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Tobe SW, Mavrakanas TA, Bajaj HS, Levin A, Tangri N, Slee A, Neuen BL, Perkovic V, Mahaffey KW, Rapattoni W, Ang FG. Impact of Canagliflozin on Kidney and Cardiovascular Outcomes by Type 2 Diabetes Duration: A Pooled Analysis of the CANVAS Program and CREDENCE Trials. Diabetes Care 2024; 47:501-507. [PMID: 38252809 PMCID: PMC10909678 DOI: 10.2337/dc23-1450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVE The study was undertaken because it was unknown whether the duration of type 2 diabetes modifies the effects of sodium-glucose cotransporter 2 inhibitor canagliflozin on cardiovascular (CV) and kidney outcomes. RESEARCH DESIGN AND METHODS This post hoc analysis of the Canagliflozin Cardiovascular Assessment Study (CANVAS) Program (N = 10,142) and Evaluation of the Effects of Canagliflozin on Renal and Cardiovascular Outcomes in Participants With Diabetic Nephropathy (CREDENCE) trial (N = 4,401) evaluated hazard ratios and 95% CIs using Cox proportional hazards for the effects of canagliflozin on CV and kidney outcomes, including progression and regression of albuminuria over 5-year intervals of disease duration. RESULTS Canagliflozin had ranges of benefit across intervals of diabetes duration, with no heterogeneity for major adverse CV events, CV death or heart failure hospitalization, and kidney failure requiring therapy or doubling serum creatinine. Furthermore, canagliflozin reduced albuminuria progression and increased albuminuria regression with no interaction across all diabetes duration subgroups. CONCLUSIONS Our findings suggest that earlier treatment with canagliflozin confers consistent cardiorenal benefits to individuals with type 2 diabetes.
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Affiliation(s)
- Sheldon W. Tobe
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Thomas A. Mavrakanas
- Division of Nephrology, Department of Medicine, McGill University Health Centre and Research Institute, Montreal, Quebec, Canada
| | | | - Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Navdeep Tangri
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Brendon L. Neuen
- The George Institute for Global Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
- Royal North Shore Hospital, Sydney, Australia
| | - Vlado Perkovic
- The George Institute for Global Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
- Royal North Shore Hospital, Sydney, Australia
- Faculty of Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Kenneth W. Mahaffey
- Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA
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Marcusohn E, Tobe SW, Dueck A, Madan M. La dénervation rénale dans le traitement de l’hypertension non contrôlée. CMAJ 2024; 196:E136-E141. [PMID: 38316459 PMCID: PMC10843440 DOI: 10.1503/cmaj.230745-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Affiliation(s)
- Erez Marcusohn
- Division de cardiologie (Marcusohn, Madan), programme de cardiologie Schulich, Centre Sunnybrook des sciences de la santé; faculté de médecine Temerty (Marcusohn, Tobe, Dueck, Madan), Université de Toronto; Division de néphrologie, Département de médecine (Tobe), Centre Sunnybrook des sciences de la santé, Toronto, Ont.; École de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont.; Division de chirurgie vasculaire (Dueck), programme de cardiologie Schulich, Centre Sunnybrook des sciences de la santé, Toronto, Ont
| | - Sheldon W Tobe
- Division de cardiologie (Marcusohn, Madan), programme de cardiologie Schulich, Centre Sunnybrook des sciences de la santé; faculté de médecine Temerty (Marcusohn, Tobe, Dueck, Madan), Université de Toronto; Division de néphrologie, Département de médecine (Tobe), Centre Sunnybrook des sciences de la santé, Toronto, Ont.; École de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont.; Division de chirurgie vasculaire (Dueck), programme de cardiologie Schulich, Centre Sunnybrook des sciences de la santé, Toronto, Ont
| | - Andrew Dueck
- Division de cardiologie (Marcusohn, Madan), programme de cardiologie Schulich, Centre Sunnybrook des sciences de la santé; faculté de médecine Temerty (Marcusohn, Tobe, Dueck, Madan), Université de Toronto; Division de néphrologie, Département de médecine (Tobe), Centre Sunnybrook des sciences de la santé, Toronto, Ont.; École de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont.; Division de chirurgie vasculaire (Dueck), programme de cardiologie Schulich, Centre Sunnybrook des sciences de la santé, Toronto, Ont
| | - Mina Madan
- Division de cardiologie (Marcusohn, Madan), programme de cardiologie Schulich, Centre Sunnybrook des sciences de la santé; faculté de médecine Temerty (Marcusohn, Tobe, Dueck, Madan), Université de Toronto; Division de néphrologie, Département de médecine (Tobe), Centre Sunnybrook des sciences de la santé, Toronto, Ont.; École de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont.; Division de chirurgie vasculaire (Dueck), programme de cardiologie Schulich, Centre Sunnybrook des sciences de la santé, Toronto, Ont.
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Lui S, Dubrofsky L, Khan NA, Tobe SW, Huynh J, Kuyper L, Mathew A, Amin S, Schiffrin EL, Harvey P, Leung AA, Ruzicka M, Mangat B, Reid D, Floras J, Bittman J, Garbutt L, Braam B, Suri R, Hannah-Shmouni F, Prebtani A, Savard S, MacMillan TE, Ruddy TD, Vallee M, Bollu A, Logan A, Padwal R, Ringrose J. Characterizing Hypertension Specialist Care in Canada: A National Survey. CJC Open 2023; 5:907-915. [PMID: 38204853 PMCID: PMC10774075 DOI: 10.1016/j.cjco.2023.08.014] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/29/2023] [Indexed: 01/12/2024] Open
Abstract
Background The hypertension specialist often receives referrals of patients with young-onset, severe, difficult-to-control hypertension, patients with hypertensive emergencies, and patients with secondary causes of hypertension. Specialist hypertension care compliments primary care for these complex patients and contributes to an overall hypertension control strategy. The objective of this study was to characterize hypertension centres and the practice patterns of Canadian hypertension specialists. Methods Adult hypertension specialists across Canada were surveyed to describe hypertension centres and specialist practice in Canada, including the following: the patient population managed by hypertension specialists; details on how care is provided; practice pattern variations; and differences in access to specialized hypertension resources across the country. Results The survey response rate was 73.5% from 25 hypertension centres. Most respondents were nephrologists and general internal medicine specialists. Hypertension centres saw between 50 and 2500 patients yearly. A mean of 17% (± 15%) of patients were referred from the emergency department and a mean of 52% (± 24%) were referred from primary care. Most centres had access to specialized testing (adrenal vein sampling, level 1 sleep studies, autonomic testing) and advanced therapies for resistant hypertension (renal denervation). Considerable heterogeneity was present in the target blood pressure in young people with low cardiovascular risk and in the diagnostic algorithms for investigating secondary causes of hypertension. Conclusions These results summarize the current state of hypertension specialist care and highlight opportunities for further collaboration among hypertension specialists, including standardization of the approach to specialist care for patients with hypertension.
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Affiliation(s)
- Samantha Lui
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa Dubrofsky
- Department of Medicine, Women’s College Hospital, Toronto, Ontario, Canada, Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nadia A. Khan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sheldon W. Tobe
- Division of Nephrology Sunnybrook Health Sciences Centre, University of Toronto, Toronto and Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Jessica Huynh
- Department of General Internal Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Laura Kuyper
- Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anna Mathew
- Division of Nephrology, Department of Medicine, St. Joseph Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Syed Amin
- Division of Nephrology, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Ernesto L. Schiffrin
- Department of Medicine, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Paula Harvey
- Division of Cardiology, Department of Medicine and Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Alexander A. Leung
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marcel Ruzicka
- Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada
| | - Birinder Mangat
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Reid
- Dvision of Nephrology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - John Floras
- University Health Network and Sinai Health Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jesse Bittman
- Division of Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lauren Garbutt
- Division of Endocrinology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Branko Braam
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Rita Suri
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Fady Hannah-Shmouni
- Division of Endocrinology, University of British Columbia, Vancouver, British Columba, Canada, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Ally Prebtani
- Division of Endocrinology & Metabolism, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sebastien Savard
- Department of Medicine, Universite Laval, Hotel-Dieu de Quebec, Quebec City, Quebec, Canada
| | - Thomas E. MacMillan
- Department of Medicine, Division of General Internal Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Terrence D. Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Michel Vallee
- Faculté de Médecine, Université de Montréal, Montreal, Quebec, Canada
| | - Apoorva Bollu
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Logan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Ringrose
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Marcusohn E, Tobe SW, Dueck A, Madan M. Renal denervation for uncontrolled hypertension. CMAJ 2023; 195:E1475-E1480. [PMID: 37931951 PMCID: PMC10627573 DOI: 10.1503/cmaj.230745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Affiliation(s)
- Erez Marcusohn
- Division of Cardiology (Marcusohn, Madan), Schulich Heart Program, Sunnybrook Health Sciences Centre; Temerty Faculty of Medicine (Marcusohn, Tobe, Dueck, Madan), University of Toronto; Division of Nephrology, Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; Division of Vascular Surgery (Dueck), Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Sheldon W Tobe
- Division of Cardiology (Marcusohn, Madan), Schulich Heart Program, Sunnybrook Health Sciences Centre; Temerty Faculty of Medicine (Marcusohn, Tobe, Dueck, Madan), University of Toronto; Division of Nephrology, Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; Division of Vascular Surgery (Dueck), Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Andrew Dueck
- Division of Cardiology (Marcusohn, Madan), Schulich Heart Program, Sunnybrook Health Sciences Centre; Temerty Faculty of Medicine (Marcusohn, Tobe, Dueck, Madan), University of Toronto; Division of Nephrology, Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; Division of Vascular Surgery (Dueck), Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Mina Madan
- Division of Cardiology (Marcusohn, Madan), Schulich Heart Program, Sunnybrook Health Sciences Centre; Temerty Faculty of Medicine (Marcusohn, Tobe, Dueck, Madan), University of Toronto; Division of Nephrology, Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; Division of Vascular Surgery (Dueck), Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ont.
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Almuhanna N, Tobe SW, Alhusayen R. Risk of Chronic Kidney Disease in Hospitalized Patients with Hidradenitis Suppurativa. Dermatology 2023; 239:912-918. [PMID: 37487485 DOI: 10.1159/000531960] [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: 07/22/2021] [Accepted: 06/23/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is associated with several comorbidities such as diabetes mellitus and cardiovascular diseases. These comorbidities are also risk factors for chronic kidney disease (CKD), yet little is known about the risk of CKD in HS patients. OBJECTIVES The objective was to study the prevalence of CKD in HS patients. METHODS Cross-sectional population-based study using the United States National Inpatient Sample database between January 1, 2002 and December 31, 2012 was performed. RESULTS We identified 23,767 hospital admissions for HS patients and 95,068 admissions for age- and gender-matched controls. The prevalence of CKD in HS patients was 6.3% (1,497/23,767) compared to non-HS controls which was 4.3% (4,052/95,068). The association of CKD was strongest in HS patients, who were ≥60 years old, 16.9% (475/2,811), male 7.3% (695/9,556), obese 7.8% (407/5,209), diabetic 12.5% (890/7,105), hyperlipidemic 13.3% (416/3,126), and had cardiovascular diseases 12.5% (631/5,045). The crude odds ratio of CKD in HS patients was 1.5 (95% CI: 1.420-1.605) compared to non-HS patients. The association remained significant after adjusting for important covariates with adjusted odds ratio of CKD in HS patients of 1.1 (95% CI: 1.014-1.176) compared to non-HS patients. CONCLUSIONS Our findings show that there is a possible association of HS with CKD. Any signs of CKD should be assessed by a nephrologist as early diagnosis can hopefully prevent further progression.
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Affiliation(s)
- Nouf Almuhanna
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Dermatology, Department of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Sheldon W Tobe
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Raed Alhusayen
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Parkinson KM, Sayre EC, Tobe SW. Evaluation of visual acuity in dry AMD patients after microcurrent electrical stimulation. Int J Retina Vitreous 2023; 9:36. [PMID: 37331928 DOI: 10.1186/s40942-023-00471-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 05/09/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND To assess micro current to improve vision for dry age-related macular degeneration. Dry age-related macular degeneration is a major cause of blindness, disability, and severe erosion of quality of life, throughout the world. Beyond nutritional supplementation, there is no approved therapy. METHODS This was a prospective randomized sham controlled clinical trial for participants with confirmed dry AMD with documented visual loss. Participants were randomized three to one, to receive transpalpebral external micro current electrical stimulation with the MacuMira device. The Treatment group received four treatments in the first two weeks, and two further treatments at weeks 14 and 26. Differences in BCVA and contrast sensitivity (CS) were estimated with mixed-effects repeated measures analysis of variance. RESULTS Change of visual acuity with ETDRS assessment of number of letters read (NLR) and contrast sensitivity at week 4 and 30, compared to the first visit, between 43 treatment and 19 sham control participants. The Sham Control group had NLR of 24.2 (SD 7.1) at baseline, 24.2 (SD 7.2) at 4 weeks, and 22.1 (SD7.4) at 30 weeks. The Treatment group had NLR of 19.6 (SD 8.9) at baseline, 27.6 (SD 9.1) at 4 weeks, and 27.8 (SD 8.4) at 30 weeks. The change in NLR from baseline in the Treatment compared to the Sham control group was 7.7 (95% CI 5.7, 9.7, p < 0.001) at 4 weeks and 10.4 (95% CI 7.8, 13.1, p < 0.001) at 30 weeks. There were similar benefits in CS. CONCLUSIONS This pilot study of transpalpebral microcurrent demonstrated improved visual measures and is very encouraging as a potential treatment for dry AMD. TRIAL REGISTRATION NCT02540148, ClinicalTrials.gov.
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Cheung AK, Whelton PK, Muntner P, Schutte AE, Moran AE, Williams B, Sarafidis P, Chang TI, Daskalopoulou SS, Flack JM, Jennings G, Juraschek SP, Kreutz R, Mancia G, Nesbitt S, Ordunez P, Padwal R, Persu A, Rabi D, Schlaich MP, Stergiou GS, Tobe SW, Tomaszewski M, Williams KA, Mann JFE. International Consensus on Standardized Clinic Blood Pressure Measurement - A Call to Action. Am J Med 2023; 136:438-445.e1. [PMID: 36621637 PMCID: PMC10159895 DOI: 10.1016/j.amjmed.2022.12.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/07/2022] [Accepted: 12/07/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Alfred K Cheung
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, La
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham
| | - Aletta E Schutte
- School of Population Health, University of New South Wales, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia
| | - Andrew E Moran
- Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Bryan Williams
- Department of Medicine, University College London, London, UK
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University, Thessaloniki, Greece
| | - Tara I Chang
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, Calif
| | - Stella S Daskalopoulou
- Division of Experimental Medicine, Department of Medicine, Research Institute of the McGill University Health Centre, McGill University, Montreal, Canada; Division of Internal Medicine, Department of Medicine, McGill University Health Centre, McGill University Montreal, Canada
| | - John M Flack
- Department of Internal Medicine, Southern Illinois School of Medicine, Springfield, Ill
| | | | - Stephen P Juraschek
- Division of General Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass
| | - Reinhold Kreutz
- Charité - Universitätsmedizin Berlin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | | | | | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC
| | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Doreen Rabi
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit, Royal Perth Hospital Research Foundation, University of Western Australia, Perth, WA, Australia
| | - George S Stergiou
- Hypertension Centre STRIDE, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sheldon W Tobe
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Kim A Williams
- Department of Internal Medicine, University of Louisville School of Medicine, Louisville, Ky
| | - Johannes F E Mann
- KfH Kidney Center, Munich, Germany; Friedrich Alexander University of Erlangen-Nürnberg, Erlangen, Germany.
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Tsoukas MA, Woo V, Tobe SW, Slee A, Rapattoni W, Ang FG, Seufert J, Neuen BL, Arnott C, Mahaffey KW, Wheeler DC. Cardiovascular and kidney outcomes with canagliflozin according to type 2 diabetes treatment targets at baseline: Data from the CANVAS Program and CREDENCE. Diabetes Obes Metab 2023. [PMID: 36942888 DOI: 10.1111/dom.15057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/23/2023]
Affiliation(s)
| | - Vincent Woo
- University of Manitoba, Winnipeg, MB, Canada
| | - Sheldon W Tobe
- Sunnybrook Research Institute, Toronto, ON, Canada
- Northern Ontario School of Medicine, Sudbury, ON, Canada
| | | | | | | | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Brendon L Neuen
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Clare Arnott
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
- Faculty of Medicine, UNSW Sydney, Sydney, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - David C Wheeler
- Centre for Nephrology, University College London, London, UK
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Jain R, Stone JA, Agarwal G, Andrade JG, Bacon SL, Bajaj HS, Baker B, Cheng G, Dannenbaum D, Gelfer M, Habert J, Hickey J, Keshavjee K, Kitty D, Lindsay P, L'Abbé MR, Lau DCW, Macle L, McDonald M, Nerenberg K, Pearson GJ, Pham T, Poppe AY, Rabi DM, Sherifali D, Selby P, Smith E, Stern S, Thanassoulis G, Terenzi K, Tu K, Udell J, Virani SA, Ward RA, Warburton DER, Wharton S, Zymantas J, Hua-Stewart D, Liu PP, Tobe SW. Ligne directrice C-CHANGE pour l’harmonisation des lignes directrices nationales de prévention et de prise en charge des maladies cardiovasculaires en contexte de soins primaires au Canada: mise à jour 2022. CMAJ 2023; 195:E21-E42. [PMID: 36623864 PMCID: PMC9829070 DOI: 10.1503/cmaj.220138-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Rahul Jain
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - James A Stone
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Gina Agarwal
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Jason G Andrade
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Simon L Bacon
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Harpreet S Bajaj
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Brian Baker
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Gemma Cheng
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - David Dannenbaum
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Mark Gelfer
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Jeffrey Habert
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - John Hickey
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Karim Keshavjee
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Darlene Kitty
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Patrice Lindsay
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Mary R L'Abbé
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - David C W Lau
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Laurent Macle
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Michael McDonald
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Kara Nerenberg
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Glen J Pearson
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Thuy Pham
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Alexandre Y Poppe
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Doreen M Rabi
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Diana Sherifali
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Peter Selby
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Eric Smith
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Sol Stern
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - George Thanassoulis
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Kristin Terenzi
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Karen Tu
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Jacob Udell
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Sean A Virani
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Richard A Ward
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Darren E R Warburton
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Sean Wharton
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Jennifer Zymantas
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Diane Hua-Stewart
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
| | - Peter P Liu
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont.
| | - Sheldon W Tobe
- Département de médecine familiale et communautaire (Jain), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Département des sciences cardiaques, Division de cardiologie (Stone), Faculté de médecine Cumming, Université de Calgary, Institut cardiovasculaire Libin de l'Alberta (Stone), Symphony of Health, Calgary, Alb.; Département de médecine familiale (Agarwal), Université McMaster, Hamilton, Ont.; Département de médecine (Andrade), Université de la Colombie-Britannique, Vancouver, C.-B.; Institut de cardiologie de Montréal (Andrade), Université de Montréal, Montréal, Qc; Bureau de la politique et de la promotion de la nutrition (Aziz), Santé Canada, Ottawa, Ont.; Département de Santé, Kinésiologie et Physiologie appliquée (Bacon), Université Concordia, et Centre de médecine comportementale de Montréal (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Qc; Centre de diabétologie Sinaï (Bajaj), Hôpital du Mont Sinaï; Département de psychiatrie (Baker), Université de Toronto, Toronto, Ont.; Centre de médecine familiale Herzl (Cheng), Hôpital général juif; Département de médecine familiale (Cheng), Université McGill; Hôpital général juif, Département de médecine (Dannenbaum), Université McGill, Montréal, Qc; Département de médecine familiale (Gelfer), Université de la Colombie-Britannique, Vancouver, C.-B.; Université de Toronto (Habert), Toronto, Ont.; Département de médecine familiale (Hickey), Hôpital régional St. Martha, Antigonish, N.-É.; Institut des politiques, de la gestion et de l'évaluation de la santé (Keshavjee), École Dalla Lana de santé publique, Université de Toronto, Toronto, Ont.; Faculté de médecine (Kitty), Université d'Ottawa, Ottawa, Ont.; Fondation canadienne des maladies du cœur et de l'AVC (Lindsay), Toronto, Ont.; Département des sciences de la nutrition (L'Abbé), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de biochimie et de biologie moléculaire (Lau), Université de Calgary, Calgary, Alb.; Institut de cardiologie de Montréal (Macle), Université de Montréal, Montréal, Qc; Division de cardiologie (McDonald), Centre de recherche en cardiologie Ted Rogers, Université de Toronto, Toronto, Ont.; Département de médecine (Nerenberg), Institut cardiovasculaire Libin, Université de Calgary, Calgary, Alb.; Division de cardiologie (Pearson), Institut de cardiologie Mazankowski; Université de l'Alberta, Faculté de médecine et de dentisterie (Pearson), Edmonton, Alb.; Division de néphrologie (Pham), Hôpital Sunnybrook, Université de Toronto, Toronto, Ont.; Division de neurologie (Poppe), Centre Hospitalier de l'Université de Montréal; Département de neurosciences (Poppe), Université de Montréal, Montréal, Qc; Division d'endocrinologie et métabolisme (Rabi), Département de médecine, Université de Calgary, Calgary, Alb.; Faculté des sciences infirmières (Sherifali), Université McMaster, Hamilton, Ont.; Centre pour les dépendances et la santé mentale (Selby); Département de médecine familiale et communautaire (Selby), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.; Département de neurosciences cliniques et Institut de neurologie Hotchkiss (Smith), Université de Calgary, Calgary, Alb.; Centre médical Argus en santé familiale (Stern), Oakville, Ont.; Services de santé Halton (Stern), Toronto, Ont.; Département de médecine (Thanassoulis), Université McGill, Montréal, Qc; Hôpital Humber River (Terenzi); Hôpital général de North York, Toronto Western Hospital-UHN, Université de Toronto (Tu); Maladies cardiovasculaires, Hôpital Women's College et Centre de cardiologie Peter Munk (Udell), Hôpital général de Toronto, Université de Toronto, Toronto, Ont.; Division de cardiologie (Virani), Université de la Colombie-Britannique; Faculté de l'éducation, programme pour la santé autochtone et l'activité physique (Warburton), Université de la Colombie-Britannique, Vancouver, C.-B.; Faculté de médecine Cumming (Ward), Université de Calgary, Calgary, Alb.; Faculté des sciences de la santé (Wharton), Université McMaster, Hamilton, Ont.; Health Sciences North (Zymantas); Faculté de médecine du Nord de l'Ontario (Zymantas), Sudbury, Ont.; Institut de recherche Sunnybrook (Hua-Stewart), Toronto, Ont.; Faculté de médecine (Liu), Institut de cardiologie de l'Université d'Ottawa, Ottawa, Ont.; Faculté de médecine (Liu), Université de Toronto; Division de néphrologie (Tobe), Centre des sciences de la santé Sunnybrook, Université de Toronto, Toronto, Ont.; Faculté de médecine du Nord de l'Ontario (Tobe), Sudbury, Ont
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Jain R, Stone JA, Agarwal G, Andrade JG, Bacon SL, Bajaj HS, Baker B, Cheng G, Dannenbaum D, Gelfer M, Habert J, Hickey J, Keshavjee K, Kitty D, Lindsay P, L'Abbé MR, Lau DCW, Macle L, McDonald M, Nerenberg K, Pearson GJ, Pham T, Poppe AY, Rabi DM, Sherifali D, Selby P, Smith E, Stern S, Thanassoulis G, Terenzi K, Tu K, Udell J, Virani SA, Ward RA, Warburton DER, Wharton S, Zymantas J, Hua-Stewart D, Liu PP, Tobe SW. Canadian Cardiovascular Harmonized National Guideline Endeavour (C-CHANGE) guideline for the prevention and management of cardiovascular disease in primary care: 2022 update. CMAJ 2022; 194:E1460-E1480. [PMID: 36343954 PMCID: PMC9828999 DOI: 10.1503/cmaj.220138] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Rahul Jain
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - James A Stone
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Gina Agarwal
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Jason G Andrade
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Simon L Bacon
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Harpreet S Bajaj
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Brian Baker
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Gemma Cheng
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - David Dannenbaum
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Mark Gelfer
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Jeffrey Habert
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - John Hickey
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Karim Keshavjee
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Darlene Kitty
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Patrice Lindsay
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Mary R L'Abbé
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - David C W Lau
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Laurent Macle
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Michael McDonald
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Kara Nerenberg
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Glen J Pearson
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Thuy Pham
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Alexandre Y Poppe
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Doreen M Rabi
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Diana Sherifali
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Peter Selby
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.
| | - Eric Smith
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Sol Stern
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - George Thanassoulis
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Kristin Terenzi
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Karen Tu
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Jacob Udell
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Sean A Virani
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Richard A Ward
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Darren E R Warburton
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Sean Wharton
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Jennifer Zymantas
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Diane Hua-Stewart
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Peter P Liu
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
| | - Sheldon W Tobe
- Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Department of Cardiac Sciences, Division of Cardiology (Stone), Cumming School of Medicine University of Calgary, Libin Cardiovascular Institute of Alberta (Stone), Symphony of Health, Calgary, Alta.; Department of Family Medicine (Agarwal), McMaster University, Hamilton, Ont.; Department of Medicine (Andrade), University of British Columbia, Vancouver, BC; Montréal Heart Institute (Andrade), Université of Montréal, Que.; Office of Nutrition Policy Promotion (Aziz), Health Canada, Ottawa, Ont.; Department of Health, Kinesiology & Applied Physiology (Bacon), Concordia University, and the Montreal Behavioural Medicine Centre (Bacon), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, Que.; Sinai Centre for Diabetes (Bajaj), Mount Sinai Hospital; Department of Psychiatry (Baker), University of Toronto, Toronto, Ont.; Herzl Family Practice Centre (Cheng), Jewish General Hospital; Department of Family Medicine (Cheng), McGill University; Jewish General Hospital, Department of Medicine (Dannenbaum), McGill University, Montréal, Que.; Department of Family Practice (Gelfer), University of British Columbia, Vancouver, BC; University of Toronto (Habert), Toronto, Ont.; Department of Family Medicine (Hickey), St. Martha's Regional Hospital, Antigonish, NS; Institute of Health Policy, Management and Evaluation (Keshavjee), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Faculty of Medicine (Kitty), University of Ottawa, Ottawa, Ont.; Heart and Stroke Foundation of Canada (Lindsay), Toronto, Ont.; Department of Nutritional Sciences (L'Abbé), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Biochemistry and Molecular Biology (Lau), University of Calgary, Calgary, Alta.; Institut de Cardiologie de Montréal (Macle), Université de Montréal, Montréal, Que.; Division of Cardiology (McDonald), Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ont.; Department of Medicine (Nerenberg), Libin Cardiovascular Institute, University of Calgary, Calgary, Alta.; Division of Cardiology (Pearson), Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Division of Nephrology (Pham), Sunnybrook Hospital, University of Toronto, Toronto, Ont.; Division of Neurology (Poppe), Centre Hospitalier de l'Université de Montréal; Department of Neurosciences (Poppe), Université de Montréal, Montréal, Que.; Division of Endocrinology and Metabolism (Rabi), Department of Medicine, University of Calgary, Calgary, Alta.; School of Nursing (Sherifali), McMaster University, Hamilton, Ont.; Centre for Addiction and Mental Health (Selby), Toronto, Ont.; Department of Family and Community Medicine (Selby), Temerty Faculty of Medicine, University of Toronto, Toront, Ont.; Department of Clinical Neurosciences and Hotchkiss Brain Institute (Smith), University of Calgary, Calgary, Alta.; Argus Medical Centre Family Health Organization (Stern), Oakville, Ont.; Halton Healthcare Services (Stern), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University, Montréal, Que.; Humber River Hospital (Terenzi), Toronto, Ont.; North York General Hospital, Toronto Western Hospital-UHN, University of Toronto (Tu), Toronto, Ont.; Cardiovascular Disease, Women's College Hospital and Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Division of Cardiology (Virani), University of British Columbia; Faculty of Education, Indigenous Health & Physical Activity Program (Warburton), University of British Columbia, Vancouver, BC; Cumming School of Medicine (Ward), University of Calgary, Calgary, Alta.; Faculty of Health Sciences (Wharton), McMaster University, Hamilton, Ont.; Health Sciences North (Zymantas); Northern Ontario School of Medicine (Zymantas), Sudbury, Ont.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Faculty of Medicine (Liu), University of Ottawa Heart Institute, Ottawa, Ont.; Faculty of Medicine (Liu), University of Toronto, Toronto, Ont.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont
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11
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Sun LY, Zghebi SS, Eddeen AB, Liu PP, Lee DS, Tu K, Tobe SW, Kontopantelis E, Mamas MA. Derivation and External Validation of a Clinical Model to Predict Heart Failure Onset in Patients With Incident Diabetes. Diabetes Care 2022; 45:2737-2745. [PMID: 36107673 PMCID: PMC9862443 DOI: 10.2337/dc22-0894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/20/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Heart failure (HF) often develops in patients with diabetes and is recognized for its role in increased cardiovascular morbidity and mortality in this population. Most existing models predict risk in patients with prevalent rather than incident diabetes and fail to account for sex differences in HF risk factors. We derived sex-specific models in Ontario, Canada to predict HF at diabetes onset and externally validated these models in the U.K. RESEARCH DESIGN AND METHODS Retrospective cohort study using international population-based data. Our derivation cohort comprised all Ontario residents aged ≥18 years who were diagnosed with diabetes between 2009 and 2018. Our validation cohort comprised U.K. patients aged ≥35 years who were diagnosed with diabetes between 2007 and 2017. Primary outcome was incident HF. Sex-stratified multivariable Fine and Gray subdistribution hazard models were constructed, with death as a competing event. RESULTS A total of 348,027 Ontarians (45% women) and 54,483 U.K. residents (45% women) were included. At 1, 5, and 9 years, respectively, in the external validation cohort, the C-statistics were 0.81 (95% CI 0.79-0.84), 0.79 (0.77-0.80), and 0.78 (0.76-0.79) for the female-specific model; and 0.78 (0.75-0.80), 0.77 (0.76-0.79), and 0.77 (0.75-0.79) for the male-specific model. The models were well-calibrated. Age, rurality, hypertension duration, hemoglobin, HbA1c, and cardiovascular diseases were common predictors in both sexes. Additionally, mood disorder and alcoholism (heavy drinker) were female-specific predictors, while income and liver disease were male-specific predictors. CONCLUSIONS Our findings highlight the importance of developing sex-specific models and represent an important step toward personalized lifestyle and pharmacologic prevention of future HF development.
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Affiliation(s)
- Louise Y. Sun
- Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Institute for Clinical Evaluation Sciences, Toronto, Ontario, Canada
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Salwa S. Zghebi
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, U.K
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, U.K
| | - Anan Bader Eddeen
- Institute for Clinical Evaluation Sciences, Toronto, Ontario, Canada
| | - Peter P. Liu
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Douglas S. Lee
- Institute for Clinical Evaluation Sciences, Toronto, Ontario, Canada
- Ted Rodgers Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Karen Tu
- Institute for Clinical Evaluation Sciences, Toronto, Ontario, Canada
- Ted Rodgers Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- North York General Hospital, Toronto, Ontario, Canada
| | - Sheldon W. Tobe
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Nephrology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Evangelos Kontopantelis
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, U.K
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, U.K
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, U.K
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Staffordshire, U.K
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, U.K
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12
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Tobe SW. Early Changes of Kidney Function Are a Tell for Heart Disease Risk. J Am Heart Assoc 2022; 11:e027733. [PMID: 36314487 PMCID: PMC9673620 DOI: 10.1161/jaha.122.027733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Affiliation(s)
- Sheldon W. Tobe
- Department of Medicine, Division of NephrologySunnybrook Health Sciences CentreOntarioTorontoCanada
- Sunnybrook Health Sciences CentreOntarioTorontoCanada
- Northern Ontario School of MedicineOntarioSudburyCanada
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13
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Campbell NRC, Padwal R, Tsuyuki RT, Leung AA, Bell A, Kaczorowski J, Tobe SW. Ups and downs of hypertension control in Canada: critical factors and lessons learned. Rev Panam Salud Publica 2022; 46:e141. [PMID: 36071924 PMCID: PMC9440728 DOI: 10.26633/rpsp.2022.141] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022] Open
Abstract
As the leading risk for death, population control of increased blood pressure represents a major challenge for all countries of the Americas. In the early 1990’s, Canada had a hypertension control rate of 13%. The control rate increased to 68% in 2010, accompanied by a sharp decline in cardiovascular disease. The unprecedented improvement in hypertension control started around the year 2000 when a comprehensive program to implement annually updated hypertension treatment recommendations started. The program included a comprehensive monitoring system for hypertension control. After 2011, there was a marked decrease in emphasis on implementation and evaluation and the hypertension control rate declined, driven by a reduction in control in women from 69% to 49%. A coalition of health and scientific organizations formed in 2011 with a priority to develop advocacy positions for dietary policies to prevent and control hypertension. By 2015, the positions were adopted by most federal political parties, but implementation has been slow. This manuscript reviews key success factors and learnings. Some key success factors included having broad representation on the program steering committee, multidisciplinary engagement with substantive primary care involvement, unbiased up to date credible recommendations, development and active adaptation of education resources based on field experience, extensive implementation of primary care resources, annual review of the program and hypertension indicators and developing and emphasizing the few interventions important for hypertension control. Learnings included the need for having strong national and provincial government engagement and support, and retaining primary care organizations and clinicians in the implementation and evaluation.
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Affiliation(s)
| | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ross T. Tsuyuki
- Faculty of Pharmacology, University of Alberta, Edmonton, Canada
| | | | - Alan Bell
- Department of Family Medicine, University of Toronto, Toronto, Canada
| | - Janusz Kaczorowski
- Department of Family Medicine, University of Montreal and CRCHUM, Montreal, Canada
| | - Sheldon W Tobe
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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14
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Tomson CRV, Cheung AK, Mann JFE, Chang TI, Cushman WC, Furth SL, Hou FF, Knoll GA, Muntner P, Pecoits-Filho R, Tobe SW, Lytvyn L, Craig JC, Tunnicliffe DJ, Howell M, Tonelli M, Cheung M, Earley A, Ix JH, Sarnak MJ. Management of Blood Pressure in Patients With Chronic Kidney Disease Not Receiving Dialysis: Synopsis of the 2021 KDIGO Clinical Practice Guideline. Ann Intern Med 2021; 174:1270-1281. [PMID: 34152826 DOI: 10.7326/m21-0834] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 11/22/2022] Open
Abstract
DESCRIPTION The Kidney Disease: Improving Global Outcomes (KDIGO) 2021 clinical practice guideline for the management of blood pressure (BP) in patients with chronic kidney disease (CKD) not receiving dialysis is an update of the KDIGO 2012 guideline on the same topic and reflects new evidence on the risks and benefits of BP-lowering therapy among patients with CKD. It is intended to support shared decision making by health care professionals working with patients with CKD worldwide. This article is a synopsis of the full guideline. METHODS The KDIGO leadership commissioned 2 co-chairs to convene an international Work Group of researchers and clinicians. After a Controversies Conference in September 2017, the Work Group defined the scope of the evidence review, which was undertaken by an evidence review team between October 2017 and April 2020. Evidence reviews were done according to the Cochrane Handbook. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used to guide the development of the recommendations and rate the strength and quality of the evidence. Practice points were included to provide guidance when evidence was insufficient to make a graded recommendation. The guideline was revised after public consultation between January and March 2020. RECOMMENDATIONS The updated guideline comprises 11 recommendations and 20 practice points. This synopsis summarizes key recommendations pertinent to the diagnosis and management of high BP in adults with CKD, excluding those receiving kidney replacement therapy. In particular, the synopsis focuses on recommendations for standardized BP measurement and a target systolic BP of less than 120 mm Hg, because these recommendations differ from some other guidelines.
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Affiliation(s)
- Charles R V Tomson
- Freeman Hospital, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom (C.R.T.)
| | | | - Johannes F E Mann
- KfH Kidney Center, University Hospital, Friedrich-Alexander University, Erlangen-Nuremberg, Germany (J.F.M.)
| | - Tara I Chang
- Stanford University, Palo Alto, California (T.I.C.)
| | - William C Cushman
- University of Tennessee Health Science Center, Memphis, Tennessee (W.C.C.)
| | - Susan L Furth
- Perelman School of Medicine at the University of Pennsylvania and The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (S.L.F.)
| | - Fan Fan Hou
- Nanfang Hospital, Southern Medical University, Guangzhou, China (F.F.H.)
| | - Gregory A Knoll
- The Ottawa Hospital, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (G.A.K.)
| | - Paul Muntner
- University of Alabama at Birmingham, Birmingham, Alabama (P.M.)
| | - Roberto Pecoits-Filho
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, and Pontifical Catholic University of Paraná, Curitiba, Brazil (R.P.)
| | - Sheldon W Tobe
- University of Toronto, Toronto, and Northern Ontario School of Medicine, Sudbury, Ontario, Canada (S.W.T.)
| | - Lyubov Lytvyn
- MAGIC Evidence Ecosystem Foundation, McMaster University, Hamilton, Ontario, Canada (L.L.)
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, and Cochrane Kidney and Transplant, Sydney, New South Wales, Australia (J.C.C.)
| | - David J Tunnicliffe
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia (D.J.T., M.H.)
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia (D.J.T., M.H.)
| | | | | | | | - Joachim H Ix
- University of California San Diego and Veterans Affairs San Diego Healthcare System, San Diego, California (J.H.I.)
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Cheung A, Chang TI, Cushman W, Furth S, Hou FF, Ix JH, Knoll G, Muntner P, Pecoits-Filho R, Sarnak MJ, Tobe SW, Tomson C, Mann J. Abstract 52: KDIGO (Kidney Disease: Improving Global Outcomes) Guideline Update On The Management Of Blood Pressure In Chronic Kidney Disease: What’s New And What’s Different From Other Guidelines. Hypertension 2021. [DOI: 10.1161/hyp.78.suppl_1.52] [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: 11/16/2022]
Abstract
Introduction:
In 2012, KDIGO released a guideline on BP management in CKD not receiving dialysis. The emergence of new trials and meta-analyses coupled with wider recognition of the importance of standardized BP measurement protocols have prompted a call to update the 2012 guideline. This summary will outline the changes to the prior recommendations and highlight similarities to guidelines from ACC/AHA and ESC/ESH.
Methods:
A systematic review was undertaken to formally assess the following issues: 1) BP measurement; 2) lifestyle interventions; BP management in 3) patients with CKD, with and without diabetes, 4) kidney transplant recipients, and 5) children with CKD.
Results:
A total of 6863 citations were screened. Of these, 290 RCTs, 14 observational studies, and 35 systematic reviews were included in the evidence review. A major addition to the KDIGO 2021 guideline is a chapter devoted to BP measurement. KDIGO recommends the use of standardized office BP over routine BP. Out-of-office measurements (ABPM, HBPM) can be used to complement standardized readings. This emphasis on standardized office BP measurement is similar to recommendations from ACC/AHA and ESC/ESH. A systolic BP target of <120 mm Hg is suggested; however, the guidance emphasizes that the target is only applicable when BP is measured using standardized office protocols. RASi are the preferred agents for adults with CKD with increased albuminuria. For lifestyle interventions, dietary sodium intake should be limited to <2 g/day, and ≥150 minutes/week of physical activity is recommended. A BP target of <130/80 mm Hg and use of CCB or ARB are preferred in kidney transplant recipients. BP in children with CKD should be guided by 24-hour MAP using ambulatory monitoring, targeting ≤50th percentile for age, sex, and height. Similar to ACC/AHA and ESC/ESH guidelines, KDIGO also encourages shared-decision making between patients and clinicians in the individualization of BP therapy.
Conclusions:
KDIGO has revised its guideline for BP management in CKD based on a rigorous development process and emerging new evidence underscoring the importance of standardized office BP measurement and a lower systolic BP target of <120 mm Hg for achieving potential cardiovascular, kidney, and mortality benefits.
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Affiliation(s)
| | | | | | | | | | - Joachim H Ix
- UNIVERSITY OF CALIFORNIA SAN DIEGO, San Diego, CA
| | - Gregory Knoll
- The Ottawa Hosp, Ottawa Hosp Rsch Institute, Ottawa, Canada
| | | | | | | | | | - Charles Tomson
- Freeman Hosp, Newcastle upon Tyne Hosps NHS Trust, Newcastle upon Tyne, United Kingdom
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16
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Tobe SW, Dubrofsky L, Nasser DI, Rajasingham R, Myers MG. Randomized Controlled Trial Comparing Automated Office Blood Pressure Readings After Zero or Five Minutes of Rest. Hypertension 2021; 78:353-359. [PMID: 34176286 DOI: 10.1161/hypertensionaha.121.17319] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Sheldon W Tobe
- From the Division of Nephrology, (S.W.T.) Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; the Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Lisa Dubrofsky
- Division of Nephrology (L.D.), Sunnybrook Health Sciences Centre and Department of Medicine, Women's College Hospital, Toronto, On, Canada
| | - Daniel I Nasser
- KMH Cardiology Centres Inc. (D.I.N.), Mississauga, ON, Canada
| | - Raveenie Rajasingham
- Spacelabs Healthcare (R.R.) (Canada) Inc, Sunnybrook Health Sciences Centre, and the Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Martin G Myers
- Schulich Heart Program (M.G.M.), Sunnybrook Health Sciences Centre, and the Department of Medicine, University of Toronto, Toronto, ON, Canada
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17
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Rapattoni W, Zante D, Tomas M, Myageri V, Golden S, Grover P, Tehrani A, Millson B, Tobe SW, Rose JB. A retrospective observational population-based study to assess the prevalence and burden of illness of type 2 diabetes with an estimated glomerular filtration rate < 90 mL/min/1.73 m 2 in Ontario, Canada. Diabetes Obes Metab 2021; 23:916-928. [PMID: 33319487 PMCID: PMC8049006 DOI: 10.1111/dom.14294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/20/2020] [Accepted: 12/07/2020] [Indexed: 12/17/2022]
Abstract
AIM To better understand the healthcare burden of people with type 2 diabetes (T2D) and estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73 m2 in Ontario, Canada. MATERIALS AND METHODS We used administrative data to evaluate the prevalence of T2D, eGFR < 90 mL/min/1.73 m2 and adverse cardiovascular co-morbidities in individuals aged ≥ 30 years living in Ontario, Canada. We also examined incremental healthcare costs and healthcare resource utilization (HCRU) for these patients with specific incident cardiovascular and renal outcomes, in comparison with controls without these outcomes. RESULTS While the prevalence of T2D in the general population aged ≥ 30 years in Ontario increased by 1.8% over a 5-year period (2011-2012 to 2015-2016), the prevalence of eGFR < 90 mL/min/1.73 m2 among people with T2D increased by 35%. In comparison with corresponding controls without these outcomes, the per patient average total costs (Canadian dollars) over a 2-year analysis period were higher for patients with cardiovascular disease/chronic kidney disease related death ($69 827; n = 32 407), doubling of serum creatinine ($52 260; n = 22 825), those who started dialysis ($150 627; n = 3499) or received a kidney transplant ($50 664; n = 651). Similarly, HCRU was significantly greater for patients with these incident outcomes. CONCLUSIONS This real-world retrospective study highlights an increasing prevalence of T2D, eGFR < 90 mL/min/1.73 m2 , and the substantially higher healthcare costs and HCRU when these patients have adverse cardiovascular and renal outcomes. The existence of such a large economic burden underpins the importance of preventing these diabetes-related complications.
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18
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Cheung AK, Chang TI, Cushman WC, Furth SL, Hou FF, Ix JH, Knoll GA, Muntner P, Pecoits-Filho R, Sarnak MJ, Tobe SW, Tomson CRV, Lytvyn L, Craig JC, Tunnicliffe DJ, Howell M, Tonelli M, Cheung M, Earley A, Mann JFE. Executive summary of the KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. Kidney Int 2021; 99:559-569. [PMID: 33637203 DOI: 10.1016/j.kint.2020.10.026] [Citation(s) in RCA: 136] [Impact Index Per Article: 45.3] [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: 10/09/2020] [Revised: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 02/06/2023]
Abstract
The Kidney Disease: Improving Global Outcomes (KDIGO) 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease for patients not receiving dialysis represents an update to the KDIGO 2012 guideline on this topic. Development of this guideline update followed a rigorous process of evidence review and appraisal. Guideline recommendations are based on systematic reviews of relevant studies and appraisal of the quality of the evidence. The strength of recommendations is based on the "Grading of Recommendations Assessment, Development and Evaluation" (GRADE) approach. The scope includes topics covered in the original guideline, such as optimal blood pressure targets, lifestyle interventions, antihypertensive medications, and specific management in kidney transplant recipients and children. Some aspects of general and cardiovascular health, such as lipid and smoking management, are excluded. This guideline also introduces a chapter dedicated to proper blood pressure measurement since all large randomized trials targeting blood pressure with pivotal outcomes used standardized preparation and measurement protocols adhered to by patients and clinicians. Based on previous and new evidence, in particular the Systolic Blood Pressure Intervention Trial (SPRINT) results, we propose a systolic blood pressure target of less than 120 mm Hg using standardized office reading for most people with chronic kidney disease (CKD) not receiving dialysis, the exception being children and kidney transplant recipients. The goal of this guideline is to provide clinicians and patients a useful resource with actionable recommendations supplemented with practice points. The burden of the recommendations on patients and resources, public policy implications, and limitations of the evidence are taken into consideration. Lastly, knowledge gaps and recommendations for future research are provided.
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Affiliation(s)
- Alfred K Cheung
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah, USA.
| | - Tara I Chang
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA
| | - William C Cushman
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Susan L Furth
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Fan Fan Hou
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Joachim H Ix
- Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA; Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, California, USA
| | - Gregory A Knoll
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Paul Muntner
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Roberto Pecoits-Filho
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA; School of Medicine, Pontifical Catholic University of Paraná, Curitiba, Paraná, Brazil
| | - Mark J Sarnak
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Sheldon W Tobe
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Charles R V Tomson
- Consultant Nephrologist, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Lyubov Lytvyn
- MAGIC Evidence Ecosystem Foundation, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; Cochrane Kidney and Transplant, Sydney, New South Wales, Australia
| | - David J Tunnicliffe
- Cochrane Kidney and Transplant, Sydney, New South Wales, Australia; Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Martin Howell
- Cochrane Kidney and Transplant, Sydney, New South Wales, Australia; Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | | | | | - Johannes F E Mann
- KfH Kidney Center, Munich, Germany; Friedrich Alexander University of Erlangen-Nürnberg, Erlangen, Germany.
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19
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Cheung AK, Chang TI, Cushman WC, Furth SL, Hou FF, Ix JH, Knoll GA, Muntner P, Pecoits-Filho R, Sarnak MJ, Tobe SW, Tomson CR, Mann JF. KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. Kidney Int 2021; 99:S1-S87. [PMID: 33637192 DOI: 10.1016/j.kint.2020.11.003] [Citation(s) in RCA: 361] [Impact Index Per Article: 120.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/02/2020] [Indexed: 12/19/2022]
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20
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Feldman RD, Padwal RS, Tobe SW. The Rise and Fall of Hypertension Control in Canada: The Beginning of the End or the End of the Beginning? Can J Cardiol 2021; 37:679-682. [PMID: 33607230 DOI: 10.1016/j.cjca.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 10/22/2022] Open
Affiliation(s)
- Ross D Feldman
- Cardiac Sciences, St Boniface Hospital, Winnipeg, Manitoba, Canada; University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Raj S Padwal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sheldon W Tobe
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Northern Ontario School of Medicine, Sudbury, Ontario, Canada
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21
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Koomen JV, Stevens J, Bakris G, Correa‐Rotter R, Hou FF, Kitzman DW, Kohan D, Makino H, McMurray JJV, Parving H, Perkovic V, Tobe SW, de Zeeuw D, Heerspink HJL. Inter-individual variability in atrasentan exposure partly explains variability in kidney protection and fluid retention responses: A post hoc analysis of the SONAR trial. Diabetes Obes Metab 2021; 23:561-568. [PMID: 33184931 PMCID: PMC7839558 DOI: 10.1111/dom.14252] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 12/24/2022]
Abstract
AIM To evaluate whether atrasentan plasma exposure explains between-patient variability in urinary albumin-to-creatinine ratio (UACR) response, a surrogate for kidney protection, and B-type natriuretic peptide (BNP) response, a surrogate for fluid expansion. METHODS Type 2 diabetic patients with chronic kidney disease (n = 4775) received 0.75 mg atrasentan for 6 weeks in the active run-in period. Individual area under the concentration-time-curve (AUC) was estimated using a population pharmacokinetic model. The association between atrasentan AUC, other clinical characteristics, and UACR and BNP response, was estimated using linear regression. RESULTS The median atrasentan AUC was 43.8 ng.h/mL with a large variation among patients (2.5th-97.5th percentiles [P]: 12.6 to 197.5 ng.h/mL). Median UACR change at the end of enrichment was -36.0% and median BNP change was 8.7%, which also varied among patients (UACR, 2.5th-97.5th P: -76.2% to 44.5%; BNP, 2.5th-97.5th P: -71.5% to 300.0%). In the multivariable analysis, higher atrasentan AUC was associated with greater UACR reduction (4.88% per doubling in ng.h/mL [95% confidence interval {CI}: 6.21% to 3.52%], P < .01) and greater BNP increase (3.08% per doubling in ng.h/mL [95% CI: 1.12% to 4.11%], P < .01) independent of estimated glomerular filtration rate, haemoglobin or BNP. Caucasian patients compared with black patients had greater UACR reduction (7.06% [95% CI: 1.38% to 13.07%]) and also greater BNP increase (8.75% [95% CI: 1.65% to 15.35%]). UACR response was not associated with BNP response (r = 0.06). CONCLUSION Atrasentan plasma exposure varied among individual patients and partially explained between-patient variability in efficacy and safety response.
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Affiliation(s)
- Jeroen V. Koomen
- Department of Clinical Pharmacy and PharmacologyUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands
| | - Jasper Stevens
- Department of Clinical Pharmacy and PharmacologyUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands
| | - George Bakris
- American Society of Hypertension Comprehensive Hypertension CenterUniversity of Chicago Medicine and Biological SciencesChicagoIllinois
| | | | - Fan Fan Hou
- Division of Nephrology, Nanfang HospitalSouthern Medical University, National Clinical Research Center for Kidney DiseaseGuangzhouChina
| | | | - Donald Kohan
- Division of NephrologyUniversity of Utah Health Sciences CenterSalt Lake CityUtah
| | | | - John J. V. McMurray
- British Heart Foundation Cardiovascular Research CentreUniversity of GlasgowGlasgowUK
| | - Hans‐Henrik Parving
- Department of Medical Endocrinology, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
- Faculty of Health ScienceAarhus UniversityAarhusDenmark
| | - Vlado Perkovic
- George Institute for Global Health and University of New South WalesSydneyNew South WalesAustralia
| | - Sheldon W. Tobe
- Division of Nephrology, Sunnybrook Health Sciences CentreUniversity of Toronto and the Northern Ontario School of MedicineTorontoOntarioCanada
| | - Dick de Zeeuw
- Department of Clinical Pharmacy and PharmacologyUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands
| | - Hiddo J. L. Heerspink
- Department of Clinical Pharmacy and PharmacologyUniversity of Groningen, University Medical Center GroningenGroningenthe Netherlands
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22
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Koomen JV, Stevens J, Bakris G, Correa-Rotter R, Hou FF, Kitzman DW, Kohan DE, Makino H, McMurray JJV, Parving HH, Perkovic V, Tobe SW, de Zeeuw D, Heerspink HJL. Individual Atrasentan Exposure is Associated With Long-term Kidney and Heart Failure Outcomes in Patients With Type 2 Diabetes and Chronic Kidney Disease. Clin Pharmacol Ther 2020; 109:1631-1638. [PMID: 33338269 PMCID: PMC8246733 DOI: 10.1002/cpt.2143] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/07/2020] [Indexed: 12/31/2022]
Abstract
Atrasentan, an endothelin receptor antagonist, showed clinically significant albuminuria reduction with minimal signs of fluid retention in phase II trials. We evaluated whether plasma exposure was associated with long-term outcomes for kidney protection and heart failure in the phase III SONAR trial (n = 3668) in type 2 diabetics with chronic kidney disease. A population pharmacokinetic model was used to estimate plasma exposure of atrasentan 0.75 mg/day. Parametric time-to-event models were used to quantify the association between plasma exposure and long-term outcomes. Mean atrasentan plasma exposure was 41.4 ng.h/mL (2.5th to 97.5th P: 14.2 to 139.9). Compared with placebo, a mean atrasentan exposure translated in a hazard ratio of 0.76 (95% confidence interval (CI): 0.28-0.85) for kidney events and 1.13 (95% CI: 1.03-2.20) for heart failure events. At the mean atrasentan exposure, the kidney protective effect was larger than the increase in heart failure supporting the atrasentan 0.75 mg/day dose in this population.
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Affiliation(s)
- Jeroen V Koomen
- Department Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jasper Stevens
- Department Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - George Bakris
- American Society of Hypertension Comprehensive Hypertension Center, University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Ricardo Correa-Rotter
- National Medical Science and Nutrition Institute Salvador Zubirán, Mexico City, Mexico
| | - Fan Fan Hou
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, Guangzhou, China
| | - Dalane W Kitzman
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Donald E Kohan
- Division of Nephrology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | | | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Hans-Henrik Parving
- Department of Medical Endocrinology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health Science, Aarhus University, Aarhus, Denmark
| | - Vlado Perkovic
- George Institute for Global Health and University of New South Wales, Sydney, New South Wales, Australia
| | - Sheldon W Tobe
- Division of Nephrology, Sunnybrook Health Sciences Centre, University of Toronto and the Northern Ontario School of Medicine, Toronto, Ontario, Canada
| | - Dick de Zeeuw
- Department Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hiddo J L Heerspink
- Department Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,George Institute for Global Health and University of New South Wales, Sydney, New South Wales, Australia
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23
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Lee TMH, Tobe SW, Butt DA, Ivers NM, Gershon AS, Barnsley J, Liu PP, Jaakkimainen L, Walker KM, Tu K. Patient- and Physician-Level Factors Associated With Adherence to C-CHANGE Recommendations in Primary Care Settings in Ontario. CJC Open 2020; 2:563-576. [PMID: 33305217 PMCID: PMC7711016 DOI: 10.1016/j.cjco.2020.07.007] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/11/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND We previously found large variation among family physicians in adherence to the Canadian Cardiovascular Harmonization of National Guidelines Endeavour (C-CHANGE). We assessed the role of patient- and physician-level factors in the variation in adherence to recommendations for managing cardiovascular disease risk factors. METHODS We conducted a retrospective study using multilevel logistic regression analyses with the Electronic Medical Record Administrative data Linked Database (EMRALD) housed at ICES in Ontario. Five quality indicators based on C-CHANGE guidelines were modelled. Effects of clustering and between-group variation, patient-level (sociodemographics, comorbidities) and physician-level characteristics (demographic and practice information) were assessed to determine odds ratios of receiving C-CHANGE recommended care. RESULTS In all, 324 Ontario physicians practicing in 41 clinics who provided care to 227,999 adult patients were studied. We found significant variation in quality indicators, with 15% to 39% of the total variation attributable to nonpatient factors. The largest variation was in performing 2-hour plasma glucose testing in prediabetic patients. Patient-level factors most frequently associated with recommendation adherence included sex, age, and multi-comorbidities. Women were more likely than men to have their body mass index measured, and their blood pressure controlled, but less likely to receive antiplatelet medications and liver-enzyme testing if overweight or obese. CONCLUSIONS The majority of variations in adherence were attributable to patient attributes, but a substantial proportion of unexplained variation was due to differences among physicians and clinics. This finding may signal suboptimal processes or structures and warrant further investigation to improve the quality of primary care management of cardiovascular disease in Ontario.
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Affiliation(s)
- Theresa Min-Hyung Lee
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Sheldon W. Tobe
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Canadian Cardiovascular Harmonization of National Guidelines Endeavour, Ottawa, Ontario, Canada
| | - Debra A. Butt
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Scarborough Health Network, Toronto, Ontario, Canada
| | - Noah M. Ivers
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women’s College Hospital, Toronto, Ontario, Canada
| | - Andrea S. Gershon
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jan Barnsley
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Peter P. Liu
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Canadian Cardiovascular Harmonization of National Guidelines Endeavour, Ottawa, Ontario, Canada
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Liisa Jaakkimainen
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kimberly M. Walker
- Canadian Cardiovascular Harmonization of National Guidelines Endeavour, Ottawa, Ontario, Canada
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Karen Tu
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- North York General Hospital, Toronto, Ontario, Canada
- Toronto Western Hospital Family Health Team, University Health Network, Toronto, Ontario, Canada
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24
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Hendren EM, Matthews N, Oliver M, Rice J, Tobe SW, Auguste BL. An Interprofessional Approach in Caring for a Patient on Maintenance Hemodialysis with COVID-19 in Toronto, Canada: An Educational Case Report. Can J Kidney Health Dis 2020; 7:2054358120957473. [PMID: 32953129 PMCID: PMC7485156 DOI: 10.1177/2054358120957473] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/01/2020] [Indexed: 11/16/2022] Open
Abstract
Rationale Hemodialysis patients are at significant risk from COVID-19 due to their frequent interaction with the health care system and medical comorbidities. We followed up the trajectory of the first COVID-19-positive maintenance hemodialysis patient at Sunnybrook Health Sciences Centre in Toronto. We present the lessons learned and changes in practices that occurred to prevent an outbreak in our center. Presenting concerns of the patient The patient, a 66-year-old woman on in-center hemodialysis, initially presented with a 2-day history of a productive cough. She subsequently developed a fever, was placed on contact and droplet isolation, and admitted to hospital. Diagnoses On March 13, 2020, the patient tested positive for COVID-19. Within the next 48 hours, she developed hypoxia and acute respiratory distress syndrome as a complication of her illness requiring an extended critical care stay. This extended critical care stay resulted in critical illness-associated secondary sclerosing cholangitis. Interventions An interprofessional team was established, performing rapid Plan-Do-Study-Act quality improvement cycles to improve screening practices and promote the safety of patients and staff in the hemodialysis unit. Outcomes We present here the lessons learned, the changes to our screening protocols, and the clinical course of our first in-center hemodialysis patient with SARS-CoV-2. Teaching points Regular review of the infection screening processes is paramount in preventing outbreaks of COVID-19, particularly in hemodialysis units. Hospital admission should be arranged if a patient exhibits any clinical signs of hemodynamic compromise or hypoxia. Early education for health care practitioners caring for patients with COVID-19 and refresher information regarding personal protective equipment helped promote the safety of staff and prevent health care-associated outbreaks.
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Affiliation(s)
- Elizabeth M Hendren
- Division of Nephrology, Department of Medicine, University of Toronto, ON, Canada
| | - Nicola Matthews
- Division of Nephrology, Department of Medicine, University of Toronto, ON, Canada
| | - Mathew Oliver
- Division of Nephrology, Department of Medicine, University of Toronto, ON, Canada.,Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Julie Rice
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Sheldon W Tobe
- Division of Nephrology, Department of Medicine, University of Toronto, ON, Canada.,Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Northern Ontario School of Medicine, Sudbury, Canada
| | - Bourne L Auguste
- Division of Nephrology, Department of Medicine, University of Toronto, ON, Canada.,Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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25
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Amberbir A, Lin SH, Berman J, Muula A, Jacoby D, Wroe E, Maliwichi-Nyirenda C, Mwapasa V, Crampin A, Makwero M, Singogo E, Phiri S, Gordon S, Tobe SW, Masiye J, Newsome B, Hosseinipour M, Nyirenda MJ, van Oosterhout JJ. Systematic Review of Hypertension and Diabetes Burden, Risk Factors, and Interventions for Prevention and Control in Malawi: The NCD BRITE Consortium. Glob Heart 2020; 14:109-118. [PMID: 31324364 DOI: 10.1016/j.gheart.2019.05.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 05/15/2019] [Indexed: 11/16/2022] Open
Abstract
Recent studies have found an increasing burden of noncommunicable diseases in sub-Saharan Africa. A compressive search of PubMed, Medline, EMBASE, and the World Health Organization Global Health Library databases was undertaken to identify studies reporting on the prevalence, risk factors, and interventions for hypertension and diabetes in Malawi. The findings from 23 included studies revealed a high burden of hypertension and diabetes in Malawi, with estimates ranging from 15.8% to 32.9% and from 2.4% to 5.6%, respectively. Associated risk factors included old age, tobacco smoking, excessive alcohol consumption, obesity, physical inactivity, high salt and sugar intake, low fruit and vegetable intake, high body mass index, and high waist-to-hip ratio. Certain antiretroviral therapy regimens were also associated with increased diabetes and hypertension risk in human immunodeficiency virus patient populations. Nationwide, the quality of clinical care was generally limited and demonstrated a need for innovative and targeted interventions to prevent, control, and treat noncommunicable diseases in Malawi.
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Affiliation(s)
- Alemayehu Amberbir
- Dignitas International, Zomba, Malawi; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Sabrina H Lin
- Dignitas International, Zomba, Malawi; Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Adamson Muula
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Darren Jacoby
- Center for Innovative Global Health Technologies, Northwestern University, Chicago, Illinois, USA
| | | | | | - Victor Mwapasa
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Amelia Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Martha Makwero
- College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Sam Phiri
- University of North Carolina-Malawi Project, Lilongwe, Malawi
| | | | - Sheldon W Tobe
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Malawi-Liverpool Wellcome Trust, Blantyre, Malawi
| | - Jones Masiye
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | | | - Mina Hosseinipour
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Joep J van Oosterhout
- Dignitas International, Zomba, Malawi; College of Medicine, University of Malawi, Blantyre, Malawi
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Kamalinia S, Josse RG, Donio PJ, Leduc L, Shah BR, Tobe SW. Risk of any hypoglycaemia with newer antihyperglycaemic agents in patients with type 2 diabetes: A systematic review and meta-analysis. Endocrinol Diabetes Metab 2020; 3:e00100. [PMID: 31922027 PMCID: PMC6947712 DOI: 10.1002/edm2.100] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/11/2019] [Accepted: 10/13/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES For patients with type 2 diabetes, newer antihyperglycaemic agents (AHA), including the dipeptidyl peptidase IV inhibitors (DPP4i), glucagon-like peptide-1 receptor agonists (GLP1RA) and sodium glucose co-transporter 2 inhibitors (SGLT2i) offer a lower risk of hypoglycaemia relative to sulfonylurea or insulin. However, it is not clear how AHA compare to placebo on risk of any hypoglycaemia. This study evaluates the risk of any and severe hypoglycaemia with AHA and metformin relative to placebo. DESIGN A systematic review and meta-analysis was conducted of randomized, placebo-controlled trials ≥12 weeks in duration. MEDLINE, Embase and the Cochrane Library were searched up to April 16, 2019. Studies allowing use of other diabetes medications were excluded. Mantel-Haenszel risk ratio with 95% confidence intervals were used to pool estimates based on class of AHA and number of concomitant therapies used. PATIENTS Eligible studies enrolled patients with type 2 diabetes ≥18 years of age. RESULTS 144 studies met our inclusion criteria. Any hypoglycaemia was not increased with AHA when used as monotherapy (DPP4i (RR 1.12; 95% CI 0.81-1.56), GLP1RA (1.77; 0.91-3.46), SGLT2i (1.34; 0.83-2.15)), or as add-on to metformin (DPP4i (0.95; 0.67-1.35), GLP1RA (1.24; 0.80-1.91), SGLT2i (1.29; 0.91-1.83)) or as triple therapy (1.13; 0.67-1.91). However, metformin monotherapy (1.73; 1.02-2.94) and dual therapy initiation (3.56; 1.79-7.10) was associated with an increased risk of any hypoglycaemia. Severe hypoglycaemia was rare not increased for any comparisons. CONCLUSIONS Metformin and the simultaneous initiation of dual therapy, but not AHA used alone or as single add-on combination therapy, was associated with an increased risk of any hypoglycaemia relative to placebo.
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Affiliation(s)
- Sanaz Kamalinia
- Institute of Medical SciencesUniversity of TorontoTorontoONCanada
| | - Robert G. Josse
- St. Michael's HospitalTorontoONCanada
- Department of MedicineUniversity of TorontoTorontoONCanada
| | | | | | - Baiju R. Shah
- Department of MedicineUniversity of TorontoTorontoONCanada
- Sunnybrook Research InstituteTorontoONCanada
| | - Sheldon W. Tobe
- Institute of Medical SciencesUniversity of TorontoTorontoONCanada
- Department of MedicineUniversity of TorontoTorontoONCanada
- Northern Ontario School of MedicineSudburyONCanada
- Sunnybrook Research InstituteTorontoONCanada
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Donio PJ, Freitas C, Austin PC, Ross HJ, Abdel-Qadir HM, Wijeysundera HC, Tu K, Cram P, Liu P, Abrams H, Udell JA, Mak S, Farkouh ME, Tu JV, Wang X, Tobe SW, Lee DS. Comparison of Readmission and Death Among Patients With Cardiac Disease in Northern vs Southern Ontario. Can J Cardiol 2019; 35:341-351. [PMID: 30825954 DOI: 10.1016/j.cjca.2019.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/25/2018] [Accepted: 01/11/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Geographic factors may influence cardiovascular disease outcomes in Canada. Circulatory diseases are a major reason for higher population mortality rates in Northern Ontario, but it is unknown if hospitalized patients with cardiovascular disease experience differential outcomes compared with those in the South. METHODS We examined 30-day and 1-year mortality and readmissions for patients hospitalized with acute myocardial infarction (AMI), heart failure (HF), atrial fibrillation (AF), or stroke in Northern compared with Southern Ontario, using the Canadian Institute for Health Information Discharge Abstract Database (2005-2016). Northern patients were defined as those residing and hospitalized in the Northwest or Northeast Local Health Integration Network regions. We used multiple Cox proportional hazards regression analysis for time-to-first event and Prentice-Williams-Peterson method to evaluate repeat and multiply admitted patients. RESULTS A total of 47,745 Northern and 465,353 Southern patients hospitalized with AMI (n = 182,158), HF (n = 130,770), AF (n = 72,326), or stroke (n = 127,844) were studied. Rates of first readmission were higher among Northern patients for AMI (adjusted hazard ratio [HR], 1.32), HF (HR, 1.16), AF (HR, 1.21), and stroke (HR, 1.27) compared with Southern patients (all P < 0.001). Repeat readmission rates among Northern patients for AMI (HR, 1.23), HF (HR, 1.13), AF (HR, 1.18), and stroke (HR, 1.22) were also increased (all P < 0.001 vs Southern). Thirty-day mortality did not differ significantly between Northern and Southern patients. CONCLUSIONS Readmissions were increased in those residing and hospitalized in the North. To reduce readmissions in the North, the quality of postacute transitional care should be examined further.
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Affiliation(s)
- Patrick J Donio
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Cassandra Freitas
- Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - Peter C Austin
- ICES, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Heather J Ross
- Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Husam M Abdel-Qadir
- University Health Network, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, Toronto, Ontario, Canada; Women's College Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Harindra C Wijeysundera
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Karen Tu
- University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Peter Cram
- University Health Network, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Peter Liu
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Howard Abrams
- University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Jacob A Udell
- University Health Network, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, Toronto, Ontario, Canada; Women's College Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Susanna Mak
- Mount Sinai Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Michael E Farkouh
- University Health Network, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Jack V Tu
- ICES, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | | | - Sheldon W Tobe
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Douglas S Lee
- Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
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Barsky J, Hunter R, McAllister C, Yeates K, Campbell N, Liu P, Perkins N, Hua-Stewart D, Maar MA, Tobe SW. Analysis of the Implementation, User Perspectives, and Feedback From a Mobile Health Intervention for Individuals Living With Hypertension (DREAM-GLOBAL): Mixed Methods Study. JMIR Mhealth Uhealth 2019; 7:e12639. [PMID: 31815678 PMCID: PMC6928701 DOI: 10.2196/12639] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 08/07/2019] [Accepted: 08/31/2019] [Indexed: 12/11/2022] Open
Abstract
Background DREAM-GLOBAL (Diagnosing hypertension—Engaging Action and Management in Getting Lower Blood Pressure in Indigenous and low- and middle-income countries) studied a SMS text messaging–based system for blood pressure measurement and hypertension management in Canadian Aboriginal and Tanzanian communities. The use of SMS text messages is an emerging point of interest in global health care initiatives because of their scalability, customizability, transferability, and cost-effectiveness. Objective The study aim was to assess the effect on the difference in blood pressure reduction of active hypertension management messages or passive health behavior messages. The system was designed to be implemented in remote areas with wireless availability. This study described the implementation and evaluation of technical components, including quantitative data from the transmission of blood pressure measurements and qualitative data collected on the operational aspects of the system from participants, health care providers, and community leadership. Methods The study was implemented in six remote Indigenous Canadian and two rural Tanzanian communities. Blood pressure readings were taken by a community health worker and transmitted to a mobile phone via Bluetooth, then by wireless to a programmed central server. From the server, the readings were sent to the participant’s own phone as well. Participants also received biweekly tailored SMS text messages on their phones. Quantitative data on blood pressure reading transmissions were collected from the study central server. Qualitative data were collected by surveys, focus groups, and key informant interviews of participants, health care providers, and health leadership. Results In Canada, between February 2014 and February 2017, 2818 blood pressure readings from 243 patients were transmitted to the central server. In Tanzania, between October 2014 and August 2015, 1165 readings from 130 patients were transmitted to the central server. The use of Bluetooth technology enabled the secure, reliable transmission of information from participants to their health care provider. The timing and frequency were satisfactory to 137 of 187 (73.2%) of participants, supporting the process of sending weekly messages twice on Mondays and Thursdays at 11 am. A total of 97.0% (164/169) of the participants surveyed said they would recommend participation in the DREAM-GLOBAL program to a friend or relative with hypertension. Conclusions In remote communities, the DREAM-GLOBAL study helped local health care providers deliver a blood pressure management program that enabled patients and community workers to feel connected. The technical components of the study were implemented as planned, and patients felt supported in their management through the SMS text messaging and mobile health program. Technological issues were solved with troubleshooting. Overall, the technical aspects of this research program enhanced clinical care and study evaluation and were well received by participants, health care workers, and community leadership. Trial Registration Clinicaltrials.gov NCT02111226; https://clinicaltrials.gov/ct2/show/NCT02111226.
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Affiliation(s)
- Jordan Barsky
- Department of Medicine, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Rebekah Hunter
- Department of Medicine, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | | | - Karen Yeates
- Department of Medicine, Queens University, Kingston, ON, Canada
| | - Norm Campbell
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Peter Liu
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Nancy Perkins
- Department of Medicine, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Diane Hua-Stewart
- Department of Medicine, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Marion A Maar
- Faculty of Medicine, Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Sheldon W Tobe
- Department of Medicine, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Faculty of Medicine, Northern Ontario School of Medicine, Sudbury, ON, Canada
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Maar MA, Beaudin V, Yeates K, Boesch L, Liu P, Madjedi K, Perkins N, Hua-Stewart D, Beaudin F, Wabano MJ, Tobe SW. Wise Practices for Cultural Safety in Electronic Health Research and Clinical Trials With Indigenous People: Secondary Analysis of a Randomized Clinical Trial. J Med Internet Res 2019; 21:e14203. [PMID: 31682574 PMCID: PMC6862000 DOI: 10.2196/14203] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 09/11/2019] [Accepted: 09/29/2019] [Indexed: 01/16/2023] Open
Abstract
Background There is a paucity of controlled clinical trial data based on research with Indigenous peoples. A lack of data specific to Indigenous peoples means that new therapeutic methods, such as those involving electronic health (eHealth), will be extrapolated to these groups based on research with other populations. Rigorous, ethical research can be undertaken in collaboration with Indigenous communities but requires careful attention to culturally safe research practices. Literature on how to involve Indigenous peoples in the development and evaluation of eHealth or mobile health apps that responds to the needs of Indigenous patients, providers, and communities is still scarce; however, the need for community-based participatory research to develop culturally safe technologies is emerging as an essential focus in Indigenous eHealth research. To be effective, researchers must first gain an in-depth understanding of Indigenous determinants of health, including the harmful consequences of colonialism. Second, researchers need to learn how colonialism affects the research process. The challenge then for eHealth researchers is to braid Indigenous ethical values with the requirements of good research methodologies into a culturally safe research protocol. Objective A recent systematic review showed that Indigenous peoples are underrepresented in randomized controlled trials (RCTs), primarily due to a lack of attention to providing space for Indigenous perspectives within the study frameworks of RCTs. Given the lack of guidelines for conducting RCTs with Indigenous communities, we conducted an analysis of our large evaluation data set collected in the Diagnosing Hypertension-Engaging Action and Management in Getting Lower Blood Pressure in Indigenous Peoples and Low- and Middle- Income Countries (DREAM-GLOBAL) trial over a period of five years. Our goal is to identify wise practices for culturally safe, collaborative eHealth and RCT research with Indigenous communities. Methods We thematically analyzed survey responses and qualitative interview/focus group data that we collected over five years in six culturally diverse Indigenous communities in Canada during the evaluation of the clinical trial DREAM-GLOBAL. We established themes that reflect culturally safe approaches to research and then developed wise practices for culturally safe research in pragmatic eHealth research. Results Based on our analysis, successful eHealth research in collaboration with Indigenous communities requires a focus on cultural safety that includes: (1) building a respectful relationship; (2) maintaining a respectful relationship; (3) good communication and support for the local team during the RCT; (4) commitment to co-designing the innovation; (5) supporting task shifting with the local team; and (6) reflecting on our mistakes and lessons learned or areas for improvement that support learning and cultural safety. Conclusions Based on evaluation data collected in the DREAM-GLOBAL RCT, we found that there are important cultural safety considerations in Indigenous eHealth research. Building on the perspectives of Indigenous staff and patients, we gleaned wise practices for RCTs in Indigenous communities. Trial Registration ClinicalTrials.gov NCT02111226; https://clinicaltrials.gov/ct2/show/NCT02111226
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Affiliation(s)
- Marion A Maar
- Faculty of Medicine, Northern Ontario School of Medicine, Laurentian University, Sudbury, ON, Canada
| | - Valerie Beaudin
- M'Chigeeng Health Centre, M'Chigeeng First Nation, ON, Canada
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Lisa Boesch
- Department of Research, Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Peter Liu
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Kian Madjedi
- Department of Medicine, Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Nancy Perkins
- Department of Medicine, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Diane Hua-Stewart
- Department of Medicine, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Faith Beaudin
- M'Chigeeng Health Centre, M'Chigeeng First Nation, ON, Canada.,Department of Medicine, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Mary Jo Wabano
- Naandwechige-Gamik Health Centre, Wiikwemkoong Unceded Territory, ON, Canada
| | - Sheldon W Tobe
- Faculty of Medicine, Northern Ontario School of Medicine, Laurentian University, Sudbury, ON, Canada.,Department of Medicine, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
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Kelly L, Matsumoto CL, Schreiber Y, Gordon J, Willms H, Olivier C, Madden S, Hopko J, Tobe SW. Prevalence of chronic kidney disease and cardiovascular comorbidities in adults in First Nations communities in northwest Ontario: a retrospective observational study. CMAJ Open 2019; 7:E568-E572. [PMID: 31501170 PMCID: PMC6768774 DOI: 10.9778/cmajo.20190040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 02/01/2023] Open
Abstract
BACKGROUND The prevalence of adult chronic kidney disease and cardiovascular comorbidities in Canadian Indigenous communities is largely unknown. We conducted a study to document the prevalence of chronic kidney disease and concurrent diabetes mellitus, hypertension and dyslipidemia in a First Nations population in northwest Ontario. METHODS In this observational study, we used retrospective data collected from regional electronic medical records of 16 170 adults (age ≥ 18 yr) from 26 First Nations communities in northwest Ontario from May 2014 to May 2017. Demographic and laboratory data included age, gender, prescribed medications, estimated glomerular filtration rate, urine albumin:creatinine ratio, low-density lipoprotein cholesterol (LDL-C) level and glycated hemoglobin (HbA1c) concentration. We identified patients with diabetes by an HbA1c concentration of 6.5% or higher, or the use of a diabetic medication, those with dyslipidemia by an elevated LDL-C level (≥ 2.0 mmol/L) or use of lipid-lowering medication, and those with hypertension by use of antihypertensive medication. RESULTS Of the 16 170 adults residing in the communities, 5224 unique patients (32.3%) had renal testing (albumin:creatinine ratio and/or estimated glomerular filtration rate). The age-adjusted prevalence of chronic kidney disease was 14.5%, and the prevalence of stage 3-5 chronic kidney disease (estimated glomerular filtration rate < 60 mL/min) was 7.0%. Most patients with chronic kidney disease (1487 [80.0%]) had at least 1 cardiovascular comorbidity. A total of 1332 patients (71.6%) had diabetes, 1313 (70.6%) had dyslipidemia, and 1098 (59.1%) had hypertension; all 3 comorbidities were present in 716 patients (38.5%). INTERPRETATION We document a high prevalence of advanced chronic kidney disease in this First Nations population, 7.0%, double the rate in the general population. High rates of cardiovascular comorbidities were also common in these patients with chronic kidney disease, which places them at increased risk for cardiovascular disease.
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Affiliation(s)
- Len Kelly
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont.
| | - Cai-Lei Matsumoto
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Yoko Schreiber
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Janet Gordon
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Hannah Willms
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Christopher Olivier
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Sharen Madden
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Josh Hopko
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Sheldon W Tobe
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
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Cheung AK, Chang TI, Cushman WC, Furth SL, Ix JH, Pecoits-Filho R, Perkovic V, Sarnak MJ, Tobe SW, Tomson CR, Cheung M, Wheeler DC, Winkelmayer WC, Mann JF, Bakris GL, Damasceno A, Dwyer JP, Fried LF, Haynes R, Hirawa N, Holdaas H, Ibrahim HN, Ingelfinger JR, Iseki K, Khwaja A, Kimmel PL, Kovesdy CP, Ku E, Lerma EV, Luft FC, Lv J, McFadden CB, Muntner P, Myers MG, Navaneethan SD, Parati G, Peixoto AJ, Prasad R, Rahman M, Rocco MV, Rodrigues CIS, Roger SD, Stergiou GS, Tomlinson LA, Tonelli M, Toto RD, Tsukamoto Y, Walker R, Wang AYM, Wang J, Warady BA, Whelton PK, Williamson JD. Blood pressure in chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2019; 95:1027-1036. [DOI: 10.1016/j.kint.2018.12.025] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/30/2018] [Accepted: 12/06/2018] [Indexed: 12/30/2022]
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Dubrofsky L, Tobe SW. Guideline Alignment in Related Areas. Can J Cardiol 2019; 35:606-610. [DOI: 10.1016/j.cjca.2019.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/18/2018] [Accepted: 01/06/2019] [Indexed: 12/01/2022] Open
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Tobe SW, Yeates K, Campbell NRC, Maar MA, Perkins N, Liu PP, Sleeth J, McAllister C, Hua-Stewart D, Wells G, Bernick J. Diagnosing hypertension in Indigenous Canadians (DREAM-GLOBAL): A randomized controlled trial to compare the effectiveness of short message service messaging for management of hypertension: Main results. J Clin Hypertens (Greenwich) 2018; 21:29-36. [PMID: 30474909 DOI: 10.1111/jch.13434] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/22/2018] [Accepted: 09/07/2018] [Indexed: 12/13/2022]
Abstract
Hypertension, the leading cause of cardiovascular morbidity and mortality, affects more than 1 billion people globally. The rise in mobile health in particular the use of mobile phones and short message service (SMS) to support disease management provides an opportunity to improve hypertension awareness, treatment, and control, in remote and vulnerable patient populations. The primary objective of this randomized controlled study was to assess the effect of active (with hypertension specific management SMS) or passive (health behaviors SMS alone) on the difference in blood pressure (BP) reduction between the active and passive SMS groups in hypertensive Canadian First Nations people from six rural and remote communities. Pragmatic features of the study included shifting of BP measures to non-medical health workers. Despite an overall reduction in BP over the study, there was no difference in the BP change between groups from baseline to final for systolic 0.8 (95% CI -4.2 to 5.8 mm Hg) or diastolic -1.0 (95% CI -3.7 to 1.8 mm Hg, P = 0.5) BP. Achieved BP control was 37.5% (25.6%-49.4%, 95% CI) in the active group and 32.8% (20.6%-44.8%, 95% CI) in the passive group (difference in proportions -4.74% (-21.7% to 12.2%, 95% CI, P = 0.6). The study looked at changes in health services delivery, mobile health technologies, and patient engagement to support better management of hypertension in Canadian First Nations communities. The active hypertension specific SMS did not lead to improvements in BP control.
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Affiliation(s)
- Sheldon W Tobe
- Department of Medicine, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.,Faculty of Medicine, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Norm R C Campbell
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marion A Maar
- Faculty of Medicine, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Nancy Perkins
- Department of Medicine, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Peter P Liu
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jessica Sleeth
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Diane Hua-Stewart
- Department of Medicine, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - George Wells
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jordan Bernick
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Tobe SW, Stone JA, Anderson T, Bacon S, Cheng AYY, Daskalopoulou SS, Ezekowitz JA, Gregoire JC, Gubitz G, Jain R, Keshavjee K, Lindsay P, L'Abbe M, Lau DCW, Leiter LA, O'Meara E, Pearson GJ, Rabi DM, Sherifali D, Selby P, Tu JV, Wharton S, Walker KM, Hua-Stewart D, Liu PP. Canadian Cardiovascular Harmonized National Guidelines Endeavour (C-CHANGE) guideline for the prevention and management of cardiovascular disease in primary care: 2018 update. CMAJ 2018; 190:E1192-E1206. [PMID: 30301743 PMCID: PMC6175624 DOI: 10.1503/cmaj.180194] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Sheldon W Tobe
- Libin Cardiovascular Institute, Cumming School of Medicine (Anderson), University of Calgary, Calgary, Alta.; Department of Health, Kinesiology, and Applied Physiology (Bacon), Concordia University, Montreal, Que. & Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Que.; St. Michael's Hospital (Cheng), University of Toronto, Toronto, Ont.; McGill University (Daskalopoulou), Montreal, Que.; Department of Medicine (Ezekowitz), University of Alberta, Edmonton, Alta.; Institut de cardiologie de Montreal (Gregoire), Montreal, Que.; Universite de Montreal (Gubitz), Montreal, Que.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Keshavjee), University of Toronto, Toronto, Ont.; Department of Nutritional Sciences (L'Abbe), University of Toronto, Toronto, Ont.; Department of Medicine and Libin Cardiovascular Institute (Lau), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Li Ka Shing Knowledge Institute (Leiter), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Heart and Stroke Foundation (Lindsay), Ottawa, Ont.; Ottawa Heart Institute (Liu), University of Ottawa, Ottawa, Ont.; Insitut de Cardiologie de Montreal (O'Meara), Universite de Montreal, Montreal, Que.; Division of Cardiology, Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Departments of Medicine, Community Health and Cardiac Sciences (Rabi), University of Calgary, Calgary, Alta.; Centre for Addiction and Mental Health, Departments of Family and Community Medicine, Psychiatry and Public Health Sciences (Selby), University of Toronto, Toronto, Ont.; School of Nursing and Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Sherifali), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Stone), University of Calgary, Calgary, Alta.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; ICES, Sunnybrook Research Institute (Tu), University of Toronto, Toronto, Ont.; St. Joseph's Health Care Centre (Walker), Toronto, Ont.; McMaster University (Wharton), Hamilton Ont.; York University (Wharton), Toronto, Ont.
| | - James A Stone
- Libin Cardiovascular Institute, Cumming School of Medicine (Anderson), University of Calgary, Calgary, Alta.; Department of Health, Kinesiology, and Applied Physiology (Bacon), Concordia University, Montreal, Que. & Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Que.; St. Michael's Hospital (Cheng), University of Toronto, Toronto, Ont.; McGill University (Daskalopoulou), Montreal, Que.; Department of Medicine (Ezekowitz), University of Alberta, Edmonton, Alta.; Institut de cardiologie de Montreal (Gregoire), Montreal, Que.; Universite de Montreal (Gubitz), Montreal, Que.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Keshavjee), University of Toronto, Toronto, Ont.; Department of Nutritional Sciences (L'Abbe), University of Toronto, Toronto, Ont.; Department of Medicine and Libin Cardiovascular Institute (Lau), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Li Ka Shing Knowledge Institute (Leiter), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Heart and Stroke Foundation (Lindsay), Ottawa, Ont.; Ottawa Heart Institute (Liu), University of Ottawa, Ottawa, Ont.; Insitut de Cardiologie de Montreal (O'Meara), Universite de Montreal, Montreal, Que.; Division of Cardiology, Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Departments of Medicine, Community Health and Cardiac Sciences (Rabi), University of Calgary, Calgary, Alta.; Centre for Addiction and Mental Health, Departments of Family and Community Medicine, Psychiatry and Public Health Sciences (Selby), University of Toronto, Toronto, Ont.; School of Nursing and Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Sherifali), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Stone), University of Calgary, Calgary, Alta.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; ICES, Sunnybrook Research Institute (Tu), University of Toronto, Toronto, Ont.; St. Joseph's Health Care Centre (Walker), Toronto, Ont.; McMaster University (Wharton), Hamilton Ont.; York University (Wharton), Toronto, Ont
| | - Todd Anderson
- Libin Cardiovascular Institute, Cumming School of Medicine (Anderson), University of Calgary, Calgary, Alta.; Department of Health, Kinesiology, and Applied Physiology (Bacon), Concordia University, Montreal, Que. & Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Que.; St. Michael's Hospital (Cheng), University of Toronto, Toronto, Ont.; McGill University (Daskalopoulou), Montreal, Que.; Department of Medicine (Ezekowitz), University of Alberta, Edmonton, Alta.; Institut de cardiologie de Montreal (Gregoire), Montreal, Que.; Universite de Montreal (Gubitz), Montreal, Que.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Keshavjee), University of Toronto, Toronto, Ont.; Department of Nutritional Sciences (L'Abbe), University of Toronto, Toronto, Ont.; Department of Medicine and Libin Cardiovascular Institute (Lau), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Li Ka Shing Knowledge Institute (Leiter), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Heart and Stroke Foundation (Lindsay), Ottawa, Ont.; Ottawa Heart Institute (Liu), University of Ottawa, Ottawa, Ont.; Insitut de Cardiologie de Montreal (O'Meara), Universite de Montreal, Montreal, Que.; Division of Cardiology, Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Departments of Medicine, Community Health and Cardiac Sciences (Rabi), University of Calgary, Calgary, Alta.; Centre for Addiction and Mental Health, Departments of Family and Community Medicine, Psychiatry and Public Health Sciences (Selby), University of Toronto, Toronto, Ont.; School of Nursing and Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Sherifali), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Stone), University of Calgary, Calgary, Alta.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; ICES, Sunnybrook Research Institute (Tu), University of Toronto, Toronto, Ont.; St. Joseph's Health Care Centre (Walker), Toronto, Ont.; McMaster University (Wharton), Hamilton Ont.; York University (Wharton), Toronto, Ont
| | - Simon Bacon
- Libin Cardiovascular Institute, Cumming School of Medicine (Anderson), University of Calgary, Calgary, Alta.; Department of Health, Kinesiology, and Applied Physiology (Bacon), Concordia University, Montreal, Que. & Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Que.; St. Michael's Hospital (Cheng), University of Toronto, Toronto, Ont.; McGill University (Daskalopoulou), Montreal, Que.; Department of Medicine (Ezekowitz), University of Alberta, Edmonton, Alta.; Institut de cardiologie de Montreal (Gregoire), Montreal, Que.; Universite de Montreal (Gubitz), Montreal, Que.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Keshavjee), University of Toronto, Toronto, Ont.; Department of Nutritional Sciences (L'Abbe), University of Toronto, Toronto, Ont.; Department of Medicine and Libin Cardiovascular Institute (Lau), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Li Ka Shing Knowledge Institute (Leiter), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Heart and Stroke Foundation (Lindsay), Ottawa, Ont.; Ottawa Heart Institute (Liu), University of Ottawa, Ottawa, Ont.; Insitut de Cardiologie de Montreal (O'Meara), Universite de Montreal, Montreal, Que.; Division of Cardiology, Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Departments of Medicine, Community Health and Cardiac Sciences (Rabi), University of Calgary, Calgary, Alta.; Centre for Addiction and Mental Health, Departments of Family and Community Medicine, Psychiatry and Public Health Sciences (Selby), University of Toronto, Toronto, Ont.; School of Nursing and Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Sherifali), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Stone), University of Calgary, Calgary, Alta.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; ICES, Sunnybrook Research Institute (Tu), University of Toronto, Toronto, Ont.; St. Joseph's Health Care Centre (Walker), Toronto, Ont.; McMaster University (Wharton), Hamilton Ont.; York University (Wharton), Toronto, Ont
| | - Alice Y Y Cheng
- Libin Cardiovascular Institute, Cumming School of Medicine (Anderson), University of Calgary, Calgary, Alta.; Department of Health, Kinesiology, and Applied Physiology (Bacon), Concordia University, Montreal, Que. & Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Que.; St. Michael's Hospital (Cheng), University of Toronto, Toronto, Ont.; McGill University (Daskalopoulou), Montreal, Que.; Department of Medicine (Ezekowitz), University of Alberta, Edmonton, Alta.; Institut de cardiologie de Montreal (Gregoire), Montreal, Que.; Universite de Montreal (Gubitz), Montreal, Que.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Keshavjee), University of Toronto, Toronto, Ont.; Department of Nutritional Sciences (L'Abbe), University of Toronto, Toronto, Ont.; Department of Medicine and Libin Cardiovascular Institute (Lau), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Li Ka Shing Knowledge Institute (Leiter), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Heart and Stroke Foundation (Lindsay), Ottawa, Ont.; Ottawa Heart Institute (Liu), University of Ottawa, Ottawa, Ont.; Insitut de Cardiologie de Montreal (O'Meara), Universite de Montreal, Montreal, Que.; Division of Cardiology, Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Departments of Medicine, Community Health and Cardiac Sciences (Rabi), University of Calgary, Calgary, Alta.; Centre for Addiction and Mental Health, Departments of Family and Community Medicine, Psychiatry and Public Health Sciences (Selby), University of Toronto, Toronto, Ont.; School of Nursing and Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Sherifali), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Stone), University of Calgary, Calgary, Alta.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; ICES, Sunnybrook Research Institute (Tu), University of Toronto, Toronto, Ont.; St. Joseph's Health Care Centre (Walker), Toronto, Ont.; McMaster University (Wharton), Hamilton Ont.; York University (Wharton), Toronto, Ont
| | - Stella S Daskalopoulou
- Libin Cardiovascular Institute, Cumming School of Medicine (Anderson), University of Calgary, Calgary, Alta.; Department of Health, Kinesiology, and Applied Physiology (Bacon), Concordia University, Montreal, Que. & Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Que.; St. Michael's Hospital (Cheng), University of Toronto, Toronto, Ont.; McGill University (Daskalopoulou), Montreal, Que.; Department of Medicine (Ezekowitz), University of Alberta, Edmonton, Alta.; Institut de cardiologie de Montreal (Gregoire), Montreal, Que.; Universite de Montreal (Gubitz), Montreal, Que.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Keshavjee), University of Toronto, Toronto, Ont.; Department of Nutritional Sciences (L'Abbe), University of Toronto, Toronto, Ont.; Department of Medicine and Libin Cardiovascular Institute (Lau), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Li Ka Shing Knowledge Institute (Leiter), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Heart and Stroke Foundation (Lindsay), Ottawa, Ont.; Ottawa Heart Institute (Liu), University of Ottawa, Ottawa, Ont.; Insitut de Cardiologie de Montreal (O'Meara), Universite de Montreal, Montreal, Que.; Division of Cardiology, Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Departments of Medicine, Community Health and Cardiac Sciences (Rabi), University of Calgary, Calgary, Alta.; Centre for Addiction and Mental Health, Departments of Family and Community Medicine, Psychiatry and Public Health Sciences (Selby), University of Toronto, Toronto, Ont.; School of Nursing and Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Sherifali), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Stone), University of Calgary, Calgary, Alta.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; ICES, Sunnybrook Research Institute (Tu), University of Toronto, Toronto, Ont.; St. Joseph's Health Care Centre (Walker), Toronto, Ont.; McMaster University (Wharton), Hamilton Ont.; York University (Wharton), Toronto, Ont
| | - Justin A Ezekowitz
- Libin Cardiovascular Institute, Cumming School of Medicine (Anderson), University of Calgary, Calgary, Alta.; Department of Health, Kinesiology, and Applied Physiology (Bacon), Concordia University, Montreal, Que. & Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Que.; St. Michael's Hospital (Cheng), University of Toronto, Toronto, Ont.; McGill University (Daskalopoulou), Montreal, Que.; Department of Medicine (Ezekowitz), University of Alberta, Edmonton, Alta.; Institut de cardiologie de Montreal (Gregoire), Montreal, Que.; Universite de Montreal (Gubitz), Montreal, Que.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Keshavjee), University of Toronto, Toronto, Ont.; Department of Nutritional Sciences (L'Abbe), University of Toronto, Toronto, Ont.; Department of Medicine and Libin Cardiovascular Institute (Lau), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Li Ka Shing Knowledge Institute (Leiter), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Heart and Stroke Foundation (Lindsay), Ottawa, Ont.; Ottawa Heart Institute (Liu), University of Ottawa, Ottawa, Ont.; Insitut de Cardiologie de Montreal (O'Meara), Universite de Montreal, Montreal, Que.; Division of Cardiology, Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Departments of Medicine, Community Health and Cardiac Sciences (Rabi), University of Calgary, Calgary, Alta.; Centre for Addiction and Mental Health, Departments of Family and Community Medicine, Psychiatry and Public Health Sciences (Selby), University of Toronto, Toronto, Ont.; School of Nursing and Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Sherifali), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Stone), University of Calgary, Calgary, Alta.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; ICES, Sunnybrook Research Institute (Tu), University of Toronto, Toronto, Ont.; St. Joseph's Health Care Centre (Walker), Toronto, Ont.; McMaster University (Wharton), Hamilton Ont.; York University (Wharton), Toronto, Ont
| | - Jean C Gregoire
- Libin Cardiovascular Institute, Cumming School of Medicine (Anderson), University of Calgary, Calgary, Alta.; Department of Health, Kinesiology, and Applied Physiology (Bacon), Concordia University, Montreal, Que. & Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Que.; St. Michael's Hospital (Cheng), University of Toronto, Toronto, Ont.; McGill University (Daskalopoulou), Montreal, Que.; Department of Medicine (Ezekowitz), University of Alberta, Edmonton, Alta.; Institut de cardiologie de Montreal (Gregoire), Montreal, Que.; Universite de Montreal (Gubitz), Montreal, Que.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Keshavjee), University of Toronto, Toronto, Ont.; Department of Nutritional Sciences (L'Abbe), University of Toronto, Toronto, Ont.; Department of Medicine and Libin Cardiovascular Institute (Lau), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Li Ka Shing Knowledge Institute (Leiter), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Heart and Stroke Foundation (Lindsay), Ottawa, Ont.; Ottawa Heart Institute (Liu), University of Ottawa, Ottawa, Ont.; Insitut de Cardiologie de Montreal (O'Meara), Universite de Montreal, Montreal, Que.; Division of Cardiology, Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Departments of Medicine, Community Health and Cardiac Sciences (Rabi), University of Calgary, Calgary, Alta.; Centre for Addiction and Mental Health, Departments of Family and Community Medicine, Psychiatry and Public Health Sciences (Selby), University of Toronto, Toronto, Ont.; School of Nursing and Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Sherifali), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Stone), University of Calgary, Calgary, Alta.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; ICES, Sunnybrook Research Institute (Tu), University of Toronto, Toronto, Ont.; St. Joseph's Health Care Centre (Walker), Toronto, Ont.; McMaster University (Wharton), Hamilton Ont.; York University (Wharton), Toronto, Ont
| | - Gord Gubitz
- Libin Cardiovascular Institute, Cumming School of Medicine (Anderson), University of Calgary, Calgary, Alta.; Department of Health, Kinesiology, and Applied Physiology (Bacon), Concordia University, Montreal, Que. & Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Que.; St. Michael's Hospital (Cheng), University of Toronto, Toronto, Ont.; McGill University (Daskalopoulou), Montreal, Que.; Department of Medicine (Ezekowitz), University of Alberta, Edmonton, Alta.; Institut de cardiologie de Montreal (Gregoire), Montreal, Que.; Universite de Montreal (Gubitz), Montreal, Que.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Keshavjee), University of Toronto, Toronto, Ont.; Department of Nutritional Sciences (L'Abbe), University of Toronto, Toronto, Ont.; Department of Medicine and Libin Cardiovascular Institute (Lau), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Li Ka Shing Knowledge Institute (Leiter), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Heart and Stroke Foundation (Lindsay), Ottawa, Ont.; Ottawa Heart Institute (Liu), University of Ottawa, Ottawa, Ont.; Insitut de Cardiologie de Montreal (O'Meara), Universite de Montreal, Montreal, Que.; Division of Cardiology, Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Departments of Medicine, Community Health and Cardiac Sciences (Rabi), University of Calgary, Calgary, Alta.; Centre for Addiction and Mental Health, Departments of Family and Community Medicine, Psychiatry and Public Health Sciences (Selby), University of Toronto, Toronto, Ont.; School of Nursing and Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Sherifali), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Stone), University of Calgary, Calgary, Alta.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; ICES, Sunnybrook Research Institute (Tu), University of Toronto, Toronto, Ont.; St. Joseph's Health Care Centre (Walker), Toronto, Ont.; McMaster University (Wharton), Hamilton Ont.; York University (Wharton), Toronto, Ont
| | - Rahul Jain
- Libin Cardiovascular Institute, Cumming School of Medicine (Anderson), University of Calgary, Calgary, Alta.; Department of Health, Kinesiology, and Applied Physiology (Bacon), Concordia University, Montreal, Que. & Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Que.; St. Michael's Hospital (Cheng), University of Toronto, Toronto, Ont.; McGill University (Daskalopoulou), Montreal, Que.; Department of Medicine (Ezekowitz), University of Alberta, Edmonton, Alta.; Institut de cardiologie de Montreal (Gregoire), Montreal, Que.; Universite de Montreal (Gubitz), Montreal, Que.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Keshavjee), University of Toronto, Toronto, Ont.; Department of Nutritional Sciences (L'Abbe), University of Toronto, Toronto, Ont.; Department of Medicine and Libin Cardiovascular Institute (Lau), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Li Ka Shing Knowledge Institute (Leiter), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Heart and Stroke Foundation (Lindsay), Ottawa, Ont.; Ottawa Heart Institute (Liu), University of Ottawa, Ottawa, Ont.; Insitut de Cardiologie de Montreal (O'Meara), Universite de Montreal, Montreal, Que.; Division of Cardiology, Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Departments of Medicine, Community Health and Cardiac Sciences (Rabi), University of Calgary, Calgary, Alta.; Centre for Addiction and Mental Health, Departments of Family and Community Medicine, Psychiatry and Public Health Sciences (Selby), University of Toronto, Toronto, Ont.; School of Nursing and Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Sherifali), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Stone), University of Calgary, Calgary, Alta.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; ICES, Sunnybrook Research Institute (Tu), University of Toronto, Toronto, Ont.; St. Joseph's Health Care Centre (Walker), Toronto, Ont.; McMaster University (Wharton), Hamilton Ont.; York University (Wharton), Toronto, Ont
| | - Karim Keshavjee
- Libin Cardiovascular Institute, Cumming School of Medicine (Anderson), University of Calgary, Calgary, Alta.; Department of Health, Kinesiology, and Applied Physiology (Bacon), Concordia University, Montreal, Que. & Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Que.; St. Michael's Hospital (Cheng), University of Toronto, Toronto, Ont.; McGill University (Daskalopoulou), Montreal, Que.; Department of Medicine (Ezekowitz), University of Alberta, Edmonton, Alta.; Institut de cardiologie de Montreal (Gregoire), Montreal, Que.; Universite de Montreal (Gubitz), Montreal, Que.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Keshavjee), University of Toronto, Toronto, Ont.; Department of Nutritional Sciences (L'Abbe), University of Toronto, Toronto, Ont.; Department of Medicine and Libin Cardiovascular Institute (Lau), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Li Ka Shing Knowledge Institute (Leiter), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Heart and Stroke Foundation (Lindsay), Ottawa, Ont.; Ottawa Heart Institute (Liu), University of Ottawa, Ottawa, Ont.; Insitut de Cardiologie de Montreal (O'Meara), Universite de Montreal, Montreal, Que.; Division of Cardiology, Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Departments of Medicine, Community Health and Cardiac Sciences (Rabi), University of Calgary, Calgary, Alta.; Centre for Addiction and Mental Health, Departments of Family and Community Medicine, Psychiatry and Public Health Sciences (Selby), University of Toronto, Toronto, Ont.; School of Nursing and Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Sherifali), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Stone), University of Calgary, Calgary, Alta.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; ICES, Sunnybrook Research Institute (Tu), University of Toronto, Toronto, Ont.; St. Joseph's Health Care Centre (Walker), Toronto, Ont.; McMaster University (Wharton), Hamilton Ont.; York University (Wharton), Toronto, Ont
| | - Patty Lindsay
- Libin Cardiovascular Institute, Cumming School of Medicine (Anderson), University of Calgary, Calgary, Alta.; Department of Health, Kinesiology, and Applied Physiology (Bacon), Concordia University, Montreal, Que. & Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Que.; St. Michael's Hospital (Cheng), University of Toronto, Toronto, Ont.; McGill University (Daskalopoulou), Montreal, Que.; Department of Medicine (Ezekowitz), University of Alberta, Edmonton, Alta.; Institut de cardiologie de Montreal (Gregoire), Montreal, Que.; Universite de Montreal (Gubitz), Montreal, Que.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Keshavjee), University of Toronto, Toronto, Ont.; Department of Nutritional Sciences (L'Abbe), University of Toronto, Toronto, Ont.; Department of Medicine and Libin Cardiovascular Institute (Lau), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Li Ka Shing Knowledge Institute (Leiter), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Heart and Stroke Foundation (Lindsay), Ottawa, Ont.; Ottawa Heart Institute (Liu), University of Ottawa, Ottawa, Ont.; Insitut de Cardiologie de Montreal (O'Meara), Universite de Montreal, Montreal, Que.; Division of Cardiology, Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Departments of Medicine, Community Health and Cardiac Sciences (Rabi), University of Calgary, Calgary, Alta.; Centre for Addiction and Mental Health, Departments of Family and Community Medicine, Psychiatry and Public Health Sciences (Selby), University of Toronto, Toronto, Ont.; School of Nursing and Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Sherifali), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Stone), University of Calgary, Calgary, Alta.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; ICES, Sunnybrook Research Institute (Tu), University of Toronto, Toronto, Ont.; St. Joseph's Health Care Centre (Walker), Toronto, Ont.; McMaster University (Wharton), Hamilton Ont.; York University (Wharton), Toronto, Ont
| | - Mary L'Abbe
- Libin Cardiovascular Institute, Cumming School of Medicine (Anderson), University of Calgary, Calgary, Alta.; Department of Health, Kinesiology, and Applied Physiology (Bacon), Concordia University, Montreal, Que. & Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Que.; St. Michael's Hospital (Cheng), University of Toronto, Toronto, Ont.; McGill University (Daskalopoulou), Montreal, Que.; Department of Medicine (Ezekowitz), University of Alberta, Edmonton, Alta.; Institut de cardiologie de Montreal (Gregoire), Montreal, Que.; Universite de Montreal (Gubitz), Montreal, Que.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Keshavjee), University of Toronto, Toronto, Ont.; Department of Nutritional Sciences (L'Abbe), University of Toronto, Toronto, Ont.; Department of Medicine and Libin Cardiovascular Institute (Lau), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Li Ka Shing Knowledge Institute (Leiter), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Heart and Stroke Foundation (Lindsay), Ottawa, Ont.; Ottawa Heart Institute (Liu), University of Ottawa, Ottawa, Ont.; Insitut de Cardiologie de Montreal (O'Meara), Universite de Montreal, Montreal, Que.; Division of Cardiology, Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Departments of Medicine, Community Health and Cardiac Sciences (Rabi), University of Calgary, Calgary, Alta.; Centre for Addiction and Mental Health, Departments of Family and Community Medicine, Psychiatry and Public Health Sciences (Selby), University of Toronto, Toronto, Ont.; School of Nursing and Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Sherifali), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Stone), University of Calgary, Calgary, Alta.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; ICES, Sunnybrook Research Institute (Tu), University of Toronto, Toronto, Ont.; St. Joseph's Health Care Centre (Walker), Toronto, Ont.; McMaster University (Wharton), Hamilton Ont.; York University (Wharton), Toronto, Ont
| | - David C W Lau
- Libin Cardiovascular Institute, Cumming School of Medicine (Anderson), University of Calgary, Calgary, Alta.; Department of Health, Kinesiology, and Applied Physiology (Bacon), Concordia University, Montreal, Que. & Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Que.; St. Michael's Hospital (Cheng), University of Toronto, Toronto, Ont.; McGill University (Daskalopoulou), Montreal, Que.; Department of Medicine (Ezekowitz), University of Alberta, Edmonton, Alta.; Institut de cardiologie de Montreal (Gregoire), Montreal, Que.; Universite de Montreal (Gubitz), Montreal, Que.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Keshavjee), University of Toronto, Toronto, Ont.; Department of Nutritional Sciences (L'Abbe), University of Toronto, Toronto, Ont.; Department of Medicine and Libin Cardiovascular Institute (Lau), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Li Ka Shing Knowledge Institute (Leiter), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Heart and Stroke Foundation (Lindsay), Ottawa, Ont.; Ottawa Heart Institute (Liu), University of Ottawa, Ottawa, Ont.; Insitut de Cardiologie de Montreal (O'Meara), Universite de Montreal, Montreal, Que.; Division of Cardiology, Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Departments of Medicine, Community Health and Cardiac Sciences (Rabi), University of Calgary, Calgary, Alta.; Centre for Addiction and Mental Health, Departments of Family and Community Medicine, Psychiatry and Public Health Sciences (Selby), University of Toronto, Toronto, Ont.; School of Nursing and Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Sherifali), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Stone), University of Calgary, Calgary, Alta.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; ICES, Sunnybrook Research Institute (Tu), University of Toronto, Toronto, Ont.; St. Joseph's Health Care Centre (Walker), Toronto, Ont.; McMaster University (Wharton), Hamilton Ont.; York University (Wharton), Toronto, Ont
| | - Lawrence A Leiter
- Libin Cardiovascular Institute, Cumming School of Medicine (Anderson), University of Calgary, Calgary, Alta.; Department of Health, Kinesiology, and Applied Physiology (Bacon), Concordia University, Montreal, Que. & Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Que.; St. Michael's Hospital (Cheng), University of Toronto, Toronto, Ont.; McGill University (Daskalopoulou), Montreal, Que.; Department of Medicine (Ezekowitz), University of Alberta, Edmonton, Alta.; Institut de cardiologie de Montreal (Gregoire), Montreal, Que.; Universite de Montreal (Gubitz), Montreal, Que.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Keshavjee), University of Toronto, Toronto, Ont.; Department of Nutritional Sciences (L'Abbe), University of Toronto, Toronto, Ont.; Department of Medicine and Libin Cardiovascular Institute (Lau), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Li Ka Shing Knowledge Institute (Leiter), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Heart and Stroke Foundation (Lindsay), Ottawa, Ont.; Ottawa Heart Institute (Liu), University of Ottawa, Ottawa, Ont.; Insitut de Cardiologie de Montreal (O'Meara), Universite de Montreal, Montreal, Que.; Division of Cardiology, Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Departments of Medicine, Community Health and Cardiac Sciences (Rabi), University of Calgary, Calgary, Alta.; Centre for Addiction and Mental Health, Departments of Family and Community Medicine, Psychiatry and Public Health Sciences (Selby), University of Toronto, Toronto, Ont.; School of Nursing and Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Sherifali), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Stone), University of Calgary, Calgary, Alta.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; ICES, Sunnybrook Research Institute (Tu), University of Toronto, Toronto, Ont.; St. Joseph's Health Care Centre (Walker), Toronto, Ont.; McMaster University (Wharton), Hamilton Ont.; York University (Wharton), Toronto, Ont
| | - Eileen O'Meara
- Libin Cardiovascular Institute, Cumming School of Medicine (Anderson), University of Calgary, Calgary, Alta.; Department of Health, Kinesiology, and Applied Physiology (Bacon), Concordia University, Montreal, Que. & Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Que.; St. Michael's Hospital (Cheng), University of Toronto, Toronto, Ont.; McGill University (Daskalopoulou), Montreal, Que.; Department of Medicine (Ezekowitz), University of Alberta, Edmonton, Alta.; Institut de cardiologie de Montreal (Gregoire), Montreal, Que.; Universite de Montreal (Gubitz), Montreal, Que.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Keshavjee), University of Toronto, Toronto, Ont.; Department of Nutritional Sciences (L'Abbe), University of Toronto, Toronto, Ont.; Department of Medicine and Libin Cardiovascular Institute (Lau), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Li Ka Shing Knowledge Institute (Leiter), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Heart and Stroke Foundation (Lindsay), Ottawa, Ont.; Ottawa Heart Institute (Liu), University of Ottawa, Ottawa, Ont.; Insitut de Cardiologie de Montreal (O'Meara), Universite de Montreal, Montreal, Que.; Division of Cardiology, Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Departments of Medicine, Community Health and Cardiac Sciences (Rabi), University of Calgary, Calgary, Alta.; Centre for Addiction and Mental Health, Departments of Family and Community Medicine, Psychiatry and Public Health Sciences (Selby), University of Toronto, Toronto, Ont.; School of Nursing and Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Sherifali), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Stone), University of Calgary, Calgary, Alta.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; ICES, Sunnybrook Research Institute (Tu), University of Toronto, Toronto, Ont.; St. Joseph's Health Care Centre (Walker), Toronto, Ont.; McMaster University (Wharton), Hamilton Ont.; York University (Wharton), Toronto, Ont
| | - Glen J Pearson
- Libin Cardiovascular Institute, Cumming School of Medicine (Anderson), University of Calgary, Calgary, Alta.; Department of Health, Kinesiology, and Applied Physiology (Bacon), Concordia University, Montreal, Que. & Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Que.; St. Michael's Hospital (Cheng), University of Toronto, Toronto, Ont.; McGill University (Daskalopoulou), Montreal, Que.; Department of Medicine (Ezekowitz), University of Alberta, Edmonton, Alta.; Institut de cardiologie de Montreal (Gregoire), Montreal, Que.; Universite de Montreal (Gubitz), Montreal, Que.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Keshavjee), University of Toronto, Toronto, Ont.; Department of Nutritional Sciences (L'Abbe), University of Toronto, Toronto, Ont.; Department of Medicine and Libin Cardiovascular Institute (Lau), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Li Ka Shing Knowledge Institute (Leiter), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Heart and Stroke Foundation (Lindsay), Ottawa, Ont.; Ottawa Heart Institute (Liu), University of Ottawa, Ottawa, Ont.; Insitut de Cardiologie de Montreal (O'Meara), Universite de Montreal, Montreal, Que.; Division of Cardiology, Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Departments of Medicine, Community Health and Cardiac Sciences (Rabi), University of Calgary, Calgary, Alta.; Centre for Addiction and Mental Health, Departments of Family and Community Medicine, Psychiatry and Public Health Sciences (Selby), University of Toronto, Toronto, Ont.; School of Nursing and Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Sherifali), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Stone), University of Calgary, Calgary, Alta.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; ICES, Sunnybrook Research Institute (Tu), University of Toronto, Toronto, Ont.; St. Joseph's Health Care Centre (Walker), Toronto, Ont.; McMaster University (Wharton), Hamilton Ont.; York University (Wharton), Toronto, Ont
| | - Doreen M Rabi
- Libin Cardiovascular Institute, Cumming School of Medicine (Anderson), University of Calgary, Calgary, Alta.; Department of Health, Kinesiology, and Applied Physiology (Bacon), Concordia University, Montreal, Que. & Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Que.; St. Michael's Hospital (Cheng), University of Toronto, Toronto, Ont.; McGill University (Daskalopoulou), Montreal, Que.; Department of Medicine (Ezekowitz), University of Alberta, Edmonton, Alta.; Institut de cardiologie de Montreal (Gregoire), Montreal, Que.; Universite de Montreal (Gubitz), Montreal, Que.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Keshavjee), University of Toronto, Toronto, Ont.; Department of Nutritional Sciences (L'Abbe), University of Toronto, Toronto, Ont.; Department of Medicine and Libin Cardiovascular Institute (Lau), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Li Ka Shing Knowledge Institute (Leiter), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Heart and Stroke Foundation (Lindsay), Ottawa, Ont.; Ottawa Heart Institute (Liu), University of Ottawa, Ottawa, Ont.; Insitut de Cardiologie de Montreal (O'Meara), Universite de Montreal, Montreal, Que.; Division of Cardiology, Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Departments of Medicine, Community Health and Cardiac Sciences (Rabi), University of Calgary, Calgary, Alta.; Centre for Addiction and Mental Health, Departments of Family and Community Medicine, Psychiatry and Public Health Sciences (Selby), University of Toronto, Toronto, Ont.; School of Nursing and Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Sherifali), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Stone), University of Calgary, Calgary, Alta.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; ICES, Sunnybrook Research Institute (Tu), University of Toronto, Toronto, Ont.; St. Joseph's Health Care Centre (Walker), Toronto, Ont.; McMaster University (Wharton), Hamilton Ont.; York University (Wharton), Toronto, Ont
| | - Diana Sherifali
- Libin Cardiovascular Institute, Cumming School of Medicine (Anderson), University of Calgary, Calgary, Alta.; Department of Health, Kinesiology, and Applied Physiology (Bacon), Concordia University, Montreal, Que. & Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Que.; St. Michael's Hospital (Cheng), University of Toronto, Toronto, Ont.; McGill University (Daskalopoulou), Montreal, Que.; Department of Medicine (Ezekowitz), University of Alberta, Edmonton, Alta.; Institut de cardiologie de Montreal (Gregoire), Montreal, Que.; Universite de Montreal (Gubitz), Montreal, Que.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Keshavjee), University of Toronto, Toronto, Ont.; Department of Nutritional Sciences (L'Abbe), University of Toronto, Toronto, Ont.; Department of Medicine and Libin Cardiovascular Institute (Lau), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Li Ka Shing Knowledge Institute (Leiter), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Heart and Stroke Foundation (Lindsay), Ottawa, Ont.; Ottawa Heart Institute (Liu), University of Ottawa, Ottawa, Ont.; Insitut de Cardiologie de Montreal (O'Meara), Universite de Montreal, Montreal, Que.; Division of Cardiology, Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Departments of Medicine, Community Health and Cardiac Sciences (Rabi), University of Calgary, Calgary, Alta.; Centre for Addiction and Mental Health, Departments of Family and Community Medicine, Psychiatry and Public Health Sciences (Selby), University of Toronto, Toronto, Ont.; School of Nursing and Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Sherifali), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Stone), University of Calgary, Calgary, Alta.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; ICES, Sunnybrook Research Institute (Tu), University of Toronto, Toronto, Ont.; St. Joseph's Health Care Centre (Walker), Toronto, Ont.; McMaster University (Wharton), Hamilton Ont.; York University (Wharton), Toronto, Ont
| | - Peter Selby
- Libin Cardiovascular Institute, Cumming School of Medicine (Anderson), University of Calgary, Calgary, Alta.; Department of Health, Kinesiology, and Applied Physiology (Bacon), Concordia University, Montreal, Que. & Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Que.; St. Michael's Hospital (Cheng), University of Toronto, Toronto, Ont.; McGill University (Daskalopoulou), Montreal, Que.; Department of Medicine (Ezekowitz), University of Alberta, Edmonton, Alta.; Institut de cardiologie de Montreal (Gregoire), Montreal, Que.; Universite de Montreal (Gubitz), Montreal, Que.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Keshavjee), University of Toronto, Toronto, Ont.; Department of Nutritional Sciences (L'Abbe), University of Toronto, Toronto, Ont.; Department of Medicine and Libin Cardiovascular Institute (Lau), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Li Ka Shing Knowledge Institute (Leiter), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Heart and Stroke Foundation (Lindsay), Ottawa, Ont.; Ottawa Heart Institute (Liu), University of Ottawa, Ottawa, Ont.; Insitut de Cardiologie de Montreal (O'Meara), Universite de Montreal, Montreal, Que.; Division of Cardiology, Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Departments of Medicine, Community Health and Cardiac Sciences (Rabi), University of Calgary, Calgary, Alta.; Centre for Addiction and Mental Health, Departments of Family and Community Medicine, Psychiatry and Public Health Sciences (Selby), University of Toronto, Toronto, Ont.; School of Nursing and Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Sherifali), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Stone), University of Calgary, Calgary, Alta.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; ICES, Sunnybrook Research Institute (Tu), University of Toronto, Toronto, Ont.; St. Joseph's Health Care Centre (Walker), Toronto, Ont.; McMaster University (Wharton), Hamilton Ont.; York University (Wharton), Toronto, Ont
| | - Jack V Tu
- Libin Cardiovascular Institute, Cumming School of Medicine (Anderson), University of Calgary, Calgary, Alta.; Department of Health, Kinesiology, and Applied Physiology (Bacon), Concordia University, Montreal, Que. & Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Que.; St. Michael's Hospital (Cheng), University of Toronto, Toronto, Ont.; McGill University (Daskalopoulou), Montreal, Que.; Department of Medicine (Ezekowitz), University of Alberta, Edmonton, Alta.; Institut de cardiologie de Montreal (Gregoire), Montreal, Que.; Universite de Montreal (Gubitz), Montreal, Que.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Keshavjee), University of Toronto, Toronto, Ont.; Department of Nutritional Sciences (L'Abbe), University of Toronto, Toronto, Ont.; Department of Medicine and Libin Cardiovascular Institute (Lau), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Li Ka Shing Knowledge Institute (Leiter), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Heart and Stroke Foundation (Lindsay), Ottawa, Ont.; Ottawa Heart Institute (Liu), University of Ottawa, Ottawa, Ont.; Insitut de Cardiologie de Montreal (O'Meara), Universite de Montreal, Montreal, Que.; Division of Cardiology, Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Departments of Medicine, Community Health and Cardiac Sciences (Rabi), University of Calgary, Calgary, Alta.; Centre for Addiction and Mental Health, Departments of Family and Community Medicine, Psychiatry and Public Health Sciences (Selby), University of Toronto, Toronto, Ont.; School of Nursing and Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Sherifali), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Stone), University of Calgary, Calgary, Alta.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; ICES, Sunnybrook Research Institute (Tu), University of Toronto, Toronto, Ont.; St. Joseph's Health Care Centre (Walker), Toronto, Ont.; McMaster University (Wharton), Hamilton Ont.; York University (Wharton), Toronto, Ont
| | - Sean Wharton
- Libin Cardiovascular Institute, Cumming School of Medicine (Anderson), University of Calgary, Calgary, Alta.; Department of Health, Kinesiology, and Applied Physiology (Bacon), Concordia University, Montreal, Que. & Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Que.; St. Michael's Hospital (Cheng), University of Toronto, Toronto, Ont.; McGill University (Daskalopoulou), Montreal, Que.; Department of Medicine (Ezekowitz), University of Alberta, Edmonton, Alta.; Institut de cardiologie de Montreal (Gregoire), Montreal, Que.; Universite de Montreal (Gubitz), Montreal, Que.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Keshavjee), University of Toronto, Toronto, Ont.; Department of Nutritional Sciences (L'Abbe), University of Toronto, Toronto, Ont.; Department of Medicine and Libin Cardiovascular Institute (Lau), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Li Ka Shing Knowledge Institute (Leiter), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Heart and Stroke Foundation (Lindsay), Ottawa, Ont.; Ottawa Heart Institute (Liu), University of Ottawa, Ottawa, Ont.; Insitut de Cardiologie de Montreal (O'Meara), Universite de Montreal, Montreal, Que.; Division of Cardiology, Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Departments of Medicine, Community Health and Cardiac Sciences (Rabi), University of Calgary, Calgary, Alta.; Centre for Addiction and Mental Health, Departments of Family and Community Medicine, Psychiatry and Public Health Sciences (Selby), University of Toronto, Toronto, Ont.; School of Nursing and Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Sherifali), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Stone), University of Calgary, Calgary, Alta.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; ICES, Sunnybrook Research Institute (Tu), University of Toronto, Toronto, Ont.; St. Joseph's Health Care Centre (Walker), Toronto, Ont.; McMaster University (Wharton), Hamilton Ont.; York University (Wharton), Toronto, Ont
| | - Kimberly M Walker
- Libin Cardiovascular Institute, Cumming School of Medicine (Anderson), University of Calgary, Calgary, Alta.; Department of Health, Kinesiology, and Applied Physiology (Bacon), Concordia University, Montreal, Que. & Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Que.; St. Michael's Hospital (Cheng), University of Toronto, Toronto, Ont.; McGill University (Daskalopoulou), Montreal, Que.; Department of Medicine (Ezekowitz), University of Alberta, Edmonton, Alta.; Institut de cardiologie de Montreal (Gregoire), Montreal, Que.; Universite de Montreal (Gubitz), Montreal, Que.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Keshavjee), University of Toronto, Toronto, Ont.; Department of Nutritional Sciences (L'Abbe), University of Toronto, Toronto, Ont.; Department of Medicine and Libin Cardiovascular Institute (Lau), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Li Ka Shing Knowledge Institute (Leiter), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Heart and Stroke Foundation (Lindsay), Ottawa, Ont.; Ottawa Heart Institute (Liu), University of Ottawa, Ottawa, Ont.; Insitut de Cardiologie de Montreal (O'Meara), Universite de Montreal, Montreal, Que.; Division of Cardiology, Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Departments of Medicine, Community Health and Cardiac Sciences (Rabi), University of Calgary, Calgary, Alta.; Centre for Addiction and Mental Health, Departments of Family and Community Medicine, Psychiatry and Public Health Sciences (Selby), University of Toronto, Toronto, Ont.; School of Nursing and Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Sherifali), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Stone), University of Calgary, Calgary, Alta.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; ICES, Sunnybrook Research Institute (Tu), University of Toronto, Toronto, Ont.; St. Joseph's Health Care Centre (Walker), Toronto, Ont.; McMaster University (Wharton), Hamilton Ont.; York University (Wharton), Toronto, Ont
| | - Diane Hua-Stewart
- Libin Cardiovascular Institute, Cumming School of Medicine (Anderson), University of Calgary, Calgary, Alta.; Department of Health, Kinesiology, and Applied Physiology (Bacon), Concordia University, Montreal, Que. & Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Que.; St. Michael's Hospital (Cheng), University of Toronto, Toronto, Ont.; McGill University (Daskalopoulou), Montreal, Que.; Department of Medicine (Ezekowitz), University of Alberta, Edmonton, Alta.; Institut de cardiologie de Montreal (Gregoire), Montreal, Que.; Universite de Montreal (Gubitz), Montreal, Que.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Keshavjee), University of Toronto, Toronto, Ont.; Department of Nutritional Sciences (L'Abbe), University of Toronto, Toronto, Ont.; Department of Medicine and Libin Cardiovascular Institute (Lau), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Li Ka Shing Knowledge Institute (Leiter), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Heart and Stroke Foundation (Lindsay), Ottawa, Ont.; Ottawa Heart Institute (Liu), University of Ottawa, Ottawa, Ont.; Insitut de Cardiologie de Montreal (O'Meara), Universite de Montreal, Montreal, Que.; Division of Cardiology, Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Departments of Medicine, Community Health and Cardiac Sciences (Rabi), University of Calgary, Calgary, Alta.; Centre for Addiction and Mental Health, Departments of Family and Community Medicine, Psychiatry and Public Health Sciences (Selby), University of Toronto, Toronto, Ont.; School of Nursing and Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Sherifali), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Stone), University of Calgary, Calgary, Alta.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; ICES, Sunnybrook Research Institute (Tu), University of Toronto, Toronto, Ont.; St. Joseph's Health Care Centre (Walker), Toronto, Ont.; McMaster University (Wharton), Hamilton Ont.; York University (Wharton), Toronto, Ont
| | - Peter P Liu
- Libin Cardiovascular Institute, Cumming School of Medicine (Anderson), University of Calgary, Calgary, Alta.; Department of Health, Kinesiology, and Applied Physiology (Bacon), Concordia University, Montreal, Que. & Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Que.; St. Michael's Hospital (Cheng), University of Toronto, Toronto, Ont.; McGill University (Daskalopoulou), Montreal, Que.; Department of Medicine (Ezekowitz), University of Alberta, Edmonton, Alta.; Institut de cardiologie de Montreal (Gregoire), Montreal, Que.; Universite de Montreal (Gubitz), Montreal, Que.; Sunnybrook Research Institute (Hua-Stewart), Toronto, Ont.; Department of Family and Community Medicine (Jain), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Keshavjee), University of Toronto, Toronto, Ont.; Department of Nutritional Sciences (L'Abbe), University of Toronto, Toronto, Ont.; Department of Medicine and Libin Cardiovascular Institute (Lau), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Li Ka Shing Knowledge Institute (Leiter), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Heart and Stroke Foundation (Lindsay), Ottawa, Ont.; Ottawa Heart Institute (Liu), University of Ottawa, Ottawa, Ont.; Insitut de Cardiologie de Montreal (O'Meara), Universite de Montreal, Montreal, Que.; Division of Cardiology, Mazankowski Alberta Heart Institute; University of Alberta, Faculty of Medicine and Dentistry (Pearson), Edmonton, Alta.; Departments of Medicine, Community Health and Cardiac Sciences (Rabi), University of Calgary, Calgary, Alta.; Centre for Addiction and Mental Health, Departments of Family and Community Medicine, Psychiatry and Public Health Sciences (Selby), University of Toronto, Toronto, Ont.; School of Nursing and Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Sherifali), McMaster University, Hamilton, Ont.; Libin Cardiovascular Institute (Stone), University of Calgary, Calgary, Alta.; Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; ICES, Sunnybrook Research Institute (Tu), University of Toronto, Toronto, Ont.; St. Joseph's Health Care Centre (Walker), Toronto, Ont.; McMaster University (Wharton), Hamilton Ont.; York University (Wharton), Toronto, Ont
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Tobe SW. What Can Declining Kidney Function Tell Us About Heart Failure? Can J Cardiol 2018; 34:1261-1263. [DOI: 10.1016/j.cjca.2018.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 08/08/2018] [Indexed: 10/28/2022] Open
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Kamalinia S, Josse RG, Donio P, Leduc L, Shah BR, Tobe SW. Risk of Hypoglycemia with New Antihyperglycemic Agents in Patients with Type 2 Diabetes. Can J Diabetes 2018. [DOI: 10.1016/j.jcjd.2018.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Webb DJ, Coll B, Heerspink HJL, Andress D, Pritchett Y, Brennan JJ, Houser M, Correa-Rotter R, Kohan D, Makino H, Perkovic V, Remuzzi G, Tobe SW, Toto R, Busch R, Pergola P, Parving HH, de Zeeuw D. Longitudinal Assessment of the Effect of Atrasentan on Thoracic Bioimpedance in Diabetic Nephropathy: A Randomized, Double-Blind, Placebo-Controlled Trial. Drugs R D 2018; 17:441-448. [PMID: 28831752 PMCID: PMC5629141 DOI: 10.1007/s40268-017-0201-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Fluid retention is a common adverse event in patients who receive endothelin (ET) receptor antagonist therapy, including the highly selective ETA receptor antagonist, atrasentan. Objective We performed longitudinal assessments of thoracic bioimpedance in patients with type 2 diabetes mellitus and nephropathy to determine whether a decrease in bioimpedance accurately reflected fluid retention during treatment with atrasentan. Study Design We conducted a randomized, double-blind, placebo-controlled study in 48 patients with type 2 diabetes mellitus and nephropathy who were receiving stable doses of renin angiotensin system inhibitors and diuretics. Methods Patients were randomized 1:1:1 to placebo, atrasentan 0.5 mg, or atrasentan 1.25 mg once daily for 8 weeks. Thoracic bioimpedance, vital signs, clinical exams, and serologies were taken at weeks 1, 2, 4, 6, and 8, with the exception of serum hemoglobin, which was not taken at week 1, and serum brain natriuretic peptide, which was only taken at baseline, week 4, and week 8. Results Alterations in bioimpedance were more often present in those who received atrasentan than in those who received placebo, though overall differences were not statistically significant. Transient declines in thoracic bioimpedance during the first 2 weeks of atrasentan exposure occurred before or during peak increases in body weight and hemodilution (decreased serum hemoglobin). Conclusions We conclude that thoracic bioimpedance did not reflect changes in weight gain or edema with atrasentan treatment in this study. However, the sample size was small, and it may be of interest to explore the use of thoracic bioimpedance in a larger population to understand its potential clinical use in monitoring fluid retention in patients with chronic kidney disease who receive ET receptor antagonists.
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Affiliation(s)
- David J Webb
- Edinburgh Hypertension Excellence Centre, Clinical Pharmacology Unit, University of Edinburgh, E3.22, QMRI, 47 Little France Crescent, Edinburgh, EH16 4TJ, Scotland, UK.
| | | | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | | | | | | | | | - Ricardo Correa-Rotter
- National Medical Science and Nutrition Institute Salvador Zubiran, Mexico City, Mexico
| | - Donald Kohan
- University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Hirofumi Makino
- Okayama University Graduate School of Medicine, Okayama, Japan
| | | | - Giuseppe Remuzzi
- Azienda Ospedaliera Papa Giovanni XXIII and IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy
| | | | - Robert Toto
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | | | - Dick de Zeeuw
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Roerecke M, Tobe SW, Kaczorowski J, Bacon SL, Vafaei A, Hasan OSM, Krishnan RJ, Raifu AO, Rehm J. Sex-Specific Associations Between Alcohol Consumption and Incidence of Hypertension: A Systematic Review and Meta-Analysis of Cohort Studies. J Am Heart Assoc 2018; 7:e008202. [PMID: 29950485 PMCID: PMC6064910 DOI: 10.1161/jaha.117.008202] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 03/13/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Although it is well established that heavy alcohol consumption increases the risk of hypertension, the risk associated with low levels of alcohol intake in men and women is unclear. METHODS AND RESULTS We searched Medline and Embase for original cohort studies on the association between average alcohol consumption and incidence of hypertension in people without hypertension. Random-effects meta-analyses and metaregressions were conducted. Data from 20 articles with 361 254 participants (125 907 men and 235 347 women) and 90 160 incident cases of hypertension (32 426 men and 57 734 women) were included. In people drinking 1 to 2 drinks/day (12 g of pure ethanol per drink), incidence of hypertension differed between men and women (relative riskwomen vs men=0.79; 95% confidence interval, 0.67-0.93). In men, the risk for hypertension in comparison with abstainers was relative risk=1.19 (1.07-1.31; I2=59%), 1.51 (1.30-1.76), and 1.74 (1.35-2.24) for consumption of 1 to 2, 3 to 4, and 5 or more standard drinks per day, respectively. In women, there was no increased risk for 1 to 2 drinks/day (relative risk=0.94; 0.88-1.01; I2=73%), and an increased risk for consumption beyond this level (relative risk=1.42; 1.22-1.66). CONCLUSIONS Any alcohol consumption was associated with an increase in the risk for hypertension in men. In women, there was no risk increase for consumption of 1 to 2 drinks/day and an increased risk for higher consumption levels. We did not find evidence for a protective effect of alcohol consumption in women, contrary to earlier meta-analyses.
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Affiliation(s)
- Michael Roerecke
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Dalla Lana School of Public Health (DLSPH), University of Toronto, Ontario, Canada
- PAHO/WHO Collaborating Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sheldon W Tobe
- Department of Medicine, University of Toronto, Ontario, Canada
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Janusz Kaczorowski
- Department of Family and Emergency Medicine, Université de Montréal, Quebec, Canada
- CRCHUM (University of Montreal Hospital Research Centre), Montreal, Quebec, Canada
| | - Simon L Bacon
- Department of Exercise Science, Concordia University, Montreal, Quebec, Canada
- Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Quebec, Canada
| | - Afshin Vafaei
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Omer S M Hasan
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Dalla Lana School of Public Health (DLSPH), University of Toronto, Ontario, Canada
| | - Rohin J Krishnan
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Amidu O Raifu
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Dalla Lana School of Public Health (DLSPH), University of Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Ontario, Canada
- PAHO/WHO Collaborating Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
- Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada
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Ward FL, Tobe SW, Naimark DMJ. The Role of Desmopressin in the Management of Severe, Hypovolemic Hyponatremia: A Single-Center, Comparative Analysis. Can J Kidney Health Dis 2018; 5:2054358118761051. [PMID: 29593879 PMCID: PMC5865454 DOI: 10.1177/2054358118761051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 04/20/2017] [Accepted: 07/28/2017] [Indexed: 12/17/2022] Open
Abstract
Background The role of desmopressin (DDAVP) to prevent or treat rapid serum sodium concentration ([Na]s) correction during hyponatremia management remains unclear. Objective To assess DDAVP use during the first 48 hours of severe, hypovolemic hyponatremia management. The primary study hypothesis was that the use of DDAVP would slow the rate of [Na]s correction compared with those not receiving DDAVP. Design A retrospective, observational, comparison study. Setting A single, Canadian, tertiary center. Patients All admitted patients referred to the nephrology service for severe, hypovolemic hyponatremia ([Na]s < 125 mmol/L) over a 12-month period from November 2015. Measurements The primary outcomes measure was the [Na]s after medical management for 48 hours. The length of hospital stay was also measured. Methods Patients were grouped based on whether they received DDAVP during the first 48 hours of treatment, and [Na]s correction was compared between groups using linear regression. An exploratory, multivariable, linear regression model was used to adjust for diabetes status, active malignancy, intensive care unit (ICU) admission, and hypertonic saline administration. Results Twenty-eight patients were identified, with baseline mean [Na]s of 112.7 ± 6.6 mmol/L versus 117 ± 4.3mmol/L (P = .06) in those receiving (n = 16) and not receiving DDAVP (n = 12), respectively. The DDAVP group had a more rapid [Na]s correction on the first day compared with those not receiving DDAVP, 7.7 ± 3.8 mmol/L/d versus 5.1 ± 2.0 mmol/L/d (P = .04). On the second day, there was a similar rate of [Na]s correction between groups: 1.3 ± 4.3 mmol/L/d versus 2.6 ± 3.2 mmol/L/d (P = .39), respectively. Overall, there was no difference in [Na]s correction after 48 hours between those who received DDAVP and those who did not: 121.7 ± 7.5 mmol/L versus 124.8 ± 5.7 mmol/L (P = .24). Patients who had experienced an overcorrection were successfully treated with DDAVP (n = 5), so that no patient had an ongoing overcorrection by 48 hours. Limitations The limited sample size and lack of randomization preclude definitive conclusion on the additional benefit of DDAVP to standard care. Conclusion DDAVP appears to be safe and effective in the management of severe, hypovolemic hyponatremia, associated with similar [Na]s correction to those who did not receive DDAVP after 48 hours, despite an initial more rapid correction. A randomized trial should examine what benefit DDAVP confers in addition to standard care in the management of severe, hypovolemic hyponatremia.
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Affiliation(s)
- Frank L Ward
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sheldon W Tobe
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - David M J Naimark
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Nerenberg KA, Zarnke KB, Leung AA, Dasgupta K, Butalia S, McBrien K, Harris KC, Nakhla M, Cloutier L, Gelfer M, Lamarre-Cliche M, Milot A, Bolli P, Tremblay G, McLean D, Padwal RS, Tran KC, Grover S, Rabkin SW, Moe GW, Howlett JG, Lindsay P, Hill MD, Sharma M, Field T, Wein TH, Shoamanesh A, Dresser GK, Hamet P, Herman RJ, Burgess E, Gryn SE, Grégoire JC, Lewanczuk R, Poirier L, Campbell TS, Feldman RD, Lavoie KL, Tsuyuki RT, Honos G, Prebtani APH, Kline G, Schiffrin EL, Don-Wauchope A, Tobe SW, Gilbert RE, Leiter LA, Jones C, Woo V, Hegele RA, Selby P, Pipe A, McFarlane PA, Oh P, Gupta M, Bacon SL, Kaczorowski J, Trudeau L, Campbell NRC, Hiremath S, Roerecke M, Arcand J, Ruzicka M, Prasad GVR, Vallée M, Edwards C, Sivapalan P, Penner SB, Fournier A, Benoit G, Feber J, Dionne J, Magee LA, Logan AG, Côté AM, Rey E, Firoz T, Kuyper LM, Gabor JY, Townsend RR, Rabi DM, Daskalopoulou SS. Hypertension Canada's 2018 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults and Children. Can J Cardiol 2018; 34:506-525. [PMID: 29731013 DOI: 10.1016/j.cjca.2018.02.022] [Citation(s) in RCA: 416] [Impact Index Per Article: 69.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 02/20/2018] [Accepted: 02/20/2018] [Indexed: 12/13/2022] Open
Abstract
Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension in adults and children. This year, the adult and pediatric guidelines are combined in one document. The new 2018 pregnancy-specific hypertension guidelines are published separately. For 2018, 5 new guidelines are introduced, and 1 existing guideline on the blood pressure thresholds and targets in the setting of thrombolysis for acute ischemic stroke is revised. The use of validated wrist devices for the estimation of blood pressure in individuals with large arm circumference is now included. Guidance is provided for the follow-up measurements of blood pressure, with the use of standardized methods and electronic (oscillometric) upper arm devices in individuals with hypertension, and either ambulatory blood pressure monitoring or home blood pressure monitoring in individuals with white coat effect. We specify that all individuals with hypertension should have an assessment of global cardiovascular risk to promote health behaviours that lower blood pressure. Finally, an angiotensin receptor-neprilysin inhibitor combination should be used in place of either an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in individuals with heart failure (with ejection fraction < 40%) who are symptomatic despite appropriate doses of guideline-directed heart failure therapies. The specific evidence and rationale underlying each of these guidelines are discussed.
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Affiliation(s)
- Kara A Nerenberg
- Division of General Internal Medicine, Departments of Medicine, Obstetrics and Gynecology, Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| | - Kelly B Zarnke
- O'Brien Institute for Public Health and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alexander A Leung
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kaberi Dasgupta
- Department of Medicine and Centre for Outcomes Research and Evaluation, McGill University and Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Sonia Butalia
- Departments of Medicine and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Kerry McBrien
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kevin C Harris
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meranda Nakhla
- Department of Medicine and Centre for Outcomes Research and Evaluation, McGill University and Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Lyne Cloutier
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Mark Gelfer
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Alain Milot
- Department of Medicine, Université Laval, Québec, Quebec, Canada
| | - Peter Bolli
- McMaster University, Hamilton, Ontario, Canada
| | - Guy Tremblay
- CHU-Québec-Hopital St. Sacrement, Québec, Quebec, Canada
| | - Donna McLean
- Alberta Health Services and Covenant Health, Edmonton, Alberta, Canada
| | - Raj S Padwal
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Karen C Tran
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Steven Grover
- McGill Comprehensive Health Improvement Program (CHIP), Montreal, Quebec, Canada
| | - Simon W Rabkin
- Vancouver Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gordon W Moe
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan G Howlett
- Departments of Medicine and Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Patrice Lindsay
- Director of Stroke, Heart and Stroke Foundation of Canada, Adjunct Faculty, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mike Sharma
- McMaster University, Hamilton Health Sciences, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Thalia Field
- University of British Columbia, Vancouver Stroke Program, Vancouver, British Columbia, Canada
| | - Theodore H Wein
- McGill University, Stroke Prevention Clinic, Montreal General Hospital, Montreal, Quebec, Canada
| | - Ashkan Shoamanesh
- McMaster University, Hamilton Health Sciences, Population Health Research Institute, Hamilton, Ontario, Canada
| | - George K Dresser
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Pavel Hamet
- Faculté de Médicine, Université de Montréal, Montréal, Quebec, Canada
| | - Robert J Herman
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ellen Burgess
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Steven E Gryn
- Department of Medicine, Western University, London, Ontario, Canada
| | - Jean C Grégoire
- Université de Montréal, Institut de cardiologie de Montréal, Montréal, Quebec, Canada
| | - Richard Lewanczuk
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Luc Poirier
- Institut National d'Excellence en Sante et Services Sociaux, Québec, Quebec, Canada
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Ross D Feldman
- Winnipeg Regional Health Authority and the University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kim L Lavoie
- University of Quebec at Montreal (UQAM), Montreal Behavioural Medicine Centre, CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada
| | - Ross T Tsuyuki
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - George Honos
- CHUM, University of Montreal, Montreal, Quebec, Canada
| | - Ally P H Prebtani
- Internal Medicine, Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada
| | - Gregory Kline
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Sheldon W Tobe
- University of Toronto, Toronto, Ontario, and Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Richard E Gilbert
- University of Toronto, Division of Endocrinology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Lawrence A Leiter
- University of Toronto, Division of Endocrinology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Charlotte Jones
- Department of Medicine, UBC Southern Medical Program, Kelowna, British Columbia, Canada
| | - Vincent Woo
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert A Hegele
- Departments of Medicine (Division of Endocrinology) and Biochemistry, Western University, London, Ontario, Canada
| | - Peter Selby
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Pipe
- University of Ottawa Heart Institute, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Philip A McFarlane
- Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paul Oh
- University Health Network, Toronto Rehab and Peter Munk Cardiac Centre, Toronto, Ontario, Canada
| | - Milan Gupta
- Department of Medicine, McMaster University, Hamilton, Ontario, and Canadian Collaborative Research Network, Brampton, Ontario, Canada
| | - Simon L Bacon
- Department of Exercise Science, Concordia University, and Montreal Behavioural Medicine Centre, CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada
| | - Janusz Kaczorowski
- Department of Family and Emergency Medicine, Université de Montréal and CRCHUM, Montréal, Quebec, Canada
| | - Luc Trudeau
- Division of Internal Medicine, Department of Medicine, McGill University, Montréal, Quebec, Canada
| | - Norman R C Campbell
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Swapnil Hiremath
- University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michael Roerecke
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Joanne Arcand
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Marcel Ruzicka
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Michel Vallée
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Quebec, Canada
| | - Cedric Edwards
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Praveena Sivapalan
- Division of General Internal Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Anne Fournier
- Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Geneviève Benoit
- Service de néphrologie, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Janusz Feber
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Janis Dionne
- Department of Pediatrics, Division of Nephrology, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Laura A Magee
- Department of Women and Children's Health, St Thomas' Hospital, London, and Department of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | | | | | - Evelyne Rey
- CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Tabassum Firoz
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Laura M Kuyper
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathan Y Gabor
- Interlake-Eastern Regional Healthy Authority, Concordia Hospital, Winnipeg, Manitoba, Canada
| | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Doreen M Rabi
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Departments of Medicine and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Stella S Daskalopoulou
- Division of Internal Medicine, Department of Medicine, McGill University, Montréal, Quebec, Canada
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Shahi N, Tobe SW. Thresholds and Targets for Hypertension Management in Adults With Type 2 Diabetes Should Remain at 130/80 mmHg: What's the Evidence? Can J Diabetes 2017; 42:166-172. [PMID: 29273294 DOI: 10.1016/j.jcjd.2017.10.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Received: 07/29/2017] [Revised: 10/03/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022]
Abstract
Hypertension and diabetes are common comorbidities and are both modifiable risk factors for cardiovascular disease and death. Lowering blood pressure reduces target organ damage and prevents cardiovascular disease outcomes. The harmonized Canadian clinical practice guidelines for managing hypertension in people with diabetes provides health-behaviour advice and medical therapy recommendations for a threshold blood pressure of 130/80 mmHg and above and to target blood pressure to below 130/80 mmHg. We have reviewed the studies supporting these recommendations and others, and they appear to be at odds with the guidelines, including those for elderly people and patients with pre-existing cardiovascular disease.
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Affiliation(s)
- Niharika Shahi
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Sheldon W Tobe
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
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Yeates K, Campbell N, Maar MA, Perkins N, Liu P, Sleeth J, Smith C, McAllister C, Hua-Stewart D, Wells G, Tobe SW. The Effectiveness of Text Messaging for Detection and Management of Hypertension in Indigenous People in Canada: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2017; 6:e244. [PMID: 29258978 PMCID: PMC5750415 DOI: 10.2196/resprot.7139] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 08/21/2017] [Accepted: 09/13/2017] [Indexed: 01/17/2023] Open
Abstract
Background Hypertension, the leading cause of morbidity and mortality, affects more than 1 billion people and is responsible globally for 10 million deaths annually. Hypertension can be controlled on a national level; in Canada, for example, awareness, treatment, and control improved dramatically from only 16% in 1990 to 66% currently. The ongoing development, dissemination, and implementation of Hypertension Canada’s clinical practice guidelines is considered to be responsible, in part, for achieving these high levels of control and the associated improvements in cardiovascular outcomes. A gap still exists between the evidence and the implementation of hypertension guidelines in Indigenous communities in Canada, as well as in low- and middle-income countries (LMICs). The rapid rise in the ownership and use of mobile phones globally and the potential for texting (short message service, SMS) to improve health literacy and to link the health team together with the patient served as a rationale for the Dream-Global study in both Canada and Tanzania. Objective The primary objective of the Dream-Global study is to assess the effect of innovative technologies and changes in health services delivery on blood pressure (BP) control of Indigenous people in Canada and rural Tanzanians with hypertension using SMS messages and community BP measurement through task shifting with transfer of the measures electronically to the patient and the health care team members. Methods This prospective, randomized blinded allocation study enrolls both adults with uncontrolled hypertension (medicated or unmedicated) and those without hypertension but at high risk of developing this condition who participate in a BP screening study. Participants will be followed for at least 12 months. Results The primary efficacy endpoint in this study will be assessed by analysis of variance. Descriptive data will be given with the mean and standard deviation for continuous data and proportions for ordinal data. Exploratory subgroup analyses will include analysis by community, sex, mobile phone ownership at baseline, and age. The knowledge gained from the text messages will be assessed using a questionnaire at study completion, and results will be compared between the groups. Conclusions This study is expected to provide insights into the implementation of an innovative system of guidelines- and community-based treatment and follow-up for hypertension in Indigenous communities in Canada and in Tanzania, an example of an LMIC. These insights are expected to provide the information needed to plan scalable and sustainable interventions to control BP virtually anywhere in the world. Trial Registration Clinicaltrials.gov NCT02111226; https://clinicaltrials.gov/ct2/show/NCT02111226 (Archived by WebCite at http://www.webcitation.org/6v7IdYzZh)
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Affiliation(s)
- Karen Yeates
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Norm Campbell
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marion A Maar
- Faculty of Medicine, Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Nancy Perkins
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Peter Liu
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Jessica Sleeth
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Carter Smith
- Department of Biology & Psychology SSP, Queen's University, Kingston, ON, Canada
| | | | - Diane Hua-Stewart
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - George Wells
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Sheldon W Tobe
- Faculty of Medicine, Northern Ontario School of Medicine, Sudbury, ON, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Abstract
Introduction:
The DreamGlobal study incorporates mobile health innovations in technology with SMS text messaging and task shifting of blood pressure measurement.
Methods:
In this pragmatic RCT study participants with uncontrolled hypertension on or off of medication, received culturally competent text messages over a one year period. All participants lived on First Nations reserves in remote and rural parts of Canada. Initial blood pressure screening was with an automated oscillometric device. Community Health Workers and nurses were trained to measure blood pressure with an approved oscillometric device which was Bluetooth enabled. Once participants were registered online, they received their blood pressure results on their own mobile phone as a text message and guidelines based text messages. Their primary health care provider also received the results as a fax. They were randomized to receive health behaviour change messages alone or active messages including a recommendation to see their health care provider if their blood pressure was above target. The baseline blood pressure was the mean of all readings in the first two months and the final blood pressure, the mean of the last two months. The main outcomes were change in blood pressure between the two groups (active or passive text messages) and the proportion achieving control.
Results:
One hundred twenty-seven subjects had hypertension. Blood pressure in the first two months of measurement was 143/85 mmHg over all. The blood pressure in the final two months of the study will be reported as will the change in blood pressure in both the active and passive text message groups and the proportion achieving blood pressure control in each group. Health literacy regarding the guideline’s based text messages was measured to determine if there was a difference between scores for the passive messages (all participants) and the active messages (active group only).
Discussion:
Achieving guidelines based management of hypertension is more challenging in remote, resource poor environments. Treatment focused SMS messages may improve hypertension management and allow the provision of guidelines based care even in rural and remote areas with health care resource challenges.
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Edwards JD, Ramirez J, Callahan BL, Tobe SW, Oh P, Berezuk C, Lanctôt K, Swardfager W, Nestor S, Kiss A, Strother S, Black SE. Antihypertensive Treatment is associated with MRI-Derived Markers of Neurodegeneration and Impaired Cognition: A Propensity-Weighted Cohort Study. J Alzheimers Dis 2017; 59:1113-1122. [DOI: 10.3233/jad-170238] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jodi D. Edwards
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute>, University of Toronto, Toronto, Canada
- Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, Canada
| | - Joel Ramirez
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute>, University of Toronto, Toronto, Canada
- Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, Canada
| | - Brandy L. Callahan
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute>, University of Toronto, Toronto, Canada
| | | | - Paul Oh
- Toronto Rehabilitation Institute, Toronto, Canada
| | - Courtney Berezuk
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute>, University of Toronto, Toronto, Canada
- Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, Canada
| | - Krista Lanctôt
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute>, University of Toronto, Toronto, Canada
- Geriatric Psychiatry, University of Toronto, Toronto, Canada
- Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Walter Swardfager
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute>, University of Toronto, Toronto, Canada
- Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, Canada
- Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Sean Nestor
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Alexander Kiss
- Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Stephen Strother
- Medical Biophysics, University of Toronto, Toronto, Canada
- Rotman Research Institute, Toronto, Canada
| | - Sandra E. Black
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute>, University of Toronto, Toronto, Canada
- Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences and University of Toronto, Toronto, Canada
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Pena MJ, de Zeeuw D, Andress D, Brennan JJ, Correa-Rotter R, Coll B, Kohan DE, Makino H, Perkovic V, Remuzzi G, Tobe SW, Toto R, Parving HH, Sharma S, Corringham T, Sharma K, Heerspink HJL. The effects of atrasentan on urinary metabolites in patients with type 2 diabetes and nephropathy. Diabetes Obes Metab 2017; 19:749-753. [PMID: 28019071 DOI: 10.1111/dom.12864] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/08/2016] [Accepted: 12/21/2016] [Indexed: 01/23/2023]
Abstract
We assessed the effect of atrasentan therapy on a pre-specified panel of 13 urinary metabolites known to reflect mitochondrial function in patients with diabetic kidney disease. This post-hoc analysis was performed using urine samples collected during the RADAR study which was a randomized, double-blind, placebo-controlled trial that tested the effects of atrasentan on albuminuria reduction in patients with type 2 diabetes and nephropathy. At baseline, 4 of the 13 metabolites, quantified by gas-chromatography mass spectrometry, were below detectable levels, and 6 were reduced in patients with eGFR < 60 mL/min/1.73 m2 . After 12 weeks of atrasentan treatment in patients with eGFR < 60 mL/min/1.73 m2 , a single-value index of the metabolites changed by -0.31 (95%CI -0.60 to -0.02; P = .035), -0.08 (-12 to 0.29; P = .43) and 0.01 (-0.21 to 0.19; P = .913) in placebo, atrasentan 0.75 and 1.25 mg/d, respectively. The metabolite index difference compared to placebo was 0.13 (-0.17 to 0.43; P = .40) and 0.35 (0.05-0.65; P = .02) for atrasentan 0.75 and 1.25 mg/d, respectively. These data corroborate previous findings of mitochondrial dysfunction in patients with type 2 diabetes, nephropathy and eGFR < 60 mL/min/1.73 m2 , suggesting that atrasentan may prevent the progression of mitochondrial dysfunction common to this specific patient population. Future studies of longer treatment duration with atrasentan are indicated.
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Affiliation(s)
- Michelle J Pena
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dick de Zeeuw
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dennis Andress
- Renal Clinical Development, AbbVie, North Chicago, Illinois
| | - John J Brennan
- Renal Clinical Development, AbbVie, North Chicago, Illinois
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico City, Mexico
| | - Blai Coll
- Clinical Research Cardiovascular, Amgen Inc., Thousand Oaks, California
| | - Donald E Kohan
- Division of Nephrology, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Hirofumi Makino
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Vlado Perkovic
- George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Giuseppe Remuzzi
- Unit of Nephrology and Dialysis, Azienda Ospedaliera Papa Giovanni XXIII, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Sheldon W Tobe
- Department of Hypertension and Nephrology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Robert Toto
- Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Hans-Henrik Parving
- Department of Medical Endocrinology, Rigshospitalet University Hospital of Copenhagen, Copenhagen, Denmark
| | | | | | - Kumar Sharma
- Institute of Metabolomic Medicine, Center for Renal Translational Medicine, Division of Nephrology-Hypertension, Division of Medical Genetics, Department of Medicine, University of California San Diego, San Diego, California
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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46
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Tu JV, Maclagan LC, Ko DT, Atzema CL, Booth GL, Johnston S, Tu K, Lee DS, Bierman A, Hall R, Bhatia RS, Gershon AS, Tobe SW, Sanmartin C, Liu P, Chu A. The Cardiovascular Health in Ambulatory Care Research Team performance indicators for the primary prevention of cardiovascular disease: a modified Delphi panel study. CMAJ Open 2017; 5:E315-E321. [PMID: 28446446 PMCID: PMC5498313 DOI: 10.9778/cmajo.20160139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 11/22/2022] Open
Abstract
BACKGROUND High-quality ambulatory care can reduce cardiovascular disease risk, but important gaps exist in the provision of cardiovascular preventive care. We sought to develop a set of key performance indicators that can be used to measure and improve cardiovascular care in the primary care setting. METHODS As part of the Cardiovascular Health in Ambulatory Care Research Team initiative, we established a 14-member multidisciplinary expert panel to develop a set of indicators for measuring primary prevention performance in ambulatory cardiovascular care. We used a 2-stage modified Delphi panel process to rate potential indicators, which were identified from the literature and national cardiovascular organizations. The top-rated indicators were pilot tested to determine their measurement feasibility with the use of data routinely collected in the Canadian health care system. RESULTS A set of 28 indicators of primary prevention performance were identified, which were grouped into 5 domains: risk factor prevalence, screening, management, intermediate outcomes and long-term outcomes. The indicators reflect the major cardiovascular risk factors including smoking, obesity, hypertension, diabetes, dyslipidemia and atrial fibrillation. All indicators were determined to be amenable to measurement with the use of population-based administrative (physician claims, hospital admission, laboratory, medication), survey or electronic medical record databases. INTERPRETATION The Cardiovascular Health in Ambulatory Care Research Team indicators of primary prevention performance provide a framework for the measurement of cardiovascular primary prevention efforts in Canada. The indicators may be used by clinicians, researchers and policy-makers interested in measuring and improving the prevention of cardiovascular disease in ambulatory care settings.
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Affiliation(s)
- Jack V Tu
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
| | - Laura C Maclagan
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
| | - Dennis T Ko
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
| | - Clare L Atzema
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
| | - Gillian L Booth
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
| | - Sharon Johnston
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
| | - Karen Tu
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
| | - Douglas S Lee
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
| | - Arlene Bierman
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
| | - Ruth Hall
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
| | - R Sacha Bhatia
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
| | - Andrea S Gershon
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
| | - Sheldon W Tobe
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
| | - Claudia Sanmartin
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
| | - Peter Liu
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
| | - Anna Chu
- Affiliations: Institute for Clinical Evaluative Sciences (J. Tu, Maclagan, Ko, Atzema, Booth, K. Tu, Lee, Hall, Bhatia, Gershon, Chu); Schulich Heart Centre (J. Tu, Ko), Division of Emergency Medicine (Atzema), and Division of Nephrology (Tobe), Sunnybrook Health Sciences Centre; University of Toronto (J. Tu, Ko, Atzema, Booth, K. Tu, Lee, Bierman, Hall, Bhatia, Gershon, Tobe, Liu, Chu); St. Michael's Hospital (Booth), Toronto, Ont.; Bruyère Research Institute (Johnston); University of Ottawa (Johnston), Ottawa, Ont.; University Health Network (K. Tu, Lee, Bhatia), Toronto, Ont.; Center for Evidence and Practice Improvement (Bierman), Agency for Healthcare Research and Quality, Rockville, MD; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; Northern Ontario School of Medicine (Tobe), Sudbury, Ont.; University of Ottawa Heart Institute (Liu); Statistics Canada (Sanmartin), Ottawa, Ont
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Maar MA, Yeates K, Perkins N, Boesch L, Hua-Stewart D, Liu P, Sleeth J, Tobe SW. A Framework for the Study of Complex mHealth Interventions in Diverse Cultural Settings. JMIR Mhealth Uhealth 2017; 5:e47. [PMID: 28428165 PMCID: PMC5418524 DOI: 10.2196/mhealth.7044] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/27/2017] [Indexed: 12/16/2022] Open
Abstract
Background To facilitate decision-making capacity between options of care under real-life service conditions, clinical trials must be pragmatic to evaluate mobile health (mHealth) interventions under the variable conditions of health care settings with a wide range of participants. The mHealth interventions require changes in the behavior of patients and providers, creating considerable complexity and ambiguity related to causal chains. Process evaluations of the implementation are necessary to shed light on the range of unanticipated effects an intervention may have, what the active ingredients in everyday practice are, how they exert their effect, and how these may vary among recipients or between sites. Objective Building on the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth) statement and participatory evaluation theory, we present a framework for the process evaluations for mHealth interventions in multiple cultural settings. We also describe the application of this evaluation framework to the implementation of DREAM-GLOBAL (Diagnosing hypertension—Engaging Action and Management in Getting Lower BP in Indigenous and LMIC [low- and middle-income countries]), a pragmatic randomized controlled trial (RCT), and mHealth intervention designed to improve hypertension management in low-resource environments. We describe the evaluation questions and the data collection processes developed by us. Methods Our literature review revealed that there is a significant knowledge gap related to the development of a process evaluation framework for mHealth interventions. We used community-based participatory research (CBPR) methods and formative research data to develop a process evaluation framework nested within a pragmatic RCT. Results Four human organizational levels of participants impacted by the mHealth intervention were identified that included patients, providers, community and organizations actors, and health systems and settings. These four levels represent evaluation domains and became the core focus of the evaluation. In addition, primary implementation themes to explore in each of the domains were identified as follows: (1) the major active components of the intervention, (2) technology of the intervention, (3) cultural congruence, (4) task shifting, and (5) unintended consequences. Using the four organizational domains and their interaction with primary implementation themes, we developed detailed evaluation research questions and identified the data or information sources to best answer our questions. Conclusions Using DREAM-GLOBAL to illustrate our approach, we succeeded in developing an uncomplicated process evaluation framework for mHealth interventions that provide key information to stakeholders, which can optimize implementation of a pragmatic trial as well as inform scale up. The human organizational level domains used to focus the primary implementation themes in the DREAM-GLOBAL process evaluation framework are sufficiently supported in our research, and the literature and can serve as a valuable tool for other mHealth process evaluations. Trial Registration ClinicalTrials.gov NCT02111226; https://clinicaltrials.gov/ct2/show/NCT02111226 (Archived by WebCite at http://www.webcitation.org/6oxfHXege)
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Affiliation(s)
- Marion A Maar
- Faculty of Medicine, Northern Ontario School of Medicine, Laurentian University, Sudbury, ON, Canada
| | - Karen Yeates
- Department of Medicine, Queens University, Kingston, ON, Canada
| | - Nancy Perkins
- Department of Medicine, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Lisa Boesch
- Department of Research, Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Diane Hua-Stewart
- Department of Medicine, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Peter Liu
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Jessica Sleeth
- Department of Medicine, Queens University, Kingston, ON, Canada
| | - Sheldon W Tobe
- Faculty of Medicine, Northern Ontario School of Medicine, Laurentian University, Sudbury, ON, Canada.,Department of Medicine, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
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48
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Heerspink HJL, Makino H, Andress D, Brennan JJ, Correa-Rotter R, Coll B, Davis JW, Idler K, Kohan DE, Liu M, Perkovic V, Remuzzi G, Tobe SW, Toto R, Parving HH, de Zeeuw D. Comparison of exposure response relationship of atrasentan between North American and Asian populations. Diabetes Obes Metab 2017; 19:545-552. [PMID: 27981738 DOI: 10.1111/dom.12851] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 12/06/2016] [Accepted: 12/08/2016] [Indexed: 12/25/2022]
Abstract
AIMS The selective endothelin (ET) A receptor antagonist atrasentan has been shown to lower albuminuria in North American and Asian patients with type 2 diabetes and nephropathy. As drug responses to many drugs may differ between North American and Asian populations, we assessed the influence of geographical region on the albuminuria and fluid retention response to atrasentan. MATERIALS AND METHODS Two 12-week double-blind randomised controlled trials were performed with atrasentan 0.75 or 1.25 mg/d vs placebo in patients with type 2 diabetes and nephropathy. The efficacy endpoint was the percentage change in albuminuria. Bodyweight change, a proxy of fluid retention, was used as a safety endpoint. Pharmacodynamics were determined in Asians (N = 77) and North Americans (N = 134). Atrasentan plasma concentration was measured in 161 atrasentan-treated patients. RESULTS Mean albuminuria reduction in Asian, compared to North American, patients was, respectively, -34.4% vs -26.3% for 0.75 mg/d ( P = .44) and -48.0% vs -28.9% for 1.25 mg/d ( P = .035). Bodyweight gain did not differ between North American and Asian populations. Atrasentan plasma concentrations were higher in Asians compared to North Americans and correlated with albuminuria response (7.2% albuminuria reduction per doubling atrasentan concentration; P = .024). Body surface area (β = -1.09 per m2 ; P < .001) and bilirubin, as a marker of hepatic organic anion transporter activity, (β = 0.69 per mg/dL increment; P = .010) were independent determinants of atrasentan plasma concentration; correction by body surface area and bilirubin left no significant difference in plasma concentration between Asian and North American populations. CONCLUSION The higher exposure and albuminuria reduction of atrasentan in Asian patients is not associated with more fluid retention, suggesting that Asian patients are less sensitive to atrasentan-induced sodium retention.
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Affiliation(s)
- Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hirofumi Makino
- Okayama University Graduate School of Medicine, Okayama City, Okayama, Japan
| | | | | | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico City, Mexico
| | - Blai Coll
- Renal Clinical Development, AbbVie, Chicago, Illinois
| | | | - Ken Idler
- Renal Clinical Development, AbbVie, Chicago, Illinois
| | - Donald E Kohan
- Division of Nephrology, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Mohan Liu
- Renal Clinical Development, AbbVie, Chicago, Illinois
| | - Vlado Perkovic
- George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Giuseppe Remuzzi
- Azienda Ospedaliera Papa Giovanni XXIII and IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy
| | - Sheldon W Tobe
- Department of Hypertension and Nephrology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Robert Toto
- Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Hans-Henrik Parving
- Department of Medical Endocrinology, Rigshospitalet University Hospital of Copenhagen, Copenhagen, Denmark
| | - Dick de Zeeuw
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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49
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Leung AA, Daskalopoulou SS, Dasgupta K, McBrien K, Butalia S, Zarnke KB, Nerenberg K, Harris KC, Nakhla M, Cloutier L, Gelfer M, Lamarre-Cliche M, Milot A, Bolli P, Tremblay G, McLean D, Tran KC, Tobe SW, Ruzicka M, Burns KD, Vallée M, Prasad GVR, Gryn SE, Feldman RD, Selby P, Pipe A, Schiffrin EL, McFarlane PA, Oh P, Hegele RA, Khara M, Wilson TW, Penner SB, Burgess E, Sivapalan P, Herman RJ, Bacon SL, Rabkin SW, Gilbert RE, Campbell TS, Grover S, Honos G, Lindsay P, Hill MD, Coutts SB, Gubitz G, Campbell NRC, Moe GW, Howlett JG, Boulanger JM, Prebtani A, Kline G, Leiter LA, Jones C, Côté AM, Woo V, Kaczorowski J, Trudeau L, Tsuyuki RT, Hiremath S, Drouin D, Lavoie KL, Hamet P, Grégoire JC, Lewanczuk R, Dresser GK, Sharma M, Reid D, Lear SA, Moullec G, Gupta M, Magee LA, Logan AG, Dionne J, Fournier A, Benoit G, Feber J, Poirier L, Padwal RS, Rabi DM. Hypertension Canada's 2017 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults. Can J Cardiol 2017; 33:557-576. [PMID: 28449828 DOI: 10.1016/j.cjca.2017.03.005] [Citation(s) in RCA: 212] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/04/2017] [Accepted: 03/05/2017] [Indexed: 01/29/2023] Open
Abstract
Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension. This year, we introduce 10 new guidelines. Three previous guidelines have been revised and 5 have been removed. Previous age and frailty distinctions have been removed as considerations for when to initiate antihypertensive therapy. In the presence of macrovascular target organ damage, or in those with independent cardiovascular risk factors, antihypertensive therapy should be considered for all individuals with elevated average systolic nonautomated office blood pressure (non-AOBP) readings ≥ 140 mm Hg. For individuals with diastolic hypertension (with or without systolic hypertension), fixed-dose single-pill combinations are now recommended as an initial treatment option. Preference is given to pills containing an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in combination with either a calcium channel blocker or diuretic. Whenever a diuretic is selected as monotherapy, longer-acting agents are preferred. In patients with established ischemic heart disease, caution should be exercised in lowering diastolic non-AOBP to ≤ 60 mm Hg, especially in the presence of left ventricular hypertrophy. After a hemorrhagic stroke, in the first 24 hours, systolic non-AOBP lowering to < 140 mm Hg is not recommended. Finally, guidance is now provided for screening, initial diagnosis, assessment, and treatment of renovascular hypertension arising from fibromuscular dysplasia. The specific evidence and rationale underlying each of these guidelines are discussed.
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Affiliation(s)
- Alexander A Leung
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Stella S Daskalopoulou
- Divisions of General Internal Medicine, Clinical Epidemiology and Endocrinology, Department of Medicine, McGill University, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kaberi Dasgupta
- Divisions of General Internal Medicine, Clinical Epidemiology and Endocrinology, Department of Medicine, McGill University, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kerry McBrien
- Departments of Family Medicine and Community Health Sciences, Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sonia Butalia
- Departments of Medicine and Community Health Sciences, Libin Cardiovascular Institute of Alberta, O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Kelly B Zarnke
- Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kara Nerenberg
- Department of Medicine and Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Kevin C Harris
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meranda Nakhla
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Lyne Cloutier
- Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Mark Gelfer
- Department of Family Medicine, University of British Columbia, Copeman Healthcare Centre, Vancouver, British Columbia, Canada
| | - Maxime Lamarre-Cliche
- Institut de Recherches Cliniques de Montréal, Université de Montréal, Montréal, Quebec, Canada
| | - Alain Milot
- Department of Medicine, Université Laval, Québec, Quebec, Canada
| | - Peter Bolli
- McMaster University, Hamilton, Ontario, Canada
| | - Guy Tremblay
- CHU-Québec-Hopital St Sacrement, Québec, Quebec, Canada
| | - Donna McLean
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Marcel Ruzicka
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin D Burns
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Michel Vallée
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Quebec, Canada
| | | | - Steven E Gryn
- Department of Medicine, Division of Clinical Pharmacology, Western University, London, Ontario, Canada
| | - Ross D Feldman
- Discipline of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | - Peter Selby
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Pipe
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ernesto L Schiffrin
- Department of Medicine and Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Philip A McFarlane
- Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paul Oh
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert A Hegele
- Departments of Medicine (Division of Endocrinology) and Biochemistry, Western University, London, Ontario, Canada
| | - Milan Khara
- Vancouver Coastal Health Addiction Services, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas W Wilson
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - S Brian Penner
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ellen Burgess
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Praveena Sivapalan
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Robert J Herman
- Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Simon L Bacon
- Department of Exercise Science, Concordia University, and Montreal Behavioural Medicine Centre, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal (CIUSSS-NIM), Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada
| | - Simon W Rabkin
- Vancouver Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard E Gilbert
- University of Toronto, Division of Endocrinology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Steven Grover
- Division of Clinical Epidemiology, Montreal General Hospital, Montreal, Quebec, Canada
| | - George Honos
- University of Montreal, Montreal, Quebec, Canada
| | - Patrice Lindsay
- Stroke, Heart and Stroke Foundation of Canada, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Shelagh B Coutts
- Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Gord Gubitz
- Division of Neurology, Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Norman R C Campbell
- Medicine, Community Health Sciences, Physiology and Pharmacology, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Gordon W Moe
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan G Howlett
- Departments of Medicine and Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jean-Martin Boulanger
- Charles LeMoyne Hospital Research Centre, Sherbrooke University, Sherbrooke, Quebec, Canada
| | | | - Gregory Kline
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lawrence A Leiter
- Keenan Research Centre in the Li Ka Shing Knowledge Institute of St Michael's Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Charlotte Jones
- University of British Columbia, Southern Medical Program, Kelowna, British Columbia, Canada
| | | | - Vincent Woo
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Janusz Kaczorowski
- Université de Montréal and Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Luc Trudeau
- Division of Internal Medicine, McGill University, Montréal, Quebec, Canada
| | - Ross T Tsuyuki
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Swapnil Hiremath
- Faculty of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Denis Drouin
- Faculty of Medicine, Université Laval, Québec, Quebec, Canada
| | - Kim L Lavoie
- Department of Psychology, University of Quebec at Montreal, Montréal, Quebec, Canada
| | - Pavel Hamet
- Faculté de Médicine, Université de Montréal, Montréal, Quebec, Canada
| | - Jean C Grégoire
- Université de Montréal, Institut de cardiologie de Montréal, Montréal, Quebec, Canada
| | | | - George K Dresser
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Mukul Sharma
- McMaster University, Hamilton Health Sciences Population Health Research Institute, Hamilton, Ontario, Canada
| | - Debra Reid
- Centre intégré de santé et de services sociaux (CISSS) de l'Outaouais, Groupes de médecine de famille (GMF) de Wakefield, Wakefield, Quebec, Canada
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Gregory Moullec
- Research Center, Hôpital du Sacré-Coeur de Montréal, Public Health School, University of Montréal, Montréal, Quebec, Canada
| | - Milan Gupta
- McMaster University, Hamilton, Ontario, and Canadian Collaborative Research Network, Brampton, Ontario, Canada
| | - Laura A Magee
- St George's, University of London and the St George's Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
| | | | - Janis Dionne
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne Fournier
- Service de cardiologie, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Geneviève Benoit
- Centre Hospitalier Universitaire Sainte-Justine, Department of Pediatrics, Université de Montréal, Montréal, Quebec, Canada
| | - Janusz Feber
- Division of Neurology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Luc Poirier
- Centre Hospitalier Universitaire de Québec et Faculté de Pharmacie, Université Laval, Québec, Quebec, Canada
| | - Raj S Padwal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Doreen M Rabi
- Departments of Medicine, Community Health and Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
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50
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Vedanthan R, Bernabe-Ortiz A, Herasme OI, Joshi R, Lopez-Jaramillo P, Thrift AG, Webster J, Webster R, Yeates K, Gyamfi J, Ieremia M, Johnson C, Kamano JH, Lazo-Porras M, Limbani F, Liu P, McCready T, Miranda JJ, Mohan S, Ogedegbe O, Oldenburg B, Ovbiagele B, Owolabi M, Peiris D, Ponce-Lucero V, Praveen D, Pillay A, Schwalm JD, Tobe SW, Trieu K, Yusoff K, Fuster V. Innovative Approaches to Hypertension Control in Low- and Middle-Income Countries. Cardiol Clin 2017; 35:99-115. [PMID: 27886793 PMCID: PMC5131527 DOI: 10.1016/j.ccl.2016.08.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Elevated blood pressure, a major risk factor for ischemic heart disease, heart failure, and stroke, is the leading global risk for mortality. Treatment and control rates are very low in low- and middle-income countries. There is an urgent need to address this problem. The Global Alliance for Chronic Diseases sponsored research projects focus on controlling hypertension, including community engagement, salt reduction, salt substitution, task redistribution, mHealth, and fixed-dose combination therapies. This paper reviews the rationale for each approach and summarizes the experience of some of the research teams. The studies demonstrate innovative and practical methods for improving hypertension control.
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Affiliation(s)
- Rajesh Vedanthan
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.
| | - Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 497, Lima 18, Peru
| | - Omarys I Herasme
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Rohina Joshi
- The George Institute for Global Health, University of Sydney, 50 Bridge Street, Sydney, NSW 2000, Australia
| | | | - Amanda G Thrift
- School of Clinical Sciences at Monash Health, Monash University, Wellington Road and Blackburn Road, Clayton, VIC 3800, Australia
| | - Jacqui Webster
- The George Institute for Global Health, University of Sydney, 50 Bridge Street, Sydney, NSW 2000, Australia
| | - Ruth Webster
- The George Institute for Global Health, University of Sydney, 50 Bridge Street, Sydney, NSW 2000, Australia
| | - Karen Yeates
- School of Medicine, Queens University, 15 Arch Street, Kingston, ON K7L 3N6, Canada
| | - Joyce Gyamfi
- School of Medicine, New York University, 550 1st Avenue, New York, NY 10016, USA
| | - Merina Ieremia
- Samoan Ministry of Health, Motootua, Ifiifi street, Apia, Samoa
| | - Claire Johnson
- The George Institute for Global Health, University of Sydney, 50 Bridge Street, Sydney, NSW 2000, Australia
| | - Jemima H Kamano
- College of Health Sciences, School of Medicine, Moi University, PO Box 3900, Eldoret 30100, Kenya
| | - Maria Lazo-Porras
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 497, Lima 18, Peru
| | - Felix Limbani
- Centre for Health Policy, School of Public Health, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg 2000, South Africa
| | - Peter Liu
- University of Ottawa, 75 Laurier Avenue East, Ottawa, ON K1N 6N5, Canada
| | - Tara McCready
- Population Health Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 497, Lima 18, Peru
| | - Sailesh Mohan
- Public Health Foundation of India, Plot No. 47, Sector 44, New Delhi, India
| | - Olugbenga Ogedegbe
- School of Medicine, New York University, 550 1st Avenue, New York, NY 10016, USA
| | - Brian Oldenburg
- School of Population and Global Health, University of Melbourne, Parkville, VC 3010, Australia
| | - Bruce Ovbiagele
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | | | - David Peiris
- The George Institute for Global Health, University of Sydney, 50 Bridge Street, Sydney, NSW 2000, Australia
| | - Vilarmina Ponce-Lucero
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 497, Lima 18, Peru
| | - Devarsetty Praveen
- The George Institute for Global Health, 301 ANR Centre, Road No 1, Banjara Hills, Hyderabad 500034, India
| | - Arti Pillay
- Pacific Research Centre for the Prevention of Obesity and Non-Communicable Diseases, Fiji National University, Suva, Fiji
| | - Jon-David Schwalm
- Population Health Research Institute, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
| | - Sheldon W Tobe
- University of Toronto, 27 King's College Circle, Toronto, ON M5S 1A1, Canada
| | - Kathy Trieu
- The George Institute for Global Health, University of Sydney, 50 Bridge Street, Sydney, NSW 2000, Australia
| | - Khalid Yusoff
- Universiti Teknologi MARA, Selangor and UCSI University, Kuala Lumpur, Malaysia
| | - Valentin Fuster
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
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