Clinical Focus

  • Preventive Cardiology
  • Internal Medicine

Academic Appointments

Administrative Appointments

  • Member, Ethics Committee, Stanford University Medical Center (2015 - Present)
  • Research Supervisor, Leadership in Health Disparities Summer Program, Stanford Center of Excellence (2016 - Present)
  • Elected Member, Medical Executive Comittee (2019 - 2022)
  • Value Based Care Champion, Cardiac Diagnostics SPRINT (2020 - Present)

Honors & Awards

  • Fellow, AHA 34th Seminar on the Epidemiology and Prevention of CVD (2008)

Boards, Advisory Committees, Professional Organizations

  • Fellow, American College of Physicians (2010 - Present)

Professional Education

  • Residency: University of Texas Southwestern Medical School Registrar (1998) TX
  • Internship: University of Texas Southwestern Medical School Registrar (1996) TX
  • Board Certification: American Board of Internal Medicine, Internal Medicine (1998)
  • Medical Education: University of Texas Southwestern Medical Center (1995) TX
  • MPH, UC Berkeley (2003)
  • Residency, UT Southwestern, Dallas, Internal Medicine (1998)

Clinical Trials

  • Cardiovascular Health in Postpartum Women Diagnosed With Excessive Gestational Weight Gain Not Recruiting

    The investigators will test the efficacy of a tailored behavioral lifestyle modification program to support cardiovascular health in postpartum women with excessive gestational weight gain. This program will include a mobile health texting component postpartum to support changes in nutrition and physical activity. The investigators will randomize women into either the control arm (usual care) or the intervention (usual care + mobile health program postpartum). The women will be recruited during their 3rd trimester once they have been identified as gaining too much weight according to the 2009 IOM guidelines during pregnancy.

    Stanford is currently not accepting patients for this trial.

    View full details

All Publications

  • An initiative to promote value-based stress test selection in primary care and cardiology clinics: A mixed methods evaluation. Journal of evaluation in clinical practice Kling, S. M., Kalwani, N. M., Winget, M., Gupta, K., Saliba-Gustafsson, E. A., Baratta, J., Garvert, D. W., Veruttipong, D., Brown-Johnson, C. G., Vilendrer, S., Gaspar, C., Levin, E., Tsai, S. 2023


    Exercise stress echocardiograms (stress echos) are overused, whereas exercise stress electrocardiograms (stress ECGs) can be an appropriate, lower-cost substitute. In this post hoc, mixed methods evaluation, we assessed an initiative promoting value-based, guideline-concordant ordering practices in primary care (PC) and cardiology clinics.Change in percent of stress ECGs ordered of all exercise stress tests (stress ECGs and echos) was calculated between three periods: baseline (January 2019-February 2020); Period 1 with reduced stress ECG report turnaround time + PC-targeted education (began June 2020); and Period 2 with the addition of electronic health record-based alternative alert (AA) providing point-of-care clinical decision support. The AA was deployed in two of five PC clinics in July 2020, two additional PC clinics in January 2021, and one of four cardiology clinics in February 2021. Nineteen primary care providers (PCPs) and five cardiologists were interviewed in Period 2.Clinicians reported reducing ECG report turnaround time was crucial for adoption. PCPs specifically reported that value-based education helped change their practice. In PC, the percent of stress ECGs ordered increased by 38% ± 6% (SE) (p < 0.0001) from baseline to Period 1. Most PCPs identified the AA as the most impactful initiative, yet stress ECG ordering did not change (6% ± 6%; p = 0.34) between Periods 1 and 2. In contrast, cardiologists reportedly relied on their expertise rather than AAs, yet their stress ECGs orders increased from Period 1 to 2 to a larger degree in the cardiology clinic with the AA (12% ± 5%; p = 0.01) than clinics without the AA (6% ± 2%; p = 0.01). The percent of stress ECGs ordered was higher in Period 2 than baseline for both specialties (both p < 0.0001).This initiative influenced ordering behaviour in PC and cardiology clinics. However, clinicians' perceptions of the initiative varied between specialties and did not always align with the observed behaviour change.

    View details for DOI 10.1111/jep.13896

    View details for PubMedID 37459156

  • 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

  • Association of Neighborhood Income with Clinical Outcomes Among Pregnant Patients with Cardiac Disease Reproductive Sciences Carland, C., Panelli, D. M., Leonard, S. A., Bryant, E., Sherwin , E. B., Lee, C. J., Levin, E., Jimenez , S., Tremmel, J. A., Tsai , S., Heidenreich , P. A., Bianco , K., Khandelwal , A. 2022
  • Bicuspid Aortic Valve and Ascending Aortic Aneurysm in a Twin Pregnancy. JACC. Case reports Bryant, E., Tsai, S., Levin, E., Fleischman, D., Ansari, J., Fischbein, M., Bianco, K., Khandelwal, A. 2020; 2 (1): 96-100


    Bicuspid aortic valve with ascending aortic aneurysm is a common condition encountered in pregnancy. There are limited data on how to manage these patients. To our knowledge, we report the only case of a bicuspid aortic valve and aortic aneurysm with twin gestations. (Level of Difficulty: Intermediate.).

    View details for DOI 10.1016/j.jaccas.2019.12.012

    View details for PubMedID 34316973

  • Psychological Distress Among Female Cardiac Patients Presenting to a Women's Heart Health Clinic AMERICAN JOURNAL OF CARDIOLOGY Edwards, K. S., Hekler, A. C., Baum, J., Nejedly, M., Tsai, S., Khandelwal, A., Naderi, S., Hoover, V., Tremmel, J. A. 2019; 123 (12): 2026–30
  • Association of triglyceride to HDL cholesterol ratio with cardiometabolic outcomes JOURNAL OF INVESTIGATIVE MEDICINE Yang, M., Rigdon, J., Tsai, S. A. 2019; 67 (3): 663–68
  • Breastfeeding Duration and the Risk of Coronary Artery Disease JOURNAL OF WOMENS HEALTH Rajaei, S., Rigdon, J., Crowe, S., Tremmel, J., Tsai, S., Assimes, T. L. 2019; 28 (1): 30–36
  • Hypertensive Disorders of Pregnancy. Current atherosclerosis reports Naderi, S., Tsai, S. A., Khandelwal, A. 2017; 19 (3): 15-?


    Although pregnancy-related deaths are rare in the USA, they are on the rise and have more than doubled in the last 20 years. A substantial portion of these deaths are related to cardiovascular disease, specifically hypertensive disorders of pregnancy (HDP). In this review, we will discuss the definitions and proposed pathophysiology of HDP as well as its potential role in cardiovascular morbidity and mortality.Placental hypoperfusion may lead to an imbalance in proangiogenic and antiangiogenic factors, notably an increase in soluble fms-like tyrosine kinsase-1 (sFlt-1), thereby leading to endothelial dysfunction. Progress has been made in terms of determining the factors which lead to preeclampsia. Potential novel biomarkers for predicting preeclampsia risk have been identified through this research. Preeclampsia not only has important implications for the health during pregnancy but also for future cardiovascular risk. However, the exact mechanism by which it increases cardiovascular risk and the degree of risk it portends are yet to be elucidated.

    View details for DOI 10.1007/s11883-017-0648-z

    View details for PubMedID 28229431

  • Association of the cardiometabolic staging system with individual engagement and quality of life in the US adult population. Obesity (Silver Spring, Md.) Tsai, S. A., Xiao, L. n., Lv, N. n., Liu, Y. n., Ma, J. n. 2017


    The aim of this study was to examine the relationships of Cardiometabolic Disease Staging (CMDS), a validated five-stage system for assessing risk for diabetes, cardiovascular mortality, and all-cause mortality, with measures of individual engagement and health-related quality of life (HRQOL) in the US adult population.Data from the 2011-2014 National Health and Nutrition Examination Survey were used to derive the CMDS stages, five participant engagement measures, and four HRQOL measures among adult participants ≥ 40 years of age. Analyses accounted for the complex sampling design and sample weights.Higher CMDS was associated with greater participant awareness of cardiometabolic risk, but after adjusting for covariates, only Stage 4 remained significant (odds ratio: 5.08; 95% CI: 3.25, 7.94). Higher CMDS was associated with receiving recommendations to engage in a healthy lifestyle, not meeting 2008 physical activity guidelines, and fewer leisure time moderate activities after controlling for covariates. For HRQOL measures, Stage 4 was associated with a higher likelihood of perceiving health as fair or poor (odds ratio: 4.85; 95% CI: 2.42, 9.73).Higher CMDS was associated with greater individual awareness of risk, less leisure time physical activity, and worse self-rated health. CMDS is a clinically practical method for identifying individuals for targeted preventive strategies.

    View details for PubMedID 28712159

  • Impact of a Genetic Risk Score for Coronary Artery Disease on Reducing Cardiovascular Risk: A Pilot Randomized Controlled Study. Frontiers in cardiovascular medicine Knowles, J. W., Zarafshar, S. n., Pavlovic, A. n., Goldstein, B. A., Tsai, S. n., Li, J. n., McConnell, M. V., Absher, D. n., Ashley, E. A., Kiernan, M. n., Ioannidis, J. P., Assimes, T. L. 2017; 4: 53


    We tested whether providing a genetic risk score (GRS) for coronary artery disease (CAD) would serve as a motivator to improve adherence to risk-reducing strategies.We randomized 94 participants with at least moderate risk of CAD to receive standard-of-care with (N = 49) or without (N = 45) their GRS at a subsequent 3-month follow-up visit. Our primary outcome was change in low density lipoprotein cholesterol (LDL-C) between the 3- and 6-month follow-up visits (ΔLDL-C). Secondary outcomes included other CAD risk factors, weight loss, diet, physical activity, risk perceptions, and psychological outcomes. In pre-specified analyses, we examined whether there was a greater motivational effect in participants with a higher GRS.Sixty-five participants completed the protocol including 30 participants in the GRS arm. We found no change in the primary outcome between participants receiving their GRS and standard-of-care participants (ΔLDL-C: -13 vs. -9 mg/dl). Among participants with a higher GRS, we observed modest effects on weight loss and physical activity. All other secondary outcomes were not significantly different, including anxiety and worry.Adding GRS to standard-of-care did not change lipids, adherence, or psychological outcomes. Potential modest benefits in weight loss and physical activity for participants with high GRS need to be validated in larger trials.

    View details for PubMedID 28856136

  • Gender Differences in Weight-Related Attitudes and Behaviors Among Overweight and Obese Adults in the United States. American journal of men's health Tsai, S. A., Lv, N., Xiao, L., Ma, J. 2016; 10 (5): 389-398


    Few studies have used nationally representative data to focus specifically on gender differences in weight-related outcomes. This article examines gender differences in weight-related outcomes across the body mass index (BMI) spectrum in overweight and obese adults. Data from the National Health and Nutrition Examination Survey 2009-2010 was analyzed. Weight-related outcomes were accurate weight perception, weight dissatisfaction, attempted weight loss, successful weight loss, and weight loss strategies. Compared with women, overweight and obese men were less likely to have accurate weight perception (odds ratio [OR] = 0.36; 95% confidence interval [CI] = 0.30-0.44), weight dissatisfaction (OR = 0.39; 95% CI = 0.32-0.47), and attempted weight loss (OR = 0.55; 95% CI = 0.48-0.63). The modifying effect of gender on these associations decreased as BMI increased. By BMI 35, the mean probability of women and men to have accurate weight perception and weight dissatisfaction was 90%; attempted weight loss was 60% (women) and 50% (men). At lower BMIs, men had up to 40% less probability than women for these weight loss outcomes. Men who attempted weight loss were more likely than women to lose and maintain ≥10 lb over 1 year (OR = 1.41; 95% CI = 1.20-1.65) and increase exercise and eat less fat as weight loss strategies; women were more likely to join weight loss programs, take prescription diet pills, and follow special diets. A need exists for male-specific interventions to improve overweight and obese men's likelihood for accurate weight perception, attempted weight loss, and ultimately, successful weight loss.

    View details for DOI 10.1177/1557988314567223

    View details for PubMedID 25595019

  • Cardiovascular Disease Prevention in Prevention Practice in Primary Care Tsai, S. A., Ravenell, J., Fernandez, S., Schoenthaler, A., Kenny, K., Ogedegbe, G. edited by Gorin, S. S. Oxford University Press. 2014: 120–149
  • Trends in menopausal hormone therapy use of US office-based physicians, 2000-2009 MENOPAUSE-THE JOURNAL OF THE NORTH AMERICAN MENOPAUSE SOCIETY Tsai, S. A., Stefanick, M. L., Stafford, R. S. 2011; 18 (4): 385-392


    The aim of this study was to evaluate recent trends and the adoption of practice recommendations for menopausal hormone therapy (MHT) use from 2001 to 2009 by formulation, dose, woman's age, and characteristics of physicians reporting MHT visits.The IMS Health (Plymouth Meeting PA) National Disease and Therapeutic Index physician survey data from 2001 to 2009 were analyzed for visits in which MHT use was reported by US office-based physicians. Estimated national volume of visits for which MHT use was reported.MHT use declined each year since 2002. Systemic MHT use fell from 16.3 million (M) visits in 2001 to 6.1 M visits in 2009. Declines were greatest for women 60 years or older (64%) but were also substantial for women younger than 50 years (59%) and women 50 to 59 years old (60%). Women 60 years or older accounted for 37% of MHT use. Lower dose product use increased modestly, from 0.7 M (2001) to 1.3 M (2009), as did vaginal MHT use, from 1.8 M (2001) to 2.4 M (2009). Declines in continuing systemic MHT use (65%) were greater than for newly initiated MHT use (51%). Compared with other physicians, obstetrician/gynecologists changed their practices less, thereby increasing their overall share of total MHT visits from 72% (2001) to 82% (2009).Total MHT use has steadily declined. Increased use of lower dose and vaginal products reflects clinical recommendations. Uptake of these products, however, has been modest, and substantial use of MHT continues in older women.

    View details for DOI 10.1097/gme.0b013e3181f43404

    View details for Web of Science ID 000288781800009

    View details for PubMedID 21127439

    View details for PubMedCentralID PMC3123410