics is unknown. In this study, we infer sex-specific genetic parameters (heritability and genetic correlation) across 33 quantitative biomarker traits in 181,064 females and 156,135 males from the UK Biobank study. We apply a Bayesian Mixture Model, Sex Effects Mixture Model(SEMM), to Genome-wide Association Study summary statistics in order to (1) estimate the contributions of sex to the genetic variance of these biomarkers and (2) identify variants whose statistical association with these traits is sex-specific. We find that the genetics of most biomarker traits are shared between males and females, with the notable exception of testosterone, where we identify 119 female and 445 male-specific variants. These include protein-altering variants in steroid hormone production genes (POR, UGT2B7). Using the sex-specific variants as genetic instruments for Mendelian randomization, we find evidence for causal links between testosterone levels and height, body mass index, waist and hip circumference, and type 2 diabetes. We also show that sex-specific polygenic risk score models for testosterone outperform a combined model. Overall, these results demonstrate that while sex has a limited role in the genetics of most biomarker traits, sex plays an important role in testosterone genetics.

  View details for DOI 10.1038/s41431-020-00712-w

  View details for PubMedID 32873964

• Statin Prescription Rates, Adherence, and Associated Clinical Outcomes Among Women with PAD and ICVD. Cardiovascular drugs and therapy Mahtta, D., Ahmed, S. T., Ramsey, D. J., Akeroyd, J. M., Lee, M. T., Rodriguez, F., Michos, E. D., Itchhaporia, D., Nasir, K., Alam, M., Jneid, H., Ballantyne, C. M., Petersen, L. A., Virani, S. S. 2020

  Abstract

  PURPOSE: This study sought to investigate gender-based disparities in statin prescription rates and adherence among patients with peripheral arterial disease (PAD) and ischemic cerebrovascular disease (ICVD).METHODS: We identified patients with PAD or ICVD seeking primary care between 2013 and 2014 in the VA healthcare system. We assessed any statin use, high-intensity statin (HIS) use, and statin adherence among women with PAD or ICVD compared with men. We also compared proportion of days covered (PDC) as a measure of statin adherence; PDC ≥ 0.8 deemed a patient statin adherent. Association between statin use (or adherence) and odds of death or myocardial infarction (MI) at 12-month follow-up was also ascertained.RESULTS: Our analyses included 192,219 males and 3188 females with PAD and 331,352 males and 10,490 females with ICVD. Women with PAD had lower prescription rates of any statin (68.5% vs. 78.7%, OR 0.68, 95% confidence interval (CI) 0.62-0.75), HIS (21.1% vs. 23.7%, OR 0.88, 95% CI 0.79-0.97), and lower statin adherence (PDC ≥ 0.8: 34.6% vs. 45.5%, OR 0.75, 95% CI 0.69-0.82) compared with men. Similar disparities were seen in ICVD patients. Among female patients with PAD or ICVD, statin adherence was associated with lower odds of MI (OR 0.76, 95% CI 0.59-0.98), while use of any statin (OR 0.71, 95% CI 0.56-0.91) and HIS (OR 0.68, 95% CI 0.48-0.97) was associated with lower odds of death at 12 months.CONCLUSIONS: Women with PAD or ICVD had lower odds of receiving any statins, HIS, or being statin adherent. Targeted clinician- and patient-level interventions are needed to study and address these disparities among patients with PAD and ICVD.

  View details for DOI 10.1007/s10557-020-07057-y

  View details for PubMedID 32840709

• Racial and Geographic Disparities in Internet Use in the United States Among Patients with Atherosclerotic Cardiovascular Disease. The American journal of cardiology Al Rifai, M., Shapiro, M. D., Sayani, S., Gulati, M., Levine, G., Rodriguez, F., Mahtta, D., Khera, A., Petersen, L. A., Virani, S. S. 2020

  View details for DOI 10.1016/j.amjcard.2020.08.001

  View details for PubMedID 32892994

• 2020 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants A Report of the American College of Cardiology Solution Set Oversight Committee 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., Gluckman, T. J., Hucker, W. J., Mehran, R., Messe, S. R., Perino, A. C., Rodriguez, F., Sarode, R., Siegal, D. M., Wiggins, B. S., Report Amer Coll Cardiology Soluti, Solution Set Oversight Comm 2020; 76 (5): 594–622

  View details for DOI 10.1016/j.jacc.2020.04.053

  View details for Web of Science ID 000557886000001

  View details for PubMedID 32680646

• Carotid plaque imaging and the risk of atherosclerotic cardiovascular disease. Cardiovascular diagnosis and therapy Zhu, G., Hom, J., Li, Y., Jiang, B., Rodriguez, F., Fleischmann, D., Saloner, D., Porcu, M., Zhang, Y., Saba, L., Wintermark, M. 2020; 10 (4): 1048-1067

  Abstract

  Carotid artery plaque is a measure of atherosclerosis and is associated with future risk of atherosclerotic cardiovascular disease (ASCVD), which encompasses coronary, cerebrovascular, and peripheral arterial diseases. With advanced imaging techniques, computerized tomography (CT) and magnetic resonance imaging (MRI) have shown their potential superiority to routine ultrasound to detect features of carotid plaque vulnerability, such as intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), fibrous cap (FC), and calcification. The correlation between imaging features and histological changes of carotid plaques has been investigated. Imaging of carotid features has been used to predict the risk of cardiovascular events. Other techniques such as nuclear imaging and intra-vascular ultrasound (IVUS) have also been proposed to better understand the vulnerable carotid plaque features. In this article, we review the studies of imaging specific carotid plaque components and their correlation with risk scores.

  View details for DOI 10.21037/cdt.2020.03.10

  View details for PubMedID 32968660

  View details for PubMedCentralID PMC7487384

• Carotid plaque imaging and the risk of atherosclerotic cardiovascular disease CARDIOVASCULAR DIAGNOSIS AND THERAPY Zhu, G., Hom, J., Li, Y., Jiang, B., Rodriguez, F., Fleischmann, D., Saloner, D., Porcu, M., Zhang, Y., Saba, L., Wintermark, M. 2020; 10 (4): 1048–67

  View details for DOI 10.21037/cdt.2020.03.10

  View details for Web of Science ID 000561681200004

• The American Heart Association COVID-19 CVD Registry powered by Get With The Guidelines. Circulation. Cardiovascular quality and outcomes Alger, H. M., Rutan, C., Williams Iv, J. H., Walchok, J. G., Bolles, M., Hall, J. L., Bradley, S. M., Elkind, M. S., Rodriguez, F., Wang, T. Y., Morrow, D. A., Das, S. R., de Lemos, J. A. 2020

  Abstract

  Background: In response to the public health emergency created by the COVID-19 pandemic, American Heart Association volunteers and staff aimed to rapidly develop and launch a resource for the medical and research community to expedite scientific advancement through shared learning, quality improvement, and research. In less than 4 weeks after it was first announced on April 3, 2020, AHA's COVID-19 CVD Registry powered by Get With The Guidelines (GWTG) received its first clinical records. Methods and Results: Participating hospitals are enrolling consecutive hospitalized patients with active COVID-19 disease, regardless of CVD status. This hospital quality improvement program will allow participating hospitals and health systems to evaluate patient-level data including mortality rates, intensive care unit (ICU) bed days, and ventilator days from individual review of electronic medical records of sequential adult patients with active COVID-19 infection. Participating sites can leverage these data for onsite, rapid quality improvement and benchmarking versus other institutions. After 9 weeks, more than 130 sites have enrolled in the program and more than 4,000 records have been abstracted in the national dataset. Additionally, the aggregate dataset will be a valuable data resource for the medical research community. Conclusions: The AHA COVID-19 CVD Registry will support greater understanding of the impact of COVID-19 on cardiovascular disease and will inform best practices for evaluation and management of patients with COVID-19.

  View details for DOI 10.1161/CIRCOUTCOMES.120.006967

  View details for PubMedID 32546000

• The Project Baseline Health Study: a step towards a broader mission to map human health NPJ DIGITAL MEDICINE Arges, K., Assimes, T., Bajaj, V., Balu, S., Bashir, M. R., Beskow, L., Blanco, R., Califf, R., Campbell, P., Carin, L., Christian, V., Cousins, S., Das, M., Dockery, M., Douglas, P. S., Dunham, A., Eckstrand, J., Fleischmann, D., Ford, E., Fraulo, E., French, J., Gambhir, S. S., Ginsburg, G. S., Green, R. C., Haddad, F., Hernandez, A., Hernandez, J., Huang, E. S., Jaffe, G., King, D., Koweek, L. H., Langlotz, C., Liao, Y. J., Mahaffey, K. W., Marcom, K., Marks, W. J., Maron, D., McCabe, R., McCall, S., McCue, R., Mega, J., Miller, D., Muhlbaier, L. H., Munshi, R., Newby, L., Pak-Harvey, E., Patrick-Lake, B., Pencina, M., Peterson, E. D., Rodriguez, F., Shore, S., Shah, S., Shipes, S., Sledge, G., Spielman, S., Spitler, R., Schaack, T., Swamy, G., Willemink, M. J., Wong, C. A. 2020; 3 (1): 84

  Abstract

  The Project Baseline Health Study (PBHS) was launched to map human health through a comprehensive understanding of both the health of an individual and how it relates to the broader population. The study will contribute to the creation of a biomedical information system that accounts for the highly complex interplay of biological, behavioral, environmental, and social systems. The PBHS is a prospective, multicenter, longitudinal cohort study that aims to enroll thousands of participants with diverse backgrounds who are representative of the entire health spectrum. Enrolled participants will be evaluated serially using clinical, molecular, imaging, sensor, self-reported, behavioral, psychological, environmental, and other health-related measurements. An initial deeply phenotyped cohort will inform the development of a large, expanded virtual cohort. The PBHS will contribute to precision health and medicine by integrating state of the art testing, longitudinal monitoring and participant engagement, and by contributing to the development of an improved platform for data sharing and analysis.

  View details for DOI 10.1038/s41746-020-0290-y

  View details for Web of Science ID 000538242900001

  View details for PubMedID 32550652

  View details for PubMedCentralID PMC7275087

• The Project Baseline Health Study: a step towards a broader mission to map human health. NPJ digital medicine Arges, K., Assimes, T., Bajaj, V., Balu, S., Bashir, M. R., Beskow, L., Blanco, R., Califf, R., Campbell, P., Carin, L., Christian, V., Cousins, S., Das, M., Dockery, M., Douglas, P. S., Dunham, A., Eckstrand, J., Fleischmann, D., Ford, E., Fraulo, E., French, J., Gambhir, S. S., Ginsburg, G. S., Green, R. C., Haddad, F., Hernandez, A., Hernandez, J., Huang, E. S., Jaffe, G., King, D., Koweek, L. H., Langlotz, C., Liao, Y. J., Mahaffey, K. W., Marcom, K., Marks, W. J., Maron, D., McCabe, R., McCall, S., McCue, R., Mega, J., Miller, D., Muhlbaier, L. H., Munshi, R., Newby, L. K., Pak-Harvey, E., Patrick-Lake, B., Pencina, M., Peterson, E. D., Rodriguez, F., Shore, S., Shah, S., Shipes, S., Sledge, G., Spielman, S., Spitler, R., Schaack, T., Swamy, G., Willemink, M. J., Wong, C. A. 2020; 3 (1): 84

  Abstract

  The Project Baseline Health Study (PBHS) was launched to map human health through a comprehensive understanding of both the health of an individual and how it relates to the broader population. The study will contribute to the creation of a biomedical information system that accounts for the highly complex interplay of biological, behavioral, environmental, and social systems. The PBHS is a prospective, multicenter, longitudinal cohort study that aims to enroll thousands of participants with diverse backgrounds who are representative of the entire health spectrum. Enrolled participants will be evaluated serially using clinical, molecular, imaging, sensor, self-reported, behavioral, psychological, environmental, and other health-related measurements. An initial deeply phenotyped cohort will inform the development of a large, expanded virtual cohort. The PBHS will contribute to precision health and medicine by integrating state of the art testing, longitudinal monitoring and participant engagement, and by contributing to the development of an improved platform for data sharing and analysis.

  View details for DOI 10.1038/s41746-020-0290-y

  View details for PubMedID 33597683

• Lipoprotein(a) and Cardiovascular Disease Prevention across Diverse Populations. Cardiology and therapy Pearson, K., Rodriguez, F. 2020

  Abstract

  Lipoprotein(a) (Lp(a)) is a highly proatherogenic lipid fraction that is genetically determined and minimally responsive to lifestyle or behavior changes. Mendelian randomization studies have suggested a causal link between elevated Lp(a) and heart disease, stroke, and aortic stenosis. There is substantial inter-ethnic variation in Lp(a) levels, with persons of African descent having the highest median values. Monitoring of Lp(a) has historically been limited by lack of standardization of assays. With the advent of novel therapeutic modalities to lower Lp(a) levels including proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitors and targeted antisense oligonucleotides, it is increasingly important to screen patients who have family or personal history of atherosclerotic cardiovascular disease for elevations in Lp(a). Further study is needed to establish a causal relationship between elevated Lp(a) and cardiovascular disease across diverse ethnic populations.

  View details for DOI 10.1007/s40119-020-00177-4

  View details for PubMedID 32451810

• STATIN USE FOR SECONDARY PREVENTION OF CARDIOVASCULAR DISEASE IN THE ELDERLY Spencer-Bonilla, G., Chung, S., Heidenreich, P. A., Palaniappan, L. P., Rodriguez, F. ELSEVIER SCIENCE INC. 2020: 1891

  View details for Web of Science ID 000522979101878

• COUNTY-LEVEL FACTORS ASSOCIATED WITH CARDIOVASCULAR MORTALITY DISAGGREGATED BY RACE/ETHNICITY Zuma, B., Valencia, A., Spencer-Bonilla, G., Blum, M. R., Knight, G., Scheinker, D., Rodriguez, F. ELSEVIER SCIENCE INC. 2020: 1884

  View details for Web of Science ID 000522979101871

• INCIDENTAL CORONARY ARTERY CALCIFICATION IN NON-GATED CT SCANS Sanders, M., Balla, S., Rodriguez, F., Patel, B., Eng, D., Khandwala, N., Sandhu, A., Maron, D. ELSEVIER SCIENCE INC. 2020: 1806

  View details for Web of Science ID 000522979101793

• Under-Reporting and Under-Representation of Racial/Ethnic Minorities in Major Atrial Fibrillation Clinical Trials. JACC. Clinical electrophysiology Sarraju, A. n., Maron, D. J., Rodriguez, F. n. 2020; 6 (6): 739–41

  View details for DOI 10.1016/j.jacep.2020.03.001

  View details for PubMedID 32553226

• Machine learning and atherosclerotic cardiovascular disease risk prediction in a multi-ethnic population. NPJ digital medicine Ward, A., Sarraju, A., Chung, S., Li, J., Harrington, R., Heidenreich, P., Palaniappan, L., Scheinker, D., Rodriguez, F. 2020; 3 (1): 125

  Abstract

  The pooled cohort equations (PCE) predict atherosclerotic cardiovascular disease (ASCVD) risk in patients with characteristics within prespecified ranges and has uncertain performance among Asians or Hispanics. It is unknown if machine learning (ML) models can improve ASCVD risk prediction across broader diverse, real-world populations. We developed ML models for ASCVD risk prediction for multi-ethnic patients using an electronic health record (EHR) database from Northern California. Our cohort included patients aged 18 years or older with no prior CVD and not on statins at baseline (n = 262,923), stratified by PCE-eligible (n = 131,721) or PCE-ineligible patients based on missing or out-of-range variables. We trained ML models [logistic regression with L2 penalty and L1 lasso penalty, random forest, gradient boosting machine (GBM), extreme gradient boosting] and determined 5-year ASCVD risk prediction, including with and without incorporation of additional EHR variables, and in Asian and Hispanic subgroups. A total of 4309 patients had ASCVD events, with 2077 in PCE-ineligible patients. GBM performance in the full cohort, including PCE-ineligible patients (area under receiver-operating characteristic curve (AUC) 0.835, 95% confidence interval (CI): 0.825-0.846), was significantly better than that of the PCE in the PCE-eligible cohort (AUC 0.775, 95% CI: 0.755-0.794). Among patients aged 40-79, GBM performed similarly before (AUC 0.784, 95% CI: 0.759-0.808) and after (AUC 0.790, 95% CI: 0.765-0.814) incorporating additional EHR data. Overall, ML models achieved comparable or improved performance compared to the PCE while allowing risk discrimination in a larger group of patients including PCE-ineligible patients. EHR-trained ML models may help bridge important gaps in ASCVD risk prediction.

  View details for DOI 10.1038/s41746-020-00331-1

  View details for PubMedID 34552202

• Women Living with Familial Hypercholesterolemia: Challenges and Considerations Surrounding Their Care. Current atherosclerosis reports Balla, S. n., Ekpo, E. P., Wilemon, K. A., Knowles, J. W., Rodriguez, F. n. 2020; 22 (10): 60

  Abstract

  To highlight the gender-based differences in presentation and disparities in care for women with familial hypercholesterolemia (FH).Women with FH experience specific barriers to care including underrepresentation in research, significant underappreciation of risk, and interrupted therapy during childbearing. National and international registry and clinical trial data show significant healthcare disparities for women with FH. Women with FH are less likely to be on guideline-recommended high-intensity statin medications and those placed on statins are more likely to discontinue them within their first year. Women with FH are also less likely to be on regimens including non-statin agents such as PCSK9 inhibitors. As a result, women with FH are less likely to achieve target low-density lipoprotein cholesterol (LDL-C) targets, even those with prior atherosclerotic cardiovascular disease (ASCVD). FH is common, under-diagnosed, and under-treated. Disparities of care are more pronounced in women than men. Additionally, FH weighs differently on women throughout the course of their lives starting from choosing contraceptives as young girls along with lipid-lowering therapy, timing pregnancy, choosing breastfeeding or resumption of therapy, and finally deciding goals of care during menopause. Early identification and appropriate treatment prior to interruptions of therapy for childbearing can lead to marked reduction in morbidity and mortality. Women access care differently than men and increasing awareness among all providers, especially cardio-obstetricians, may improve diagnostic rates. Understanding the unique challenges women with FH face is crucial to close the gaps in care they experience.

  View details for DOI 10.1007/s11883-020-00881-5

  View details for PubMedID 32816232

• Disparities in Cardiovascular Care and Outcomes for Women From Racial/Ethnic Minority Backgrounds. Current treatment options in cardiovascular medicine Balla, S., Gomez, S. E., Rodriguez, F. 2020; 22 (12): 75

  Abstract

  Purpose of review: Racial, ethnic, and gender disparities in cardiovascular care are well-documented. This review aims to highlight the disparities and impact on a group particularly vulnerable to disparities, women from racial/ethnic minority backgrounds.Recent findings: Women from racial/ethnic minority backgrounds remain underrepresented in major cardiovascular trials, limiting the generalizability of cardiovascular research to this population. Certain cardiovascular risk factors are more prevalent in women from racial/ethnic minority backgrounds, including traditional risk factors such as hypertension, obesity, and diabetes. Female-specific risk factors including gestational diabetes and preeclampsia as well as non-traditional psychosocial risk factors like depressive and anxiety disorders, increased child care, and familial and home care responsibility have been shown to increase risk for cardiovascular disease events in women more so than in men, and disproportionately affect women from racial/ethnic minority backgrounds. Despite this, minimal interventions to address differential risk have been proposed. Furthermore, disparities in treatment and outcomes that disadvantage minority women persist. The limited improvement in outcomes over time, especially among non-Hispanic Black women, is an area that requires further research and active interventions.Summary: Understanding the lack of representation in cardiovascular trials, differential cardiovascular risk, and disparities in treatment and outcomes among women from racial/ethnic minority backgrounds highlights opportunities for improving cardiovascular care among this particularly vulnerable population.

  View details for DOI 10.1007/s11936-020-00869-z

  View details for PubMedID 33223802

• Improving adherence to cardiovascular guidelines: realistic transition from paper to patient. Expert review of cardiovascular therapy Mahtta, D. n., Rodriguez, F. n., Jneid, H. n., Levine, G. N., Virani, S. S. 2020

  Abstract

  Introduction: The emphasis on clinical trials to inform evidence-based medicine remains paramount within the cardiovascular community. Although such high-quality evidence is often translated into national and international guidelines, there exists a large gap between guideline development and guideline implementation into daily clinical practice.Areas covered: This article outlines barriers that impede guideline adherence and possible strategies to overcome such barriers. Barriers intrinsic and extrinsic to clinicians are discussed. The structured process of guideline implementation including guideline adoption, diffusion, and dissemination is discussed. Lastly, the authors review in detail the current and potential future elements of guideline diffusion and dissemination.Expert opinion: Improving guideline adherence remains challenging as it requires understanding of and navigation through various barriers. However, further research specific to cardiovascular medicine guidelines is necessary to better understand the objective effectiveness of various strategies employed by guideline writers and medical societies to improve adherence. The cost effectiveness of nationwide dissemination strategies in improving guideline adherence and patient outcomes is also necessary but is largely unknown.

  View details for DOI 10.1080/14779072.2020.1717335

  View details for PubMedID 31941396

• Canagliflozin and cardiovascular outcomes in Type 2 diabetes. Future cardiology Sarraju, A. n., Spencer-Bonilla, G. n., Rodriguez, F. n., Mahaffey, K. W. 2020

  Abstract

  SGLT2 inhibitors have risen to prominence in recent years as Type 2 diabetes mellitus medications with favorable effects on cardiovascular (CV) and renal outcomes. Canagliflozin is a US FDA-approved SGLT2 inhibitor that has demonstrated CV and renal outcome benefits in large scale placebo-controlled randomized trials of patients with Type 2 diabetes mellitus and elevated CV risk. Canagliflozin use may also be associated with serious and nonserious adverse effects requiring ongoing monitoring in patients initiated on this medication. This paper provides a detailed overview of canagliflozin including its pharmacologic profile, clinical efficacy and safety data, with discussion of both clinical trial results, as well as real-world evidence.

  View details for DOI 10.2217/fca-2020-0029

  View details for PubMedID 32748638

• Readability of Online Patient Educational Materials for Coronary Artery Calcium Scans and Implications for Health Disparities. Journal of the American Heart Association Rodriguez, F. n., Ngo, S. n., Baird, G. n., Balla, S. n., Miles, R. n., Garg, M. n. 2020: e017372

  Abstract

  Background Coronary artery calcium (CAC) scans can help reclassify risk and guide patient-clinician shared treatment decisions for cardiovascular disease prevention. Patients increasingly access online patient educational materials (OPEMs) to guide medical decision-making. The American Medical Association (AMA) recommends that OPEMs should be written below a 6th-grade reading level. This study estimated the readability of commonly accessed OPEMs on CAC scans. Methods and Results The terms "coronary artery calcium scan," "heart scan," and "CAC score" were queried using an online search engine to identify the top 50 commonly accessed websites based on order of search results on December 17, 2019. Grade-level readability was calculated using generalized estimating equations, with observations nested within readability metrics from each website. Results were compared with AMA-recommended readability parameters. Overall grade-level readability among all search terms was 10.9 (95% CI, 9.3-12.5). Average grade-level readability of OPEMs for the search terms "coronary artery calcium scan," "heart scan," and "CAC score," was 10.7 (95% CI, 9.0-12.5), 10.5 (95% CI, 8.9-12.1), and 11.9 (95% CI, 10.3-13.5), respectively. Professional society and news/media/blog websites had the highest average reading grade level of 12.6, while health system websites had the lowest average reading grade level of 10.0. Less than half of the unique websites (45.3%) included explanatory images or videos. Conclusions Current OPEMs on CAC scans are written at a higher reading level than recommended for the general public. This may lead to patient misunderstanding, which could exacerbate disparities in cardiovascular health among groups with lower health literacy.

  View details for DOI 10.1161/JAHA.120.017372

  View details for PubMedID 32865121

• Left Ventricular Compression and Hypotension Due to Acute Colonic Pseudo-Obstruction. Federal practitioner : for the health care professionals of the VA, DoD, and PHS Garg, M. n., Miles, R. C., Rodriguez, F. n., Stetson, G. n. 2020; 37 (12): 566–68

  Abstract

  Acute colonic pseudo-obstruction is a postsurgical dilatation of the colon that presents with abdominal distension, pain, nausea, vomiting, constipation, or diarrhea and may lead to colonic ischemia and bowel perforation.

  View details for DOI 10.12788/fp.0075

  View details for PubMedID 33424215

  View details for PubMedCentralID PMC7789847

• Machine learning and atherosclerotic cardiovascular disease risk prediction in a multi-ethnic population. NPJ digital medicine Ward, A. n., Sarraju, A. n., Chung, S. n., Li, J. n., Harrington, R. n., Heidenreich, P. n., Palaniappan, L. n., Scheinker, D. n., Rodriguez, F. n. 2020; 3: 125

  Abstract

  The pooled cohort equations (PCE) predict atherosclerotic cardiovascular disease (ASCVD) risk in patients with characteristics within prespecified ranges and has uncertain performance among Asians or Hispanics. It is unknown if machine learning (ML) models can improve ASCVD risk prediction across broader diverse, real-world populations. We developed ML models for ASCVD risk prediction for multi-ethnic patients using an electronic health record (EHR) database from Northern California. Our cohort included patients aged 18 years or older with no prior CVD and not on statins at baseline (n = 262,923), stratified by PCE-eligible (n = 131,721) or PCE-ineligible patients based on missing or out-of-range variables. We trained ML models [logistic regression with L2 penalty and L1 lasso penalty, random forest, gradient boosting machine (GBM), extreme gradient boosting] and determined 5-year ASCVD risk prediction, including with and without incorporation of additional EHR variables, and in Asian and Hispanic subgroups. A total of 4309 patients had ASCVD events, with 2077 in PCE-ineligible patients. GBM performance in the full cohort, including PCE-ineligible patients (area under receiver-operating characteristic curve (AUC) 0.835, 95% confidence interval (CI): 0.825-0.846), was significantly better than that of the PCE in the PCE-eligible cohort (AUC 0.775, 95% CI: 0.755-0.794). Among patients aged 40-79, GBM performed similarly before (AUC 0.784, 95% CI: 0.759-0.808) and after (AUC 0.790, 95% CI: 0.765-0.814) incorporating additional EHR data. Overall, ML models achieved comparable or improved performance compared to the PCE while allowing risk discrimination in a larger group of patients including PCE-ineligible patients. EHR-trained ML models may help bridge important gaps in ASCVD risk prediction.

  View details for DOI 10.1038/s41746-020-00331-1

  View details for PubMedID 33043149

  View details for PubMedCentralID PMC7511400

• Carotid Artery Imaging Is More Strongly Associated With the 10-Year Atherosclerotic Cardiovascular Disease Score Than Coronary Artery Imaging. Journal of computer assisted tomography Li, Y., Zhu, G., Ding, V., Jiang, B., Boothroyd, D., Rodriguez, F., Fleischmann, D., Desai, M., Saloner, D., Saba, L., Hom, J., Wintermark, M. 2019; 43 (5): 679–85

  Abstract

  PURPOSE: The aim of this study was to compare coronary and carotid artery imaging and determine which one shows the strongest association with atherosclerotic cardiovascular disease (ASCVD) score.PATIENTS AND METHODS: Two separate series patients who underwent either coronary computed tomography angiography (CTA) or carotid CTA were included. We recorded the ASCVD scores and assessed the CTA imaging. Two thirds were used to build predictive models, and the remaining one third generated predicted ASCVD scores. The Bland-Altman analysis analyzed the concordance.RESULTS: A total of 110 patients were included in each group. There was no significant difference between clinical characteristics. Three imaging variables were included in the carotid model. Two coronary models (presence of calcium or Agatston score) were created. The bias between true and predicted ASCVD scores was 0.37 ± 5.72% on the carotid model, and 2.07 ± 7.18% and 2.47 ± 7.82% on coronary artery models, respectively.CONCLUSIONS: Both carotid and coronary artery imaging features can predict ASCVD score. The carotid artery was more associated to the ASCVD score than the coronary artery.

  View details for DOI 10.1097/RCT.0000000000000920

  View details for PubMedID 31609291

• Consequences of Slow Progress Toward Pragmatism in Randomized Clinical Trials: It Is Time to Get Practical. JAMA cardiology Rodriguez, F., Califf, R. M., Harrington, R. A. 2019

  View details for DOI 10.1001/jamacardio.2019.3922

  View details for PubMedID 31473764

• Diabetes Prevalence by Leisure-, Transportation-, and Occupation-Based Physical Activity Among Racially/Ethnically Diverse U.S. Adults. Diabetes care Divney, A. A., Murillo, R., Rodriguez, F., Mirzayi, C. A., Tsui, E. K., Echeverria, S. E. 2019; 42 (7): 1241–47

  Abstract

  OBJECTIVE: Leisure-time physical activity (LTPA) has been shown to prevent or delay the development of diabetes. However, little research exists examining how other domains of PA (e.g., occupation based [OPA] and transportation based [TPA]) are associated with diabetes prevalence across diverse racial/ethnic groups. We examined associations between OPA, TPA, and LTPA and diabetes prevalence and whether associations differed by race/ethnicity.RESEARCH DESIGN AND METHODS: Participants in the 2011-2016 National Health and Nutrition Examination Survey (NHANES) self-reported domain-specific PA. Diabetes status was determined by self-reported doctor/health professional-diagnosis of diabetes or a glycosylated hemoglobin (HbA1c) measurement of ≥6.5% (48 mmol/mol). Multivariable log binomial models examined differences in diabetes prevalence by PA level in each domain and total PA among Latinos (n = 3,931), non-Latino whites (n = 6,079), and non-Latino blacks (n = 3,659).RESULTS: Whites reported the highest prevalence of achieving PA guidelines (64.9%), followed by Latinos (61.6%) and non-Latino blacks (60.9%; P < 0.0009). Participants achieving PA guidelines were 19-32% less likely to have diabetes depending on PA domain in adjusted models. Diabetes prevalence was consistently higher among non-Latino blacks (17.1%) and Latinos (14.1%) compared with non-Latino whites (10.7%; P < 0.0001), but interaction results showed the protective effect of PA was similar across PA domain and race/ethnicity-except within TPA, where the protective effect was 4% greater among non-Latino whites compared with Latinos (adjusted difference in risk differences 0.04, P = 0.01).CONCLUSIONS: PA policies and programs, beyond LTPA, can be leveraged to reduce diabetes prevalence among all population groups. Future studies are needed to confirm potentially differential effects of transportation-based active living on diabetes prevalence across race/ethnicity.

  View details for DOI 10.2337/dc18-2432

  View details for PubMedID 31221695

• Studies Evaluating Statin Adherence and Outcome Should Adjust for Smoking Persistence and Antiplatelet Treatment Discontinuation-Reply. JAMA cardiology Rodriguez, F., Maron, D. J., Heidenreich, P. A. 2019

  View details for DOI 10.1001/jamacardio.2019.1969

  View details for PubMedID 31241723

• YEARS OF POTENTIAL LIFE LOST FROM CARDIOVASCULAR DISEASE AMONG HISPANICS ETHNICITY & DISEASE Manjunath, L., Hu, J., Palaniappan, L., Rodriguez, F. 2019; 29 (3): 477–84

  Abstract

  To quantify the impact of cardiovascular disease and its subtypes on the premature mortality of Hispanics in the United States.We used national death records to identify deaths for the three largest Hispanic subgroups (Mexicans, Puerto Ricans, and Cubans) in the United States from 2003 to 2012 (N = 832,550). We identified all deaths from cardiovascular disease and by subtype (ie, ischemic, cerebrovascular, hypertensive and heart failure) using the underlying cause of death via ICD-10 codes. Years of potential life lost (YPLL) was calculated by age categories standardizing with the 2000 US Census population. Population estimates were calculated using linear interpolation from 2000 and 2010 US Census data.After standardization, Puerto Ricans experienced the highest YPLL for all types of cardiovascular disease compared with Mexicans and Cubans (1,139 years per 100,000 compared with 868 and 841, respectively), a disparity that remained consistent over the course of a decade. Among different subcategories of cardiovascular disease, Puerto Ricans had the highest YPLL for ischemic and hypertensive heart disease, while Mexicans had the highest YPLL from cerebrovascular disease.In conclusion, disaggregation of Hispanic subgroups revealed marked heterogeneity in premature cardiovascular mortality. These findings suggest that measures to improve the cardiovascular health of Hispanics should incorporate subgroup status as a key part of public health strategy.

  View details for DOI 10.18865/ed.29.3.477

  View details for Web of Science ID 000476474900004

  View details for PubMedID 31367168

  View details for PubMedCentralID PMC6645724

• Comparison of Ideal Cardiovascular Health Attainment and Acculturation among Asian Americans and Latinos. Ethnicity & disease Rodriguez, F., Echeverría, S. E., Pentakota, S. R., Amadi, C., Hastings, K. G., Palaniappan, L. P. 2019; 29 (2): 287-296

  Abstract

  To determine the association between language and ideal cardiovascular health among Asian Americans and Latinos.Cross-sectional study using 2011-2016 National Health and Nutrition Examination Survey of Asian Americans (n=2,009) and Latinos (n=3,906).Participants were classified according to language spoken at home (only/mostly English spoken, both English and native language spoken equally, or mostly/only native language spoken).Ideal, intermediate and poor cardiovascular health status for smoking, blood pressure, glucose level, and total cholesterol.The majority of Asian Americans and Latinos had ideal smoking status, but those who only/mostly spoke English were more likely to smoke compared with those who spoke only/mostly spoke their native language. Approximately one third of Asian Americans and Latinos had intermediate (ie, borderline or treated to goal) levels of cardiovascular health for blood pressure, glucose level and total cholesterol. In adjusted models, those who spoke only/mostly their native language were significantly less likely to have poor smoking or hypertension status than those who spoke only/mostly English. Among Latinos, only/mostly Spanish speakers were more likely to have poor/ intermediate glucose levels (PR=1.35, 95% CI =1.21, 1.49) than those who spoke only/ mostly English, becoming statistically non-significant after adjusting for education and income.We found significant variation in ideal cardiovascular health attainment by language spoken at home in two of the largest immigrant groups in the United States. Findings suggest the need for language and culturally tailored public health and clinical initiatives to reduce cardiovascular risk in diverse populations.

  View details for DOI 10.18865/ed.29.2.287

  View details for PubMedID 31057314

  View details for PubMedCentralID PMC6478041

• 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

  Abstract

  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

• 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)

  View details for DOI 10.1161/JAHA.118.010744

  View details for Web of Science ID 000484574300007

• 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)

  View details for DOI 10.1001/jamanetworkopen.2019.2884

  View details for Web of Science ID 000476798700064

• COMPARISON OF IDEAL CARDIOVASCULAR HEALTH ATTAINMENT AND ACCULTURATION AMONG ASIAN AMERICANS AND LATINOS ETHNICITY & DISEASE Rodriguez, F., Echeverria, S. E., Pentakota, S., Amadi, C., Hastings, K. G., Palaniappan, L. P. 2019; 29 (2): 287–96

  View details for DOI 10.18865/ed.29.2.287

  View details for Web of Science ID 000465200600008

• 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 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

  Abstract

  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: ClinicalTrials.gov 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 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 PubMedID 30732737

• Diabetes-attributable mortality in the United States from 2003 to 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; 148: 169–78

  View details for DOI 10.1016/j.diabres.2019.01.015

  View details for Web of Science ID 000458859200019

• 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

  Abstract

  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 PubMedID 30641162

• Association between frequency of primary care provider visits and evidence-based statin prescribing and statin adherence: Findings from the Veterans Affairs system. American heart journal Ahmed, S. T., Mahtta, D. n., Rehman, H. n., Akeroyd, J. n., Al Rifai, M. n., Rodriguez, F. n., Jneid, H. n., Nasir, K. n., Samad, Z. n., Alam, M. n., Petersen, L. A., Virani, S. S. 2019; 221: 9–18

  Abstract

  Statin use remains suboptimal in patients with atherosclerotic cardiovascular disease (ASCVD). We assessed if the frequency of visits with primary care providers (PCPs) is associated with higher use of evidence-based statin prescriptions and adherence among patients with ASCVD.We identified patients with ASCVD aged ≥18 years receiving care in 130 facilities and associated community-based outpatient clinics in the entire Veterans Affairs Health Care System between October 1, 2013 and September 30, 2014. Patients were divided into frequent PCP visitors (annual PCP visits ≥ median number of PCP visits for the entire cohort) and infrequent PCP visitors (annual PCP visits < median number of patient visits). We assessed any- and high-intensity statin prescription as well as statin adherence which was defined by proportion of days covered (PDC).We included 1,249,061 patients with ASCVD (mean age was 71.9 years; 98.0% male). Median number of annual PCP visits was 3. Approximately 80.1% patients were on statins with 23.8% on high-intensity statins. Mean PDC was 0.715 ± 0.336 with 58.3% patients with PDC ≥0.8. Frequent PCP visitors had higher frequency of statin use (82.2% vs 77.4%), high-intensity statin use (26.4% vs 20.3%), and statin adherence (mean PDC 0.73 vs 0.68; P < .01) compared to infrequent PCP visitors. After adjusting for covariates, frequent PCP visits was associated with greater odds of being on any statin, high intensity statin, and higher statin adherence.Frequent visits with PCPs is associated with a higher likelihood of any statin use, high intensity statin use, and statin adherence. Further research endeavors are needed to understand the reasons behind these associations.

  View details for DOI 10.1016/j.ahj.2019.11.019

  View details for PubMedID 31896038

• Creating Fair Models of Atherosclerotic Cardiovascular Disease Pfohl, S., Marafino, B., Coulet, A., Rodriguez, F., Palaniappan, L., Shah, N. H., Assoc Comp Machinery ASSOC COMPUTING MACHINERY. 2019: 271–78

  View details for DOI 10.1145/3306618.3314278

  View details for Web of Science ID 000556121100038

• CardioClick an Innovative Telehealth Approach to Lifestyle Intervention in High Risk South Asians Parameswaran, V., Josan, K., Winterbottom, J., Shearer, J., Khandelwal, A., Nallamshetty, S., Dash, R., Rodriguez, F. LIPPINCOTT WILLIAMS & WILKINS. 2019

  View details for DOI 10.1161/circ.139.suppl_1.P337

  View details for Web of Science ID 000478079000280

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

  Abstract

  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

  Abstract

  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 PubMedID 30623167

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

  Abstract

  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

• 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. 2019; 56 (1): 84–92

  View details for DOI 10.1016/j.amepre.2018.07.036

  View details for Web of Science ID 000453383700013

• Semiautomated Characterization of Carotid Artery Plaque Features From Computed Tomography Angiography to Predict Atherosclerotic Cardiovascular Disease Risk Score. Journal of computer assisted tomography Zhu, G. n., Li, Y. n., Ding, V. n., Jiang, B. n., Ball, R. L., Rodriguez, F. n., Fleischmann, D. n., Desai, M. n., Saloner, D. n., Gupta, A. n., Saba, L. n., Hom, J. n., Wintermark, M. n. 2019

  Abstract

  To investigate whether selected carotid computed tomography angiography (CTA) quantitative features can predict 10-year atherosclerotic cardiovascular disease (ASCVD) risk scores.One hundred seventeen patients with calculated ASCVD risk scores were considered. A semiautomated imaging analysis software was used to segment and quantify plaque features. Eighty patients were randomly selected to build models using 14 imaging variables and the calculated ASCVD risk score as the end point (continuous and binarized). The remaining 37 patients were used as the test set to generate predicted ASCVD scores. The predicted and observed ASCVD risk scores were compared to assess properties of the predictive model.Nine of 14 CTA imaging variables were included in a model that considered the plaque features in a continuous fashion (model 1) and 6 in a model that considered the plaque features dichotomized (model 2). The predicted ASCVD risk scores were 18.87% ± 13.26% and 18.39% ± 11.6%, respectively. There were strong correlations between the observed ASCVD and the predicted ASCVDs, with r = 0.736 for model 1 and r = 0.657 for model 2. The mean biases between observed ASCVD and predicted ASCVDs were -1.954% ± 10.88% and -1.466% ± 12.04%, respectively.Selected quantitative imaging carotid features extracted from the semiautomated carotid artery analysis can predict the ASCVD risk scores.

  View details for PubMedID 31082978

• Association of acculturation with cardiac structure and function among Hispanics/Latinos: a cross-sectional analysis of the echocardiographic study of Latinos. BMJ open López, L. n., Swett, K. n., Rodriguez, F. n., Kizer, J. R., Penedo, F. n., Gallo, L. n., Allison, M. n., Arguelles, W. n., Gonzalez, F. n., Kaplan, R. C., Rodriguez, C. J. 2019; 9 (11): e028729

  Abstract

  Hispanics/Latinos, the largest immigrant population in the USA, undergo the process of acculturation and have a large burden of heart failure risk. Few studies have examined the association of acculturation on cardiac structure and function.Cross-sectional.The Echocardiographic Study of Latinos.1818 Hispanic adult participants with baseline echocardiographic assessment and acculturation measured by the Short Acculturation Scale, nativity, age at immigration, length of US residence, generational status and language.Echocardiographic assessment of left atrial volume index (LAVI), left ventricular mass index (LVMI), early diastolic transmitral inflow and mitral annular velocities.The study population was predominantly Spanish-speaking and foreign-born with mean residence in the US of 22.7 years, mean age of 56.4 years; 50% had hypertension, 28% had diabetes and 44% had a body mass index >30 kg/m2. Multivariable analyses demonstrated higher LAVI with increasing years of US residence. Foreign-born and first-generation participants had higher E/e' but lower LAVI and e' velocities compared with the second generation. Higher acculturation and income >$20K were associated with higher LVMI, LAVI and E/e' but lower e' velocities. Preferential Spanish-speakers with an income <$20K had a higher E/e'.Acculturation was associated with abnormal cardiac structure and function, with some effect modification by socioeconomic status.

  View details for DOI 10.1136/bmjopen-2018-028729

  View details for PubMedID 31784430

• Patient-Reported Satisfaction and Study Drug Discontinuation: Post-Hoc Analysis of Findings from ROCKET AF. Cardiology and therapy Ungar, L. n., Rodriguez, F. n., Hellkamp, A. S., Becker, R. C., Berkowitz, S. D., Breithardt, G. n., Fox, K. A., Hacke, W. n., Halperin, J. L., Hankey, G. J., Nessel, C. C., Singer, D. E., Patel, M. R., Piccini, J. P., Mahaffey, K. W. 2019

  Abstract

  Patient-reported outcomes (PROs) and satisfaction endpoints are increasingly important in clinical trials and may be associated with treatment adherence. In this post hoc substudy from ROCKET AF, we examined whether patient-reported satisfaction was associated with study drug discontinuation.ROCKET AF (n = 14,264) compared rivaroxaban with warfarin for prevention of stroke and systemic embolism in patients with atrial fibrillation. We analyzed treatment satisfaction scores: the Anti-Clot Treatment Scale (ACTS) and Treatment Satisfaction Questionnaire for Medication version II (TSQM II). We compared satisfaction with study drug between the two treatment arms, and examined the association between satisfaction and patient-driven study drug discontinuation (stopping study drug due to withdrawal of consent, noncompliance, or loss to follow-up).A total of 1577 (11%) patients participated in the Patient Satisfaction substudy; 1181 (8.3%) completed both the ACTS and TSQM II 4 weeks after starting study drug. Patients receiving rivaroxaban did not experience significant differences in satisfaction compared with those receiving warfarin. During a median follow-up of 1.6 years, 448 premature study drug discontinuations occurred (213 rivaroxaban group; 235 warfarin group), of which 116 (26%) were patient-driven (52 [24%] rivaroxaban group; 64 [27%] warfarin group). No significant differences were observed between satisfaction level and rates of patient-driven study drug discontinuation.Study drug satisfaction did not predict rate of study drug discontinuation. No significant difference was observed between satisfaction with warfarin and rivaroxaban, as expected given the double-blind trial design. Although these results are negative, the importance of PRO data will only increase, and these analyses may inform future studies that explore the relationship between drug-satisfaction PROs, adherence, and clinical outcomes. CLINICALTRIALS.GOV: NCT00403767.The ROCKET AF trial was funded by Johnson & Johnson and Bayer.

  View details for DOI 10.1007/s40119-019-00146-6

  View details for PubMedID 31376090

• Atherosclerotic Cardiovascular Disease Risk Prediction in Disaggregated Asian and Hispanic Subgroups Using Electronic Health Records. Journal of the American Heart Association Rodriguez, F. n., Chung, S. n., Blum, M. R., Coulet, A. n., Basu, S. n., Palaniappan, L. P. 2019; 8 (14): e011874

  Abstract

  Background Risk assessment is the cornerstone for atherosclerotic cardiovascular disease ( ASCVD ) treatment decisions. The Pooled Cohort Equations ( PCE ) have not been validated in disaggregated Asian or Hispanic populations, who have heterogeneous cardiovascular risk and outcomes. Methods and Results We used electronic health record data from adults aged 40 to 79 years from a community-based, outpatient healthcare system in northern California between January 1, 2006 and December 31, 2015, without ASCVD and not on statins. We examined the calibration and discrimination of the PCE and recalibrated the equations for disaggregated race/ethnic subgroups. The cohort included 231 622 adults with a mean age of 53.1 (SD 9.7) years and 54.3% women. There were 56 130 Asian (Chinese, Asian Indian, Filipino, Japanese, Vietnamese, and other Asian) and 19 760 Hispanic (Mexican, Puerto Rican, and other Hispanic) patients. There were 2703 events (332 and 189 in Asian and Hispanic patients, respectively) during an average of 3.9 (SD 1.5) years of follow-up. The PCE overestimated risk for NHW s, African Americans, Asians, and Hispanics by 20% to 60%. The extent of overestimation of ASCVD risk varied by disaggregated racial/ethnic subgroups, with a predicted-to-observed ratio of ASCVD events ranging from 1.1 for Puerto Rican patients to 1.9 for Chinese patients. The PCE had adequate discrimination, although it varied significantly by race/ethnic subgroups (C-indices 0.66-0.83). Recalibration of the PCE did not significantly improve its performance. Conclusions Using electronic health record data from a large, real-world population, we found that the PCE generally overestimated ASCVD risk, with marked heterogeneity by disaggregated Asian and Hispanic subgroups.

  View details for DOI 10.1161/JAHA.118.011874

  View details for PubMedID 31291803

• Interventions to Reduce Ethnic and Racial Disparities in Dyslipidemia Management. Current treatment options in cardiovascular medicine Chang, A. Y., Abou-Arraj, N. E., Rodriguez, F. n. 2019; 21 (5): 24

  Abstract

  Race and ethnicity are associated with disparities in risk assessment, screening, patient awareness, treatment, and control of dyslipidemia and can contribute to worsened cardiovascular outcomes. This review summarizes these gaps in care and highlights recent interventions aimed at reducing them.Disparities in dyslipidemia diagnosis and treatment are well documented among certain racial and ethnic minority groups. Less is known about dyslipidemia among Hispanics, Asians, and Native Americans/Pacific Islanders, who have significant heterogeneity in cardiovascular risk and outcomes. Programs to reduce inequalities have focused on targeted risk assessment, improved screening practices, statin adherence-enhancing policies, culturally inclusive risk factor modification campaigns, and multidisciplinary treatment teams, with variable success. Interventions to reduce racial/ethnic disparities in dyslipidemia are important at all phases of care. Nevertheless, initiatives concentrating on single elements of the lipid treatment cascade were generally less effective at improving clinical endpoints than those that comprehensively addressed multiple phases. Moreover, there was a disproportionately greater number of published studies analyzing patient-facing lifestyle-based risk factor modifications than other types of interventions. Future investigations should focus on understudied populations such as disaggregated Hispanic, Asian, and Native American populations. Additionally, innovative strategies utilizing information technology and provider-facing programs are needed.

  View details for PubMedID 31065884

• 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

  Abstract

  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 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

  Abstract

  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 PubMedID 30442464

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

  Abstract

  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 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

  Abstract

  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 PubMedID 30371295

• Men Versus Women. Circulation. Cardiovascular interventions Rodriguez, F., Harrington, R. A. 2018; 11 (8): e007016

  View details for DOI 10.1161/CIRCINTERVENTIONS.118.007016

  View details for PubMedID 30354789

• 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

  Abstract

  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

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

  View details for PubMedID 29847614

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

  Abstract

  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. n., Sing, D. n., Shah, S. n., Hu, J. n., Duvernoy, C. n., Harrington, R. A., Rodriguez, F. n. 2018; 11 (12): e005040

  Abstract

  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

• Promise and Perils of Big Data and Artificial Intelligence in Clinical Medicine and Biomedical Research. Circulation research Rodriguez, F. n., Scheinker, D. n., Harrington, R. A. 2018; 123 (12): 1282–84

  View details for PubMedID 30566055

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

  Abstract

  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

• Dietary Patterns and Long-Term Survival: A Retrospective Study of Healthy Primary Care Patients 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. 2018; 131 (1): 48–55

  View details for DOI 10.1016/j.amjmed.2017.08.010

  View details for Web of Science ID 000417605300030

• 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. n., Zhu, G. n., Ding, V. n., Huang, Y. n., Jiang, B. n., Ball, R. L., Rodriguez, F. n., Fleischmann, D. n., Desai, M. n., Saloner, D. n., Saba, L. n., Hom, J. n., Wintermark, M. n. 2018

  Abstract

  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

• 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): 3042-3067

  View details for DOI 10.1016/j.jacc.2017.09.1085

  View details for PubMedID 29203195

• 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

  Abstract

  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

  Abstract

  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. n., Finley, C. E., Rodriguez, F. n., Sarraju, A. n., Barlow, C. E., DeFina, L. F., Willis, B. L., Haskell, W. L., Maron, D. J. 2017

  Abstract

  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 PubMedID 28860032

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

  Abstract

  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 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

  Abstract

  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

  Abstract

  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

  Abstract

  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

  View details for DOI 10.1161/CIRCULATIONAHA.116.023010

  View details for Web of Science ID 000378900300006

  View details for PubMedID 27358433

• 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

  Abstract

  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

  Abstract

  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 Web of Science ID 000377472000013

  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

  Abstract

  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. n., Harrington, R. A. 2016; 316 (19): 1967–68

  View details for PubMedID 27838727

• The Role of Peer Support in Attaining Ideal Cardiovascular Health: Peer Pressure and Prevention. Journal of the American College of Cardiology Rodriguez, F. n., Harrington, R. A. 2016; 67 (5): 486–87

  View details for PubMedID 26562045

• 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

  Abstract

  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)

  Abstract

  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

  View details for PubMedCentralID PMC4599495

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

  Abstract

  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

  Abstract

  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

  Abstract

  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)

  Abstract

  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

  Abstract

  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)

  Abstract

  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

  Abstract

  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

• RACIAL DISPARITIES IN HOSPITALIZATIONS, PROCEDURAL TREATMENTS AND MORTALITY OF PATIENTS HOSPITALIZED WITH ATRIAL FIBRILLATION ETHNICITY & DISEASE Naderi, S., Rodriguez, F., Wang, Y., Foody, J. M. 2014; 24 (2): 144-149

  Abstract

  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)

  Abstract

  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

  Abstract

  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

  Abstract

  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

  Abstract

  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)

  Abstract

  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

  Abstract

  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

  Abstract

  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

• LOVE YOUR HEART: A PILOT COMMUNITY-BASED INTERVENTION TO IMPROVE THE CARDIOVASCULAR HEALTH OF AFRICAN AMERICAN WOMEN ETHNICITY & DISEASE Rodriguez, F., Christopher, L., Johnson, C. E., Wang, Y., Foody, J. M. 2012; 22 (4): 416-421

  Abstract

  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

  Abstract

  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

  Abstract

  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

  Abstract

  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

  Abstract

  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

• Semiautomated Characterization of Carotid Artery Plaque Features From Computed Tomography Angiography to Predict Atherosclerotic Cardiovascular Disease Risk Score. Journal of computer assisted tomography Zhu, G. n., Li, Y. n., Ding, V. n., Jiang, B. n., Ball, R. L., Rodriguez, F. n., Fleischmann, D. n., Desai, M. n., Saloner, D. n., Gupta, A. n., Saba, L. n., Hom, J. n., Wintermark, M. n. ; 43 (3): 452–59

  Abstract

  To investigate whether selected carotid computed tomography angiography (CTA) quantitative features can predict 10-year atherosclerotic cardiovascular disease (ASCVD) risk scores.One hundred seventeen patients with calculated ASCVD risk scores were considered. A semiautomated imaging analysis software was used to segment and quantify plaque features. Eighty patients were randomly selected to build models using 14 imaging variables and the calculated ASCVD risk score as the end point (continuous and binarized). The remaining 37 patients were used as the test set to generate predicted ASCVD scores. The predicted and observed ASCVD risk scores were compared to assess properties of the predictive model.Nine of 14 CTA imaging variables were included in a model that considered the plaque features in a continuous fashion (model 1) and 6 in a model that considered the plaque features dichotomized (model 2). The predicted ASCVD risk scores were 18.87% ± 13.26% and 18.39% ± 11.6%, respectively. There were strong correlations between the observed ASCVD and the predicted ASCVDs, with r = 0.736 for model 1 and r = 0.657 for model 2. The mean biases between observed ASCVD and predicted ASCVDs were -1.954% ± 10.88% and -1.466% ± 12.04%, respectively.Selected quantitative imaging carotid features extracted from the semiautomated carotid artery analysis can predict the ASCVD risk scores.

  View details for PubMedID 31082951