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McKinley EC, Bittner VA, Brown TM, Chen L, Exter J, Farkouh ME, Huang L, Jackson EA, Levitan EB, Orroth KK, Reading SR, Rosenson RS, Safford MM, Woodward M, Muntner P, Colantonio LD. The Projected Impact of Population-Wide Achievement of LDL Cholesterol <70 mg/dL on the Number of Recurrent Events Among US Adults with ASCVD. Cardiovasc Drugs Ther 2023; 37:107-116. [PMID: 34599698 DOI: 10.1007/s10557-021-07268-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 01/14/2023]
Abstract
PURPOSE Adults with atherosclerotic cardiovascular disease (ASCVD) are recommended high-intensity statins, with those at very high risk for recurrent events recommended adding ezetimibe and/or a proprotein convertase subtilisin/kexin type 9 inhibitor if their low-density lipoprotein cholesterol (LDL-C) is ≥70 mg/dL. We estimated the number of recurrent ASCVD events potentially averted if all adults in the United States (US) ≥45 years of age with ASCVD achieved an LDL-C <70 mg/dL. METHODS The number of US adults with ASCVD and LDL-C ≥70 mg/dL was estimated from the National Health and Nutrition Examination Survey 2009-2016 (n = 596). The 10-year cumulative incidence of recurrent ASCVD events was estimated from the REasons for Geographic And Racial Differences in Stroke study (n = 5390), weighted to the US population by age, race, and sex. The ASCVD risk reduction by achieving an LDL-C <70 mg/dL was estimated from meta-analyses of lipid-lowering treatment trials. RESULTS Overall, 14.7 (95% CI, 13.7-15.8) million US adults had ASCVD, of whom 11.6 (95% CI, 10.6-12.5) million had LDL-C ≥70 mg/dL. The 10-year cumulative incidence of ASCVD events was 24.3% (95% CI, 23.2-25.6%). We projected that 2.823 (95% CI, 2.543-3.091) million ASCVD events would occur over 10 years among US adults with ASCVD and LDL-C ≥70 mg/dL. Overall, 0.634 (95% CI, 0.542-0.737) million ASCVD events could potentially be averted if all US adults with ASCVD achieved and maintained LDL-C <70 mg/dL. CONCLUSION A substantial number of recurrent ASCVD events could be averted over 10 years if all US adults with ASCVD achieved, and maintained, an LDL-C <70 mg/dL.
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Affiliation(s)
- Emily C McKinley
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd, RPHB 523B, Birmingham, AL, 35233-0013, USA.
| | - Vera A Bittner
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Todd M Brown
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ligong Chen
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd, RPHB 523B, Birmingham, AL, 35233-0013, USA
| | | | - Michael E Farkouh
- Peter Munk Cardiac Centre, University of Toronto and Heart and Stroke Richard Lewar Centre of Excellence, Toronto, ON, Canada
| | - Lei Huang
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd, RPHB 523B, Birmingham, AL, 35233-0013, USA
| | - Elizabeth A Jackson
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Emily B Levitan
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd, RPHB 523B, Birmingham, AL, 35233-0013, USA
| | - Kate K Orroth
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | | | - Robert S Rosenson
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Monika M Safford
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd, RPHB 523B, Birmingham, AL, 35233-0013, USA
| | - Lisandro D Colantonio
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd, RPHB 523B, Birmingham, AL, 35233-0013, USA
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Levintow SN, Reading SR, Noshad S, Mayer SE, Wiener C, Eledath B, Exter J, Brookhart MA. Lipid Testing Trends Before and After Hospitalization for Myocardial Infarction Among Adults in the United States, 2008-2019. Clin Epidemiol 2022; 14:737-748. [PMID: 35677476 PMCID: PMC9167839 DOI: 10.2147/clep.s361258] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/19/2022] [Indexed: 11/24/2022] Open
Abstract
Background Routine monitoring of low-density lipoprotein cholesterol (LDL-C) identifies patients who may benefit from modifying lipid-lowering therapies (LLT). However, the extent to which LDL-C testing is occurring in clinical practice is unclear, specifically among patients hospitalized for a myocardial infarction (MI). Methods Using US commercial claims data, we identified patients with an incident MI hospitalization between 01/01/2008-03/31/2019. LDL-C testing was assessed in the year before admission (pre-MI) and the year after discharge (post-MI). Changes in LDL-C testing were evaluated using a Poisson model fit to pre-MI rates and extrapolated to the post-MI period. We predicted LDL-C testing rates if no MI had occurred (ie, based on pre-MI trends) and estimated rate differences and ratios (contrasting observed vs predicted rates). Results Overall, 389,367 patients were hospitalized for their first MI during the study period. In the month following discharge, 9% received LDL-C testing, increasing to 27% at 3 months and 52% at 12 months. Mean rates (tests per 1000 patients per month) in the pre- and post-MI periods were 51.9 (95% CI: 51.7, 52.1) and 84.4 (95% CI: 84.1, 84.6), respectively. Over 12 months post-MI, observed rates were higher than predicted rates; the maximum rate difference was 66 tests per 1000 patients in month 2 (rate ratio 2.2), stabilizing at a difference of 15-20 (ratio 1.2-1.3) for months 6-12. Conclusion Although LDL-C testing increased following MI hospitalization, rates remained lower than recommended by clinical guidelines. This highlights a potential gap in care, where increased LDL-C testing after MI may provide opportunities for LLT modification and decrease risk of subsequent cardiovascular events.
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Affiliation(s)
- Sara N Levintow
- NoviSci, Inc., Durham, NC, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Sophie E Mayer
- NoviSci, Inc., Durham, NC, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | - M Alan Brookhart
- NoviSci, Inc., Durham, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
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McKinley EC, Bittner VA, Brown TM, Chen L, Colantonio LD, Exter J, Orroth KK, Reading SR, Rosenson RS, Muntner P. Factors associated with time to initiation of a PCSK9 inhibitor after hospital discharge for acute myocardial infarction. J Clin Lipidol 2021; 16:75-82. [PMID: 34848176 DOI: 10.1016/j.jacl.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 10/26/2021] [Accepted: 11/01/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) lower atherosclerotic cardiovascular disease (ASCVD) event risk. OBJECTIVE Analyze patient characteristics associated with time to PCSK9i initiation following an acute myocardial infarction (AMI). METHODS We analyzed characteristics of patients ≥21 years of age in the Marketscan or Medicare databases who initiated a PCSK9i 0-89 days, 90-179 days, or 180-365 days after an AMI between July 2015 and December 2018 (n=1,705). We estimated the cumulative incidence of recurrent ASCVD events before PCSK9i initiation. RESULTS Overall, 42%, 25%, and 33% of patients who initiated a PCSK9i did so 0-89 days, 90-179 days, and 180-365 days following AMI hospital discharge, respectively. Taking ezetimibe prior to AMI hospitalization and initiating ezetimibe within 30 days after AMI hospital discharge were each associated with a higher likelihood of PCSK9i initiation in the 0-89 days versus 180-365 days post-discharge (adjusted odds ratio [OR] 1.83, 95% confidence interval [95%CI] 1.35-2.49 and 1.76, 95%CI 1.11-2.80, respectively). Statin use before and statin initiation within 30 days after AMI hospitalization were associated with a lower likelihood of PCSK9i initiation 0-89 days versus 180-365 days post-discharge (adjusted OR 0.64, 95%CI 0.49-0.84 and 0.39, 95%CI 0.28-0.54, respectively). Overall, 8.0%, 10.5%, and 12.5% of patients had an ASCVD event at 90, 180, and 365 days following AMI hospital discharge and before initiating a PCSK9i, respectively. CONCLUSION Among patients initiating a PCSK9i after AMI, a low proportion did so within 89 days of hospital discharge. Many patients had a recurrent ASCVD event before treatment initiation.
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Affiliation(s)
- E C McKinley
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham AL, United States.
| | - V A Bittner
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham AL, United States.
| | - T M Brown
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham AL, United States.
| | - L Chen
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham AL, United States.
| | - L D Colantonio
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham AL, United States.
| | - J Exter
- Amgen Inc., Thousand Oaks CA, United States.
| | - K K Orroth
- Center for Observational Research, Amgen Inc., Thousand Oaks CA, United States.
| | - S R Reading
- Center for Observational Research, Amgen Inc., Thousand Oaks CA, United States.
| | - R S Rosenson
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York NY, United States.
| | - P Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham AL, United States.
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4
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Levintow SN, Reading SR, Noshad S, Mayer S, Wiener C, Eledath B, Palagashvili T, Brookhart MA. Lipid testing trends before and after hospitalization for myocardial infarction among adults in the U.S., 2008–2019. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Routine monitoring of low-density lipoprotein cholesterol (LDL-C) identifies patients who are candidates for initiation of lipid-lowering therapies (LLT), assesses adherence and response, and measures clinical indications for modifications to treatment. This study investigated LDL-C testing trends among patients hospitalized for incident myocardial infarction (MI), a population at high risk of future atherosclerotic cardiovascular disease (ASCVD) events who may benefit from additional LLT.
Purpose
Our objective was to estimate rates of LDL-C testing before and after MI hospitalization, hypothesizing that testing rates would increase following MI.
Methods
Using claims data from a large population with Medicare supplemental or commercial insurance, we identified U.S. adults aged ≥20 years discharged from a MI hospitalization. Patients qualified for the study cohort if their first MI hospitalization occurred during 1/1/2008–3/31/2019, with one year of continuous enrolment in insurance leading up to the hospitalization. Patients were required to be discharged alive to the community (excluded if died or transferred to another facility). LDL-C testing was assessed in the year before admission (pre-MI) and for up to one year after discharge (post-MI), with censoring due to insurance plan disenrollment. To evaluate changes in LDL-C testing, we fit an overdispersed Poisson model to the time-series of pre-MI rates and extrapolated the model to the post-MI period, accounting for person-time and seasonality. We predicted the LDL-C testing rates if no MI occurred (i.e., based only on pre-MI testing trends) and estimated rate differences with 95% confidence intervals (contrasting observed vs. model-predicted rates).
Results
A total of 389,367 patients were hospitalized for their first MI during the study period with 60% aged <65 years, 64% were male, and 51% filled a statin prescription after discharge (half being high-intensity statins). In the year pre-MI, 25% had a history of diabetes mellitus, 35% used statins, and 4% used ezetimibe. In the year post-MI, only 52% had an LDL-C test. Mean observed rates (tests per 1,000 patients per month) in the pre- and post-MI periods were 51.9 (95% CI: 51.7, 52.1) and 84.4 (95% CI: 84.1, 84.6), respectively. Across the 12 months post-MI, observed rates were higher than model-predicted rates, with the magnitude of rate differences changing over time (Figure). The observed testing rate peaked two months post-MI (rate difference: 65.7, 95% CI: 64.6, 66.7).
Conclusions
Our findings indicate that LDL-C testing rates increased following a MI hospitalization and stayed elevated throughout the following year. Despite this increase, overall rates remained low, with only one in two patients receiving an LDL-C test in the year after MI. These results highlight a potential gap in care, particularly given the importance of LDL-C monitoring for this population to reduce risk of future ASCVD events.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): This study was funded by Amgen, Inc. Several authors are employees and own stock in Amgen.
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Affiliation(s)
- S N Levintow
- University of North Carolina, Epidemiology, Chapel Hill, United States of America
| | - S R Reading
- Amgen, Inc., Thousand Oaks, United States of America
| | - S Noshad
- Amgen, Inc., Thousand Oaks, United States of America
| | - S Mayer
- NoviSci, Inc., Durham, United States of America
| | - C Wiener
- NoviSci, Inc., Durham, United States of America
| | - B Eledath
- NoviSci, Inc., Durham, United States of America
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5
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Montresor-López JA, Reading SR, Yanosky JD, Mittleman MA, Bell RA, Crume TL, Dabelea D, Dolan L, D'Agostino RB, Marcovina SM, Pihoker C, Reynolds K, Urbina E, Liese AD, Quirós-Alcalá L, Smith JC, Bueno de Mesquita PJ, Puett RC. The relationship between traffic-related air pollution exposures and allostatic load score among youth with type 1 diabetes in the SEARCH cohort. Environ Res 2021; 197:111075. [PMID: 33798519 PMCID: PMC8187288 DOI: 10.1016/j.envres.2021.111075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 03/15/2021] [Accepted: 03/21/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE We investigated the effects of chronic exposures to particulate and traffic-related air pollution on allostatic load (AL) score, a marker of cumulative biological risk, among youth with type 1 diabetes. RESEARCH DESIGN AND METHODS Participants were drawn from five clinical sites of the SEARCH for Diabetes in Youth (SEARCH) study (n = 2338). Baseline questionnaires, anthropometric measures, and a fasting blood test were taken at a clinic visit between 2001 and 2005. AL was operationalized using 10 biomarkers reflecting cardiovascular, metabolic, and inflammatory risk. Annual residential exposures to PM2.5 and proximity to heavily-trafficked major roadways were estimated for each participant. Poisson regression models adjusted for sociodemographic and lifestyle factors were conducted for each exposure. RESULTS No significant associations were observed between exposures to PM2.5 or proximity to traffic and AL score, however analyses were suggestive of effect modification by race for residential distance to heavily-trafficked major roadways (p = 0.02). In stratified analyses, residing <100, 100-<200 and 200-<400 m compared to 400 m or more from heavily-trafficked major roadways was associated with 11%, 26% and 14% increases in AL score, respectively (95% CIs: -4, 29; 9, 45; -1, 30) for non-white participants compared to 6%, -2%, and -2% changes (95% CIs: -2, 15; -10, 7; -8, 6) for white participants. CONCLUSIONS Among this population of youth with type 1 diabetes, we did not observe consistent relationships between chronic exposures to particulate and traffic-related air pollution and changes in AL score, however associations for traffic-related pollution exposures may differ by race/ethnicity and warrant further examination.
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Affiliation(s)
- Jessica A Montresor-López
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, 255 Valley Dr., Suite 2234, College Park, MD, 20742, USA
| | - Stephanie R Reading
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave #2, Pasadena, CA, 91101, USA
| | - Jeffrey D Yanosky
- Division of Epidemiology, Department of Public Health Sciences, Pennsylvania State University College of Medicine, 700 HMC Crescent Road, Hershey, PA, 17033, USA
| | - Murray A Mittleman
- Department of Epidemiology, TH Chan Harvard School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Ronny A Bell
- Department of Public Health, Brody School of Medicine, East Carolina University, 115 Heart Dr., Greenville, NC, 27834, USA
| | - Tessa L Crume
- Department of Epidemiology, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Center, 13001 E. 17th Place, Mail Stop B119, Fitzsimons Building, Room W3110, Aurora, CO, 80045, USA
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Center, 13001 E. 17th Place, Mail Stop B119, Fitzsimons Building, Room W3110, Aurora, CO, 80045, USA
| | - Lawrence Dolan
- Division of Pediatric Endocrinology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Ralph B D'Agostino
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, 475 Vine Street, Winston-Salem, NC, 27101, USA
| | - Santica M Marcovina
- Division of Metabolism, Endocrinology and Nutrition, Northwest Lipid Metabolism and Diabetes Research Laboratories, 401 Queen Anne Avenue North UW, Mailbox 359119, Seattle, WA, 98109, USA
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, 4245 Roosevelt Way NE 4th Floor, Seattle, WA, 98105, USA
| | - Kristi Reynolds
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave #2, Pasadena, CA, 91101, USA
| | - Elaine Urbina
- Heart Institute, Cincinnati Children's Hospital Medical Center, C4 Clinic, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Discovery 1 461, 915 Greene St, Columbia, SC, 29208, USA
| | - Lesliam Quirós-Alcalá
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Room E6616, Baltimore, MD, 21205, USA
| | - J Carson Smith
- Department of Kinesiology, School of Public Health, University of Maryland, 255 Valley Dr., Suite 2234, College Park, MD, 20742, USA
| | - P Jacob Bueno de Mesquita
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, 255 Valley Dr., Suite 2234, College Park, MD, 20742, USA
| | - Robin C Puett
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, 255 Valley Dr., Suite 2234, College Park, MD, 20742, USA.
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Schubert J, Lindahl B, Melhus H, Renlund H, Leosdottir M, Yari A, Ueda P, James S, Reading SR, Dluzniewski PJ, Hamer AW, Jernberg T, Hagström E. Low-density lipoprotein cholesterol reduction and statin intensity in myocardial infarction patients and major adverse outcomes: a Swedish nationwide cohort study. Eur Heart J 2021; 42:243-252. [PMID: 33367526 PMCID: PMC7954251 DOI: 10.1093/eurheartj/ehaa1011] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/02/2020] [Accepted: 11/27/2020] [Indexed: 12/31/2022] Open
Abstract
Aims Clinical trials have demonstrated that a reduction in low-density lipoprotein cholesterol (LDL-C) reduces cardiovascular (CV) events. This has, however, not yet been shown in a real-world setting. We aimed to investigate the association between LDL-C changes and statin intensity with prognosis after a myocardial infarction (MI). Methods and results Patients admitted with MI were followed for mortality and major CV events. Changes in LDL-C between the MI and a 6- to 10-week follow-up visit were analysed. The associations between quartiles of LDL-C change and statin intensity with outcomes were assessed using adjusted Cox regression analyses. A total of 40 607 patients were followed for a median of 3.78 years. The median change in LDL-C was a 1.20 mmol/L reduction. Patients with larger LDL-C reduction (1.85 mmol/L, 75th percentile) compared with a smaller reduction (0.36 mmol/L, 25th percentile) had lower hazard ratios (HR) for all outcomes (95% confidence interval): composite of CV mortality, MI, and ischaemic stroke 0.77 (0.70–0.84); all-cause mortality 0.71 (0.63–0.80); CV mortality 0.68 (0.57–0.81); MI 0.81 (0.73–0.91); ischaemic stroke 0.76 (0.62–0.93); heart failure hospitalization 0.73 (0.63–0.85), and coronary artery revascularization 0.86 (0.79–0.94). Patients with ≥50% LDL-C reduction using high-intensity statins at discharge had a lower incidence of all outcomes compared with those using a lower intensity statin. Conclusions Larger early LDL-C reduction and more intensive statin therapy after MI were associated with a reduced hazard of all CV outcomes and all-cause mortality. This supports clinical trial data suggesting that earlier lowering of LDL-C after an MI confers the greatest benefit.
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Affiliation(s)
- Jessica Schubert
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Uppsala Clinical Research Center, Uppsala, Sweden
| | - Håkan Melhus
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Margrét Leosdottir
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Ali Yari
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Peter Ueda
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Stefan James
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Uppsala Clinical Research Center, Uppsala, Sweden
| | | | | | | | - Tomas Jernberg
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Uppsala Clinical Research Center, Uppsala, Sweden
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7
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Levintow SN, Reading SR, Saul BC, Yu Y, Reams D, McGrath LJ, Philip K, Dluzniewski PJ, Brookhart MA. Lipid Testing Trends in the US Before and After the Release of the 2013 Cholesterol Treatment Guidelines. Clin Epidemiol 2020; 12:835-845. [PMID: 32801921 PMCID: PMC7414934 DOI: 10.2147/clep.s259757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/14/2020] [Indexed: 11/23/2022] Open
Abstract
Background The 2013 ACC/AHA cholesterol treatment guidelines removed the recommendation to treat adults at risk of cardiovascular disease to goal levels of low-density lipoprotein cholesterol (LDL-C). We anticipated that the frequency of LDL-C testing in clinical practice would decline as a result. To test this hypothesis, we evaluated the frequency of LDL-C testing before and after the guideline release. Methods We used the MarketScan® Commercial and Medicare Supplemental claims data (1/1/2007–12/31/2016) to identify four cohorts: 1) statin initiators (any intensity), 2) high-intensity statin initiators, 3) ezetimibe initiators, and 4) patients at very high cardiovascular risk (≥2 hospitalizations for myocardial infarction or ischemic stroke, with prevalent statin use). Rates of LDL-C testing by calendar year quarter were estimated for each cohort. To estimate rates in the absence of a guideline change, we fit a time-series model to the pre-guideline rates and extrapolated to the post-guideline period, adjusting for covariates, seasonality, and time trend. Results Pre- and post-guideline rates (LDL-C tests per 1,000 persons per quarter) were 248 and 235, respectively, for 3.9 million statin initiators; 263 and 246 for 1.3 million high-intensity statin initiators; 277 and 261 for 323,544 ezetimibe initiators; and 180 and 158 for 42,108 very high-risk patients. For all cohorts, observed post-guideline rates were similar to model-predicted rates. On average, the difference between observed and predicted rates was 8.5 for patients initiating any statin; 2.6 for patients initiating a high-intensity statin; 11.4 for patients initiating ezetimibe, and −0.5 for high-risk patients. Conclusion We observed no discernible impact of the release of the 2013 ACC/AHA guidelines on LDL-C testing rates. Rather, there was a gradual decline in testing rates starting prior to the guideline change and continuing throughout the study period. Our findings suggest that the guidelines had little to no impact on use of LDL-C testing.
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Affiliation(s)
- Sara N Levintow
- NoviSci, Inc, Durham, NC, USA.,Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | | | | | - Ying Yu
- NoviSci, Inc, Durham, NC, USA
| | | | | | - Kiran Philip
- Center for Observational Research, Amgen, Thousand Oaks, CA, USA
| | | | - M Alan Brookhart
- NoviSci, Inc, Durham, NC, USA.,Department of Population Health Sciences, Duke University, Durham, NC, USA
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8
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Chi GC, Kanter MH, Li BH, Qian L, Reading SR, Harrison TN, Jacobsen SJ, Scott RD, Cavendish JJ, Lawrence JM, Tartof SY, Reynolds K. Trends in Acute Myocardial Infarction by Race and Ethnicity. J Am Heart Assoc 2020; 9:e013542. [PMID: 32114888 PMCID: PMC7335574 DOI: 10.1161/jaha.119.013542] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Trends in acute myocardial infarction (AMI) incidence rates for diverse races/ethnicities are largely unknown, presenting barriers to understanding the role of race/ethnicity in AMI occurrence. Methods and Results We identified AMI hospitalizations for Kaiser Permanente Southern California members, aged ≥35 years, during 2000 to 2014 using discharge diagnostic codes. We excluded hospitalizations with missing race/ethnicity information. We calculated annual incidence rates (age and sex standardized to the 2010 US census population) for AMI, ST‐segment–elevation myocardial infarction, and non–ST‐segment–elevation myocardial infarction by race/ethnicity (Hispanic and non‐Hispanic racial groups: Asian or Pacific Islander, black, and white). Using Poisson regression, we estimated annual percentage change in AMI, non–ST‐segment–elevation myocardial infarction, and ST‐segment–elevation myocardial infarction incidence by race/ethnicity and AMI incidence rate ratios between race/ethnicity pairs, adjusting for age and sex. We included 18 630 776 person‐years of observation and identified 44 142 AMI hospitalizations. During 2000 to 2014, declines in AMI, non–ST‐segment–elevation myocardial infarction, and ST‐segment–elevation myocardial infarction were 48.7%, 34.2%, and 69.8%, respectively. Age‐ and sex‐standardized AMI hospitalization rates/100 000 person‐years declined for Hispanics (from 307 to 162), Asians or Pacific Islanders (from 271 to 158), blacks (from 347 to 199), and whites (from 376 to 189). Annual percentage changes ranged from −2.99% to −4.75%, except for blacks, whose annual percentage change was −5.32% during 2000 to 2009 and −1.03% during 2010 to 2014. Conclusions During 2000 to 2014, AMI, non–ST‐segment–elevation myocardial infarction, and ST‐segment–elevation myocardial infarction hospitalization incidence rates declined substantially for each race/ethnic group. Despite narrowing rates among races/ethnicities, differences persist. Understanding these differences can help identify unmet needs in AMI prevention and management to guide targeted interventions.
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Affiliation(s)
- Gloria C Chi
- Epidemic Intelligence Service Division of Scientific Education and Professional Development Centers for Disease Control and Prevention Atlanta GA.,Department of Research and Evaluation Kaiser Permanente Southern California Pasadena CA
| | - Michael H Kanter
- Southern California Permanente Medical Group Pasadena CA.,Department of Clinical Science Kaiser Permanente School of Medicine Pasadena CA
| | - Bonnie H Li
- Department of Research and Evaluation Kaiser Permanente Southern California Pasadena CA
| | - Lei Qian
- Department of Research and Evaluation Kaiser Permanente Southern California Pasadena CA
| | - Stephanie R Reading
- Department of Research and Evaluation Kaiser Permanente Southern California Pasadena CA.,Amgen Inc Thousand Oaks CA
| | - Teresa N Harrison
- Department of Research and Evaluation Kaiser Permanente Southern California Pasadena CA
| | - Steven J Jacobsen
- Department of Research and Evaluation Kaiser Permanente Southern California Pasadena CA
| | | | | | - Jean M Lawrence
- Department of Research and Evaluation Kaiser Permanente Southern California Pasadena CA
| | - Sara Y Tartof
- Department of Research and Evaluation Kaiser Permanente Southern California Pasadena CA
| | - Kristi Reynolds
- Department of Research and Evaluation Kaiser Permanente Southern California Pasadena CA
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9
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Mefford MT, Li BH, Qian L, Reading SR, Harrison TN, Scott RD, Cavendish JJ, Jacobsen SJ, Kanter MH, Woodward M, Reynolds K. Sex-Specific Trends in Acute Myocardial Infarction Within an Integrated Healthcare Network, 2000 Through 2014. Circulation 2020; 141:509-519. [DOI: 10.1161/circulationaha.119.044738] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
In recent decades, the rates of incident acute myocardial infarction (AMI) have declined in the United States, yet disparities by sex remain. In an integrated healthcare delivery system, we examined temporal trends in incident AMI among women and men.
Methods:
We identified hospitalized AMI among members ≥35 years of age in Kaiser Permanente Southern California. The first hospitalization for AMI overall, and for ST-segment–elevation MI and non–ST-segment–elevation MI was identified by
International Classification of Diseases, Ninth Revision, Clinical Modification
primary discharge diagnosis codes in each calendar year from 2000 through 2014. Age- and sex-standardized incidence rates per 100 000 person-years were calculated by using direct adjustment to the 2010 US Census population. Average annual percent changes (AAPCs) and period percent changes were calculated, and trend tests were conducted using Poisson regression.
Results:
We identified 45 331 AMI hospitalizations between 2000 and 2014. Age- and sex-standardized incidence rates of AMI declined from 322.4 (95% CI, 311.0–333.9) in 2000 to 174.6 (95% CI, 168.2–181.0) in 2014, representing an AAPC of –4.4% (95% CI, –4.2 to –4.6) and a period percent change of –46.6%. The AAPC for AMI in women was –4.6% (95% CI, –4.1 to –5.2) between 2000 and 2009 and declined to –2.3% (95% CI, –1.2 to –3.4) between 2010 and 2014. The AAPC for AMI in men was stable over the study period (–4.7% [95% CI, –4.4 to –4.9]). The AAPC for ST-segment–elevation MI hospitalization overall was –8.3% (95% CI, –8.0% to –8.6%).The AAPC in ST-segment–elevation MI changed among women in 2009 (2000–2009: –10.2% [95% CI, –9.3 to –11.1] and in 2010–2014: –5.2% [95% CI, –3.1 to –7.3]) while remaining stable among men (–8.0% [95% CI, –7.6 to –8.4]). The AAPC for non–ST-segment–elevation MI hospitalization was smaller than for ST-segment–elevation MI among both women and men (–1.9% [95% CI, –1.5 to –2.3] and –2.8% [95% CI, –2.5 to –3.2], respectively).
Conclusions:
These results suggest that the incidence of hospitalized AMI declined between 2000 and 2014; however, declines in AMI have slowed among women in comparison with men in recent years. Determining unmet care needs among women may reduce these sex-based AMI disparities.
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Affiliation(s)
- Matthew T. Mefford
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (M.T.M., B.H.L., L.Q., S.R.R., T.N.H., S.J.J., K.R.)
| | - Bonnie H. Li
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (M.T.M., B.H.L., L.Q., S.R.R., T.N.H., S.J.J., K.R.)
| | - Lei Qian
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (M.T.M., B.H.L., L.Q., S.R.R., T.N.H., S.J.J., K.R.)
| | - Stephanie R. Reading
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (M.T.M., B.H.L., L.Q., S.R.R., T.N.H., S.J.J., K.R.)
- Center for Observational Research, Amgen, Inc, Thousand Oaks, CA (S.R.R.)
| | - Teresa N. Harrison
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (M.T.M., B.H.L., L.Q., S.R.R., T.N.H., S.J.J., K.R.)
| | - Ronald D. Scott
- Southern California Permanente Medical Group, West Los Angeles (R.D.S.)
| | - Jeffrey J. Cavendish
- Southern California Permanente Medical Group, San Diego Medical Center, San Diego (J.J.C.)
| | - Steven J. Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (M.T.M., B.H.L., L.Q., S.R.R., T.N.H., S.J.J., K.R.)
- Department of Health Systems Science (S.J.J., K.R.), Kaiser Permanente School of Medicine, Pasadena, CA
| | - Michael H. Kanter
- Department of Clinical Science (M.H.K.), Kaiser Permanente School of Medicine, Pasadena, CA
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (M.W.)
- The George Institute for Global Health, University of Oxford, United Kingdom (M.W.)
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.)
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (M.T.M., B.H.L., L.Q., S.R.R., T.N.H., S.J.J., K.R.)
- Department of Health Systems Science (S.J.J., K.R.), Kaiser Permanente School of Medicine, Pasadena, CA
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10
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Rosenson RS, Hubbard D, Monda KL, Reading SR, Chen L, Dluzniewski PJ, Burkholder GA, Muntner P, Colantonio LD. Excess Risk for Atherosclerotic Cardiovascular Outcomes Among US Adults With HIV in the Current Era. J Am Heart Assoc 2019; 9:e013744. [PMID: 31880980 PMCID: PMC6988153 DOI: 10.1161/jaha.119.013744] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background In the 2000s, adults with HIV had a higher risk for atherosclerotic cardiovascular disease (ASCVD) compared with those without HIV. There is uncertainty if this excess risk still exists in the United States given changes in antiretroviral therapies and increased statin use. Methods and Results We compared the risk for ASCVD events between US adults aged ≥19 years with and without HIV who had commercial or supplemental Medicare health insurance between January 1, 2011, and December 31, 2016. Beneficiaries with HIV (n=82 426) were frequency matched 1:4 on age, sex, and calendar year to those without HIV (n=329 704). Beneficiaries with and without HIV were followed up through December 31, 2016, for ASCVD events, including myocardial infarction, stroke, and lower extremity artery disease hospitalizations. Most beneficiaries were aged <55 years (79%) and men (84%). Over a median follow‐up of 1.6 years (maximum, 6 years), there were 3287 ASCVD events, 2190 myocardial infarctions, 891 strokes, and 322 lower extremity artery disease events. The rate per 1000 person‐years among beneficiaries with and without HIV was 5.53 and 3.49 for ASCVD, respectively, 3.58 and 2.34 for myocardial infarction, respectively, 1.49 and 0.94 for stroke, respectively, and 0.65 and 0.31 for lower extremity artery disease hospitalizations, respectively. The multivariable‐adjusted hazard ratio (95% CI) for ASCVD, myocardial infarction, stroke, and lower extremity artery disease hospitalizations comparing beneficiaries with versus without HIV was 1.29 (1.18–1.40), 1.26 (1.13–1.39), 1.30 (1.11–1.52), and 1.46 (1.11–1.92), respectively. Conclusions Adults with HIV in the United States continue to have a higher ASCVD risk compared with their counterparts without HIV.
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Affiliation(s)
| | | | | | | | - Ligong Chen
- University of Alabama at Birmingham Birmingham AL
| | | | | | - Paul Muntner
- University of Alabama at Birmingham Birmingham AL
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11
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Reynolds K, Mues KE, Harrison TN, Qian L, Chen S, Hsu JWY, Philip KJ, Monda KL, Reading SR, Brar SS. Trends in statin utilization among adults with severe peripheral artery disease including critical limb ischemia in an integrated healthcare delivery system. Vasc Med 2019; 25:3-12. [PMID: 31512991 DOI: 10.1177/1358863x19871100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Evidence suggests that statin therapy in patients with peripheral artery disease (PAD) is beneficial yet use remains suboptimal. We examined trends in statin use, intensity, and discontinuation among adults aged ⩾ 40 years with incident severe PAD and a subset with critical limb ischemia (CLI) between 2002 and 2015 within an integrated healthcare delivery system. Discontinuation of statin therapy was defined as the first 90-day gap in treatment within 1 year following PAD diagnosis. We identified 11,059 patients with incident severe PAD: 31.1% (n = 3442) with CLI and 68.9% (n = 7617) without CLI. Mean (SD) age was 68.6 (11.3) years, 60.5% were male, 54.2% white, 23.2% Hispanic, and 16.2% black. Statin use in the year before diagnosis increased from 50.4% in 2002 to 66.0% in 2015 (CLI: 43.7% to 68.0%; without CLI: 53.1% to 64.2%, respectively). The proportion of patients on high-intensity statins increased from 7.3% in 2002 to 41.9% in 2015 (CLI: 7.2% to 39.4%; without CLI: 7.4% to 44.2%, respectively). Of the 40.5% (n = 4481) who were not on a statin in the year before diagnosis, 13.5% (n = 607) newly initiated therapy within 1 month (CLI: 10.1% (n = 150); without CLI: 15.3% (n = 457)). Following diagnosis, 12.5% (n = 660) discontinued statin therapy within 1 year (CLI: 15.5% (n = 202); without CLI: 11.5% (n = 458)). Although use of statins increased from 2002 to 2015, a substantial proportion of the overall PAD and CLI subpopulation remained untreated with statins, representing a significant treatment gap in a population at high risk for cardiovascular events and adverse limb outcomes.
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Affiliation(s)
- Kristi Reynolds
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, USA
| | | | - Teresa N Harrison
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, USA
| | - Lei Qian
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, USA
| | - Songyue Chen
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, USA
| | - Jin-Wen Y Hsu
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, USA
| | | | | | - Stephanie R Reading
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, USA.,Amgen Inc., Thousand Oaks, CA, USA
| | - Somjot S Brar
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
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12
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Reading SR, Black MH, Singer DE, Go AS, Fang MC, Udaltsova N, Harrison TN, Wei RX, Liu ILA, Reynolds K. Risk factors for medication non-adherence among atrial fibrillation patients. BMC Cardiovasc Disord 2019; 19:38. [PMID: 30744554 PMCID: PMC6371431 DOI: 10.1186/s12872-019-1019-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/04/2019] [Indexed: 12/16/2022] Open
Abstract
Background Atrial fibrillation (AF) patients are routinely prescribed medications to prevent and treat complications, including those from common co-occurring comorbidities. However, adherence to such medications may be suboptimal. Therefore, we sought to identify risk factors for general medication non-adherence in a population of patients with atrial fibrillation. Methods Data were collected from a large, ethnically-diverse cohort of Kaiser Permanente Northern and Southern California adult members with incident diagnosed AF between January 1, 2006 and June 30, 2009. Self-reported questionnaires were completed between May 1, 2010 and September 30, 2010, assessing patient socio-demographics, health behaviors, health status, medical history and medication adherence. Medication adherence was assessed using a previously validated 3-item questionnaire. Medication non-adherence was defined as either taking medication(s) as the doctor prescribed 75% of the time or less, or forgetting or choosing to skip one or more medication(s) once per week or more. Electronic health records were used to obtain additional data on medical history. Multivariable logistic regression analyses examined the associations between patient characteristics and self-reported general medication adherence among patients with complete questionnaire data. Results Among 12,159 patients with complete questionnaire data, 6.3% (n = 771) reported medication non-adherence. Minority race/ethnicity versus non-Hispanic white, not married/with partner versus married/with partner, physical inactivity versus physically active, alcohol use versus no alcohol use, any days of self-reported poor physical health, mental health and/or sleep quality in the past 30 days versus 0 days, memory decline versus no memory decline, inadequate versus adequate health literacy, low-dose aspirin use versus no low-dose aspirin use, and diabetes mellitus were associated with higher adjusted odds of non-adherence, whereas, ages 65–84 years versus < 65 years of age, a Charlson Comorbidity Index score ≥ 3 versus 0, and hypertension were associated with lower adjusted odds of non-adherence. Conclusions Several potentially preventable and/or modifiable risk factors related to medication non-adherence and a few non-modifiable risk factors were identified. These risk factors should be considered when assessing medication adherence among patients diagnosed with AF.
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Affiliation(s)
- Stephanie R Reading
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., 2nd floor, Pasadena, CA, 91101, USA
| | - Mary Helen Black
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., 2nd floor, Pasadena, CA, 91101, USA
| | - Daniel E Singer
- Department of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.,Departments of Epidemiology, Biostatistics and Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Margaret C Fang
- Division of Hospital Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Natalia Udaltsova
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Teresa N Harrison
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., 2nd floor, Pasadena, CA, 91101, USA
| | - Rong X Wei
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., 2nd floor, Pasadena, CA, 91101, USA
| | - In-Lu Amy Liu
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., 2nd floor, Pasadena, CA, 91101, USA
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., 2nd floor, Pasadena, CA, 91101, USA.
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13
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Reading SR, Porter KR, Slezak JM, Harrison TN, Gelfond JS, Chien GW, Jacobsen SJ. Racial and Ethnic Variation in Health-Related Quality of Life Scores Prior to Prostate Cancer Treatment. Sex Med 2017; 5:e219-e228. [PMID: 28827045 PMCID: PMC5693455 DOI: 10.1016/j.esxm.2017.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/23/2017] [Accepted: 07/10/2017] [Indexed: 11/24/2022] Open
Abstract
Introduction Many men diagnosed with prostate cancer are concerned with how the disease and its course of treatment could affect their health-related quality of life (HRQOL). To aid in the decision-making process on a course of treatment and to better understand how these treatments can affect HRQOL, knowledge of pretreatment HRQOL is essential. Aims To assess the racial and ethnic variations in HRQOL scores in men newly diagnosed with prostate cancer before electing a course of treatment. Methods Male members of the Kaiser Permanente of Southern California health plan who were newly diagnosed with prostate cancer completed the five-domain specific Expanded Prostate Index Composite–26 (EPIC-26) HRQOL questionnaire from March 1, 2011 through August 31, 2013 (N = 2,579). Domain scores were compared across racial and ethnic subgroups and multiple logistic regression analyses were used to assess the association after adjusting for sociodemographic and clinical characteristics. Main Outcome Measures The five EPIC-26 domain scores (sexual, bowel, hormonal, urinary incontinence, and urinary irritation and obstruction). Results Results from the fully adjusted analyses indicated that non-Hispanic black men were more likely to be above the sample median on the sexual (odds ratio [OR] = 1.43, 95% CI = 1.09–1.88), hormonal (OR = 1.35, 95% CI = 1.03–1.77), and urinary irritation and obstruction (OR = 1.34, 95% CI = 1.03–1.74) domains compared with non-Hispanic white men. The Asian or Pacific Islander men were less likely to be above the sample median on the sexual domain (OR = 0.60, 95% CI = 0.44–0.83) compared with non-Hispanic white men. No additional statistically significant differences were identified. Conclusions Within an integrated health care organization, we found minimal racial and ethnic differences, aside from sexual function, in pretreatment HRQOL in men newly diagnosed with prostate cancer. These findings provide important insight with which to interpret HRQOL changes in men newly diagnosed with prostate cancer during and after prostate cancer treatment. Reading SR, Porter KR, Slezak JM, et al. Racial and Ethnic Variation in Health-Related Quality of Life Scores Prior to Prostate Cancer Treatment. Sex Med 2017;5:e219–e228.
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Affiliation(s)
- Stephanie R Reading
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Kimberly R Porter
- Division of Chronic Disease and Injury Prevention, Department of Public Health Los Angeles County, Los Angeles, CA, USA
| | - Jeffrey M Slezak
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Teresa N Harrison
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Joy S Gelfond
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Gary W Chien
- Department of Urology, Kaiser Permanente Southern California, Los Angeles, CA, USA
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
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14
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Abstract
Background Atrial fibrillation (AF) is the most common clinically significant arrhythmia in adults and a major risk factor for ischemic stroke. Nonetheless, previous research suggests that many individuals diagnosed with AF lack awareness about their diagnosis and inadequate health literacy may be an important contributing factor to this finding. Methods and Results We examined the association between health literacy and awareness of an AF diagnosis in a large, ethnically diverse cohort of Kaiser Permanente Northern and Southern California adults diagnosed with AF between January 1, 2006 and June 30, 2009. Using self‐reported questionnaire data completed between May 1, 2010 and September 30, 2010, awareness of an AF diagnosis was evaluated using the question “Have you ever been told by a doctor or other health professional that you have a heart rhythm problem called atrial fibrillation or atrial flutter?” and health literacy was assessed using a validated 3‐item instrument examining problems because of reading, understanding, and filling out medical forms. Of the 12 517 patients diagnosed with AF, 14.5% were not aware of their AF diagnosis and 20.4% had inadequate health literacy. Patients with inadequate health literacy were less likely to be aware of their AF diagnosis compared with patients with adequate health literacy (prevalence ratio=0.96; 95% CI [0.94, 0.98]), adjusting for sociodemographics, health behaviors, and clinical characteristics. Conclusions Lower health literacy is independently associated with less awareness of AF diagnosis. Strategies designed to increase patient awareness of AF and its complications are warranted among individuals with limited health literacy.
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Affiliation(s)
- Stephanie R Reading
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Margaret C Fang
- Division of Hospital Medicine, University of California San Francisco, San Francisco, CA
| | - Daniel E Singer
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - In-Lu Amy Liu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Mary Helen Black
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Natalia Udaltsova
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
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15
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Reading SR, Reynolds K, Li BH, Qian LX, Ryan DS, Harrison TN, Scott RD, Cavendish JJ, Jacobsen SJ, Kanter MH. Abstract 061: Sex-specific Trends in Acute Myocardial Infarction Hospitalization, 2000 to 2014. Circ Cardiovasc Qual Outcomes 2017. [DOI: 10.1161/circoutcomes.10.suppl_3.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives:
Age and sex-specific differences exist in acute myocardial infarction (AMI) prevalence, morbidity and mortality. Thus, within a diverse integrated health care delivery system of over 4 million members, we examined how sex-specific temporal trends in AMI incidence may have contributed to these differences and reflect evolving changes in AMI prevention efforts.
Methods:
We identified all Kaiser Permanente Southern California members (aged ≥35 years) with a primary ICD-9-CM hospital discharge diagnosis of AMI between January 1, 2000 and December 31, 2014. Incident AMI hospitalization was defined as the first event documented in the electronic health record between 2000 and 2014, with no prior AMI hospitalization. Incident ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) were identified similarly. Age-standardized (using U.S. 2010 Census data) and age-specific incidence rates by sex were calculated separately for AMI, STEMI and NSTEMI events for each calendar year. Average annual percent change and 95% confidence intervals (CIs) were estimated using log-linear Poisson models.
Results:
A total of 45,331 AMI, 16,524 STEMI and 32,552 NSTEMI incident events were identified between 2000 and 2014. Age-standardized incidence rates (per 100,000 person years) of AMI declined an average of 4.7%/year (95% CI [4.4, 4.9]) for men from 441.9 in 2000 to 223.6 in 2014 and 3.9%/year (95% CI [3.6, 4.2]) for women from 246.5 in 2000 to 146.4 in 2014. NSTEMIs declined an average of 2.8%/year (95% CI [2.5, 3.2]) for men from 268.2 in 2000 to 170.2 in 2014 and 1.9%/year (95% CI [1.5, 2.3]) for women from 156.1 in 2000 to 121.8 in 2014. Although STEMI incidence rates declined substantially from 2000 to 2014, sex differences were minimal, with an average decline of 8.0%/year (95% CI [7.6, 8.4]) for men from 205.9 in 2000 to 67.5 in 2014 and 8.9%/year (95% CI [8.3, 9.5]) for women from 107.2 in 2000 to 32.3 in 2014. Comparing 2000 to 2014, age-specific incidence rates of AMI, NSTEMI and STEMI declined in both men and women across all age groups (
Table
).
Conclusions:
Despite absolute differences, both men and women have experienced similar declines in hospitalized AMI, STEMI and NSTEMI incidence rates, presumably due to increased efforts in both primary and secondary AMI prevention.
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Affiliation(s)
| | | | - Bonnie H Li
- Kaiser Permanente of Southern California, Pasadena, CA
| | - Lei X Qian
- Kaiser Permanente of Southern California, Pasadena, CA
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16
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Reading SR, Porter KR, Hsu JWY, Wallner LP, Loo RK, Jacobsen SJ. Racial and Ethnic Variation in Time to Prostate Biopsy After an Elevated Screening Level of Serum Prostate-specific Antigen. Urology 2016; 96:121-127. [PMID: 27316374 DOI: 10.1016/j.urology.2016.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/06/2016] [Accepted: 06/08/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine the racial and ethnic variation in time to prostate biopsy after an elevated screening level of serum prostate-specific antigen (PSA). METHODS Male members of the Kaiser Permanente of Southern California health plan, 45 years of age or older, with no history of prostate cancer or a prostate biopsy, and at least 1 elevated screening level of serum PSA between January 1, 1998 and December 31, 2007 were retrospectively identified (n = 59,506). All participants were passively followed via electronic health records until their time of prostate biopsy, death, membership disenrollment, or study conclusion (December 31, 2014), whichever was the initial event. Proportional hazard regression analyses were used to estimate the association between time from an elevated screening level of serum PSA to prostate biopsy, adjusting for age, benign prostatic hyperplasia, prostatitis, type 2 diabetes mellitus, hypertension, and Charlson Comorbidity Index score. RESULTS Median time until biopsy was 0.6 years (214 days), with approximately 41% of participants receiving a prostate biopsy within the study period. Results from the fully adjusted analysis indicated that the non-Hispanic Asian or Pacific Islanders (hazard ratio: 1.10, 95% confidence interval: [1.04, 1.15]) and the non-Hispanic blacks (hazard ratio: 1.04, 95% confidence interval: [1.00, 1.08]) had a slightly shorter time to prostate biopsy after an elevated screening level of serum PSA compared to the non-Hispanic whites. CONCLUSION These data suggest that, within an integrated healthcare organization, minimal differences exist between racial and ethnic subgroups in their time to prostate biopsy after an elevated screening level of serum PSA.
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Affiliation(s)
- Stephanie R Reading
- Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena, CA
| | - Kimberly R Porter
- Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena, CA
| | - Jin-Wen Y Hsu
- Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena, CA
| | - Lauren P Wallner
- Department of Medicine and Epidemiology, University of Michigan, Ann Arbor, MI
| | - Ronald K Loo
- Department of Urology, Kaiser Permanente of Southern California, Los Angeles, CA
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena, CA.
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Slezak JM, Chien GW, Quinn VP, Reading SR, Jacobsen SJ. Patient-provider language concordance and choice of treatment for prostate cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.6604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jeff M. Slezak
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Gary W. Chien
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Virginia P. Quinn
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Stephanie R. Reading
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Steven J. Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
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Reading SR, Porter KR, Slezak JM, Chien GW, Jacobsen SJ. Racial and ethnic variation in baseline health-related quality of life scores prior to prostate cancer treatment. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.3_suppl.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
232 Background: To compare the racial and ethnic variations in baseline health-related quality of life (HRQOL) scores among men newly-diagnosed with prostate cancer prior to their prostate cancer treatment. Methods: Male members of the Kaiser Permanente of Southern California (KPSC) health plan, newly-diagnosed with prostate cancer, completed the five-domain specific Expanded Prostate Index Composite (EPIC-26) health-related quality of life (HRQOL) questionnaire between March 1, 2011 and August 31, 2013 (n=2,225). The five EPIC-26 domain scores (sexual, bowel, hormonal, urinary incontinence and urinary irritation) were compared across racial and ethnic subgroups and multiple logistic regression analyses were used to assess the association, adjusting for socio-demographic and clinical characteristics. Results: Within each racial and ethnic subgroup,higher baseline HRQOL scores were seen on the bowel, hormonal, urinary incontinence and urinary irritation domains (median score range: 87.5 – 100) as compared to the sexual domain (median score range: 49.3 – 62.5). Asian or Pacific Islander men were less likely to be above the sample median on the sexual (OR=0.51; 95% CI [0.36, 0.74]; p<0.001) and urinary incontinence domains (OR=0.65; 95% CI [0.46, 0.92]; p=0.015) as compared to the non-Hispanic white men. No additional statistically significant differences (p<0.05) were identified. Conclusions: These data suggest that few differences exist in baseline HRQOL scores across racial and ethnic subgroups among men newly-diagnosed with prostate cancer in an integrated health care organization. This finding provides important insight into the pre-treatment HRQOL status among these men with which to interpret HRQOL changes during and after prostate cancer treatment.
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Affiliation(s)
- Stephanie R. Reading
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Kimberly R. Porter
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Jeffrey M. Slezak
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Gary W. Chien
- Department of Urology, Kaiser Permanente Southern California, Los Angeles, CA
| | - Steven J. Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
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Abstract
OBJECTIVE Patients with rheumatoid arthritis (RA) have an increased risk for developing cardiovascular disease (CVD) compared to subjects in the general population. The development of CVD has also been linked to chronic sleep apnea. The purpose of this study was to examine the risk for sleep apnea in patients with RA compared to subjects without RA. METHODS We recruited RA patients and non-RA subjects who were age and sex matched from the same population. These persons completed the Berlin Sleep Questionnaire, which evaluated their level of risk (high or low) for sleep apnea. In addition, there were 3 subscales evaluating snoring, fatigue, and relevant comorbidities [i.e., high blood pressure and obesity [body mass index (BMI) > or = 30 kg/m(2))]. Chi-squared tests were used for comparisons. RESULTS The study population consisted of 164 patients with RA and 328 patients without RA. Age, sex and BMI were similar for both groups. There was no difference in snoring (p = 0.31) or in the comorbidities subscale (p = 0.37). However, RA patients reported more fatigue (38%) than subjects without RA (13%; p < 0.001). Overall, the risk for sleep apnea was significantly higher for the RA patients (50%) than the non-RA subjects (31%; p < 0.001). CONCLUSION Patients with RA may be at a higher risk for sleep apnea compared to non-RA subjects. This apparent risk difference may be attributed to reports of fatigue in RA patients, which may be associated with sleep apnea or RA disease itself.
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Affiliation(s)
- Stephanie R. Reading
- Department of Health Sciences Research, Division of Epidemiology; Mayo Clinic and Mayo Graduate School of Medicine, Rochester, Minnesota, USA
| | - Cynthia S. Crowson
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic and Mayo Graduate School of Medicine, Rochester, Minnesota, USA
| | - Richard J. Rodeheffer
- Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic and Mayo Graduate School of Medicine, Rochester, Minnesota, USA
| | - Patrick D. Fitz-Gibbon
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic and Mayo Graduate School of Medicine, Rochester, Minnesota, USA
| | - Hilal Maradit-Kremers
- Department of Health Sciences Research, Division of Epidemiology; Mayo Clinic and Mayo Graduate School of Medicine, Rochester, Minnesota, USA
| | - Sherine E. Gabriel
- Department of Health Sciences Research, Division of Epidemiology; Mayo Clinic and Mayo Graduate School of Medicine, Rochester, Minnesota, USA
- Department of Medicine, Division of Rheumatology; Mayo Clinic and Mayo Graduate School of Medicine, Rochester, Minnesota, USA
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