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  • 11
    Online Resource
    Online Resource
    Abstract 11906: Association Between Neighborhood Environment and Physical Activity in Adults With Cardiovascular Disease in the United States
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Introduction: Identifying attributes of the built environment that influence an individual’s adherence to recommended physical activity (PA) levels can inform cardiovascular-healthy urban-planning policies. However, no research has examined whether perceived neighborhood environment characteristics are associated with this among adults with CVD. Methods: Cross-sectional study using 2020 data from the National Health Interview Survey, which included 3191 adults with CVD. Perceived walkability and safety barriers were captured from 9 questions on participants’ feelings about the neighborhood’s safety and amenities to allow for walking. Meeting PA recommendation was evaluated based on 2012 ACC/AHA guidelines for individuals with stable CVD based on the self-reported measures of activity (Figure). Adjusted logistic models were created to evaluate the association of perceived walkability and safety with the odds of achieving PA goals. Results: In the study population, 36.8% met the overall PA guideline, of whom 7% met only strength activity, 19.5% met only aerobic activity, and 10.3% met both. Men were more likely to meet PA guidelines (42.5% vs. 29.2%) than women. In adjusted weighted analysis, having roads for a walk (OR 1.70, 95%CI 1.23-2.36), fun places such as parks, theatres, and libraries to walk near the living area (OR 1.43, 95%CI 1.08-1.89), and places to walk for relaxing and reducing stress (OR 1.46, 95%CI 1.10-1.95) were strongly associated with meeting PA recommendations. Conclusions: In adults with CVD, the neighborhood environment characteristics strongly associated with adherence to PA recommendations were the presence of places to walk for fun and relaxation. Although residual confounding is a possibility, our findings suggest that investing in social determinants by developing communities with amenities such as parks might help encourage physical activity for cardiovascular health.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.11906
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 12
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    Abstract 11993: Area Deprivation Index and Risk of Poly-Vascular Disease: Insights From Houston Methodist Cardiovascular Disease Learning Health System Registry
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Introduction: Poly-vascular disease (PVD), defined as presence of atherosclerotic disease in 〉 1 vascular territory, typically coronary artery disease (CAD), peripheral arterial disease (PAD), or cerebrovascular disease, is associated with worse CV prognosis. The impact of social vulnerability among this very high-risk subgroup has not been well studied. We aim to leverage readily available measures of neighborhood-level social vulnerability (area deprivation index, ADI) associated with increasing burden of overall and premature ( 〈 65 years) PVD in a large integrated healthcare system. Methods: Cross-sectional study using data from 1.12M patients aged 18+ years in Houston Methodist CVD Learning Health System Registry (2016-2022). Patients were ranked by ADI quintiles (Q1-Q5) as validated index of neighborhood socioeconomic disadvantage built from 17 metrics at census tract level quantified using Geographic Information Systems. CAD, PAD, and stroke were identified using ICD 10-CM codes. Results: We included a total of 1.1M adults with ADI ranking. Overall, prevalence of CAD, PAD and stroke was 5.7%, 1.7% and 3.2% respectively with 1.4% & 0.3% having vascular disease in 2 and 3 vascular beds respectively. Age-adjusted prevalence of any & premature PVD was higher with worse ADI groups ( Table ). Overall, 35% and 41% of patients with premature 2-3 PVD were in the highest 4-5 th ADI quintile (most deprived neighborhood) compared to 28% with premature single vascular CVD. After adjusting for age, sex, race/ethnicity, CV risk factors, adults in the highest ADI quintile had odds of 1.18(1.11-1.26) of PVD in 2 territories & 1.33(1.15-1.54) in 3 vascular beds compared to ADI quintile 1 (least deprived neighborhood). Conclusion: Readily available neighborhood social deprivation such as ADI is strongly associated with worsening poly-vascular CVD. It can be used to inform comprehensive preventive and management strategies for this vulnerable population at health system level.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.11993
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 13
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    Abstract 13740: Cumulative Social Disadvantage and Cost-Related Medication Non-Adherence Among US Adults With Hypertension: The National Health Interview Survey 2014-2017
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Introduction: Less than 50% adherence is reported 1 year after initiating antihypertensives. We examined social disparities in cost-related medication non-adherence (CRN) by insurance and family income categories in adults with hypertension. Methods: We used National Health Interview Survey 2014-2017 data from adults who reported hypertension and were taking antihypertensive medications. Respondents reported their insurance plan and family income. A cumulative SDoH index was created by aggregating 45 determinants from 6 domains, and respondents were grouped by quartiles (SDoH-Q1 to Q4). Higher SDoH quartiles indicated greater disadvantage. CRN was present if an individual skipped medication to save money, took less medicine to save money, or delayed filling a prescription to save money in the last 12 months. Results: A total of 35,893 adults managed for hypertension were surveyed, with a mean age 62.48 [SD 14.24] years, female 51.3%). The prevalence of CRN was 9.5%. The uninsured (34.6%) and those with low income were most likely to report CRN. Regardless of insurance or income, higher SDoH quartile groups were more likely to report CRN. This trend was accentuated among the uninsured and the middle-income group. Adjusting for demographics and comorbidities, the least increment in the odds of CRN with SDoH quartiles was seen among Medicare beneficiaries and low-income: SDoH-Q4 was associated with OR = 8.47 (95%CI, 2.11, 33.93) for Medicare beneficiaries, and OR = 17.80 (95%CI, 7.91, 40.03) for low-income. The highest increment in the odds of CRN with SDoH quartiles were observed with the uninsured (OR = 22.89; 95%CI [4.91, 106.81] ), and the middle-income group (OR = 21.57; 95%CI [13.78, 33.77]). Conclusion: While cumulative social disadvantage was associated with higher cost-related medication non-adherence among adults on medications for hypertension, this association was stronger in the uninsured, Medicaid beneficiaries, and the middle-income group.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.13740
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 14
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    Abstract 14524: Low Testosterone Levels and Cardiovascular Disease: Insights From the Houston Methodist CVD Registry
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Introduction: Low testosterone (LowT) has been suggested to be associated with increased ASCVD risk and mortality, but results are conflicting across studies. We evaluated the independent relationship between low testosterone levels in adult males and ASCVD using data from an EHR-based database. Methods Cross-sectional study using the Houston Methodist CVD Learning Health System Registry, which includes data from 1.1 million patients aged ≥18 years (June 2016-April 2022). Analyses were restricted to men, and those on testosterone replacement therapy were excluded. We evaluated the associations between total testosterone levels (categorized as quartiles [Q], lowest Q as exposure of interest and highest Q as reference) and ASCVD (CAD, PAD, stroke), using logistic regression. Conditions and risk factors were identified using ICD 10-CM codes. Results: We evaluated 30,150 men ≥18 years (mean age 55.3 years, 12% NHB, 15% Hispanics) with testosterone level data. Men in testosterone Q1 (lowest levels: ≤285 ng/dl) had higher prevalence of almost all risk factors and composite ASCVD compared to Q4 (highest levels: ≥515 ng/dl) (Panel A). In unadjusted analyses, men in testosterone Q1 vs Q4 had higher odds of ASCVD (OR 1.54, 95% CI 1.41-1.68). In multivariable adjusted logistic regression, the increased odds persisted adjusting for age, sex, and race OR 1.33 (CI 1.21 - 1.46), while it was fully attenuated (OR 1.04 CI 0.94 - 1.14) after adjusting for risk factors (DM, HTN, dyslipidemia, obesity) (Panel B). The attenuation in association with prevalent ASCVD was highest adjusting for DM (67%) and HTN (58%) (Panel C). Similar results were noted when cutoff of 〈 200 ng/dl was used for LowT. Conclusions: ASCVD and CV risk factors are widely prevalent among men with LowT. The association between LowT and ASCVD might be related to CV risk factors, mainly hypertension and DM. Early identification and intensive CV risk factor management among men with LowT levels may help reduce their risk of ASCVD.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.14524
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 15
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    Abstract P332: Self-perceived Psychological Factors and Their Impact on Ideal Cardiovascular Health by Gender: the Baptist Health South Florida (BHSF) Employee Study
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Circulation Vol. 135, No. suppl_1 ( 2017-03-07)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 135, No. suppl_1 ( 2017-03-07)
    Abstract: Introduction: Psychological factors including stress are associated with adverse cardiovascular (CV) disease outcomes. Gender differences exist in both the perception of stress and the magnitude of the stress response. We hypothesize that self-perceived psychological stressors would have a greater impact on women compared to men as measured by the American Heart Association Life’s Simple Seven (LS7) health metrics. Methods: This was a cross-sectional study conducted among employees of BHSF. The LS7 metrics (smoking, physical activity, diet, body mass index, blood pressure, cholesterol and glucose) were each scored as ideal (2), intermediate (1), or poor (0), with composite scores ranging from 0 to 14. Total scores were categorized as optimal (11-14), average (9-10) and inadequate (0-8). We used multinomial logistic regression to compare psychological factors obtained by questionnaire (self-perceived stress, life satisfaction, hopelessness, sadness, depression, anxiety) with the LS7 score (inadequate score served as reference). The model was stratified by gender and adjusted for age, ethnicity, and education level. Results: Of the 9,056 participants, 74% were female, 17% white, 57% Hispanic, 16% black, with a mean age of 43±12 years. Self-perceived adverse psychological factors were associated with being less likely to achieve adequate and optimal LS7 scores (Table). For example both women and men, respectively, with self-perceived stress were less likely to have optimal LS7 metrics [OR 0.47 (95% CI 0.40-0.56) vs. 0.50 (0.36-0.69)]. There were some interactions by gender (P 〈 0.05), but the results were qualitatively similar in both men and women. Conclusions: In an ethnically diverse population, participants with negative self-perceived psychological factors are more likely to have inadequate CV health as measured by LS7. Contrary to our hypothesis, in general, men and women were similarly affected by adverse psychological factors. Addressing psychological stressors may be one mechanism to improve CV health.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.135.suppl_1.p332
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
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  • 16
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    Abstract 13639: The Impact of Income Level on All-Cause and Cardiovascular Mortality Across the Spectrum of Cardiovascular Health & Disease Among Adults in the United States
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation Vol. 144, No. Suppl_1 ( 2021-11-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_1 ( 2021-11-16)
    Abstract: Introduction: There is increasing interest in the role of income level as a social determinant of health for cardiovascular disease (CVD). In this study we examine the interplay of household income, all-cause mortality, and CVD mortality in a representative US adult population. Methods: We used National Health Interview Survey data from 2006-2014 including adults ≥18 years. Mortality data with follow-up till December 2015 was derived from the National Death Index. We evaluated age-adjusted all-cause, CVD and non-CVD mortality rates across income levels (lowest, low, middle, and high; defined based on based on the percentage of family income relative to the federal poverty level), among people with and without ASCVD at baseline. We further classified participants without ASCVD as having optimal (0-1 risk factors), average (2-3), and poor ( 〉 3) cardiovascular risk factor (CRF) profile. Cox regression models were used to evaluate the association between income and mortality. Results: The analysis included 256,991 adults, representing ~230 million adults annually. Mean age was 46.3 (SD=17.7), 52% were women, 13% NHB, and 8% had ASCVD. Overall, 18% were in the lowest income category compared to 39% in highest group. During the 10 years of follow up, participants with highest income and optimal CVH had the lowest all-cause and cause-specific mortality rates, whereas those with lowest income and poor CVH had the highest rates (Figure). Additionally, multivariate adjustment for demographics and CRF, lower income was associated with increased all-cause mortality (lowest/low vs middle/high income, HR: 1.22; 95% CI: 1.11-1.35 CVD vs non-CVD HR: 1.24, 95% CI: 1.16-1.33) and CVD mortality (lowest/low vs middle/high income: HR: 1.29, 95% CI: 1.07-1.56 CVD vs non-CVD HR: 1.44, 95% CI: 1.23-1.67). Conclusions: In a US representative population, lower income adults were consistently associated with increased risk of all-cause and CVD mortality irrespective of baseline CVD status.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.144.suppl_1.13639
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 17
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    Abstract 60: Impact of a Multisite, Protocol-Driven, Nurse Practitioner-Led, Cardiovascular Prevention Program in a Hispanic Medicare Advantage Population at High Risk for ASCVD: Healthy Heart Program at Cano Health.
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Circulation Vol. 147, No. Suppl_1 ( 2023-02-28)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 147, No. Suppl_1 ( 2023-02-28)
    Abstract: Introduction: Despite availability of effective and inexpensive pharmacologic therapies for hypercholesterolemia and hypertension, many patients at high risk for atherosclerotic cardiovascular disease (ASCVD) do not achieve optimal low-density lipoprotein (LDL) and systolic blood pressure (SBP) levels. We hypothesized that risk factor control could be improved by using nurse practitioners and a guideline-directed protocol in a Medicare Advantage (MA) population. Methods: We designed and implemented an ongoing 18 site, multistate (FL, TX, NV), ASCVD risk assessment and management program (Healthy Heart) in a large national MA primary care clinic (Cano Health). The cardiometabolic risk assessment and management program was designed by a team of preventive cardiologists, with the plan of being Nurse Practitioner (NP)-led, with remote support by a cardiologist. Protocols provided details on initiation and titration of drug therapy to achieve LDL-C and SBP goals. Patients with organ transplants, advanced cancer, an ejection fraction 〈 35%, and on hemodialysis were excluded. Results: From October 2021-October 2022, 5430 patients were enrolled in the program. A total of 1858 (34.2%) had established ASCVD, 1033 (19.0%) had diabetes mellitus (DM). A total of 713 (13.1%) had both ASCVD and DM. In patients who had ASCVD and diabetes together, high intensity statin use increased from 39.4% to 68.3% after enrollment; 52.66% achieved an LDL-C 〈 70 mg/dl after enrollment compared to 31.0% at baseline. Antihypertensive medications were intensified in 408/1041 (39.2%) of ASCVD and 276/558 (49.5%) of DM patients, with a higher proportion achieving a SBP 〈 130 mm Hg after enrollment. Conclusions: Implementing a novel cardiovascular prevention program in a population of mostly Hispanic MA patients at high risk for ASCVD, using NPs, with strict adherence to a step-by-step evidence-based protocol supervised by cardiologists, is associated with reduction in LDL levels and SBP and with improvement in reaching LDL and SBP targets.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.147.suppl_1.60
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
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  • 18
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    Abstract P107: Utilization of Statins in Patients With versus Without Cancer and Atherosclerotic Cardiovascular Disease
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Circulation Vol. 147, No. Suppl_1 ( 2023-02-28)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 147, No. Suppl_1 ( 2023-02-28)
    Abstract: Background: Patients with cancer and concomitant atherosclerotic cardiovascular disease (ASCVD) have an increased risk of cardiovascular mortality compared with general population. Accordingly, optimal utilization of statins remains crucial to curtail adverse cardiovascular events in this high-risk cohort. We sought to compare the demographic burden and utilization of statins in ASCVD patients with cancer versus without cancer. Methods: Houston Methodist Learning Health System Outpatient Registry is an EMR-linked registry which was queried for adult patients with established ASCVD (2016-2022). International Classification of Diseases 10 th Revision Clinical Modification codes (ICD 10-CM) were utilized to ascertain ASCVD and cancer diagnosis. ATC codes were used to identify statin use and dose in the database, and this information was recorded based on medication reconciliation reviews with patients during every clinical encounter. Results: A total of 97,819 patients with ASCVD were included in this analysis of which 16,926 patients (17.3%) had a concurrent cancer diagnosis. Patients with ASCVD and cancer reported lower utilization of any statin (69.6% vs 71.2%) and high-intensity statin (33.2% vs 37.6%) compared with patients without cancer. Consistent results were observed across gender, age and racial strata with the exception of Hispanics and NHB, where ASCVD patients with cancer reported increased utilization of any statin compared with patients without cancer. Interestingly, patients with ASCVD and cancer were more likely to have LDL 〈 70mg/dL compared with ASCVD patients without cancer (41.1% vs 36.2%) across gender, age and racial strata. Conclusion: Albeit higher risk of adverse cardiovascular events, utilization of statins, particularly high-intensity statins remains suboptimal in cancer patients with established ASCVD. Considering the underlying cardiovascular risk patients with cancer and concomitant ASCVD may derive the greatest benefit from intensive LDL-C lowering therapies.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.147.suppl_1.P107
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
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  • 19
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    Abstract P199: Keep Moving, Your Health Depends On It: Impact Of Improved Physical Activity And Weight Loss In A Wellness Program
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Circulation Vol. 129, No. suppl_1 ( 2014-03-25)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 129, No. suppl_1 ( 2014-03-25)
    Abstract: Negative impact of CVD as the leading cause of death in the US is worsened by the significant burden of obesity and associated morbidity and concerns about the growing population inactivity. The American Heart Association has emphasized worksite-based interventions to improve CV health. We evaluated the benefits of improved physical activity(PA) and weight loss(WL) among employees of the Baptist Health South Florida enrolled in a wellness intervention program. Methods: Employees with two or more Cardio-metabolic risk factors , such as total cholesterol ≥ 200 mg/dl, systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, hemoglobin A1C ≥ 6.5%, and body mass index (BMI) ≥ 30 were enrolled in an intervention program themed “My unlimited potential”. Interventions were focused on diet and PA modifications. We defined improved physical activity as the difference in the metabolic equivalents (METs) at 12 weeks follow-up and at baseline. WL (lbs) was the difference in weight at follow-up. The relationship between WL and changes in METs was explored in an ordered logistic regression. Results: Overall 203 (48±10 years, 78% females) employees were enrolled with a retention rate of 89% (n=181) at 12 weeks follow-up. At baseline the median weights was 211 lbs., and mean METs- 8.6, while at follow-up the median weight was 200 lbs, and the mean METs 11. At 12 weeks follow up 38% had significant WL (lost 〉 5% of baseline weight). The median WL was 8.4 (IQR 4.8-13.0) lbs and the mean change in METs was 2.4±1.8. Median WL increased with increasing tertiles of METs change; tertile1- 6.5(4-11) lbs., tertile2- 9(6-13)lbs. tertile3- 11(7-15)lbs. Increased PA was related to increased WL across BMI categories adjusting for age, gender and baseline weight. Conclusion: This study points strongly toward the benefit of increasing PA among other lifestyle modification interventions in controlling weight. Although further follow-up of this population to evaluate sustainability of change is needed, our results clearly relate improved PA and health.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.129.suppl_1.p199
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
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  • 20
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    Abstract 25: Favorable Modifiable Cardiovascular Risk Profile is Associated with Lower Healthcare Costs: The 2012 Medical Expenditure Panel Survey
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Circulation Vol. 133, No. suppl_1 ( 2016-03)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 133, No. suppl_1 ( 2016-03)
    Abstract: Background: The AHA’s 2020 Strategic Goals emphasize the value of favorable modifiable risk factor (MRF) profile to reduce the burden of CVD morbidity and mortality. In this study we aimed to quantify the overall and incremental impact of MRF on health care expenditure in the U.S among those with and without CVD. Methods: The study population was derived from the 2012 Medical Expenditure Panel Survey (MEPS), a nationally representative adult sample (≥ 40 years). Direct costs were calculated for all-cause health care resource utilization. Variables of interest included CVD diagnoses (coronary artery disease, stroke, peripheral artery disease, dysrhythmias or heart failure), ascertained by ICD-9-CM codes, and MRF (hypertension, diabetes mellitus, hypercholesterolemia, smoking, physical activity and/or obesity). Two-part econometric models were utilized to study cost data; a generalized linear model with gamma distribution and link log was used to assess expenditures, taking into consideration the survey’s complex design. Results: The final study sample consisted of 15,651 MEPS participants (57 ± 12 years, 52% female). Overall, 6,231 (39%) had 0-1, 7,429 (49%) had 2-3, and 1,991 (12%) had ≥ 4 MRF, translating to 55.5, 69.9 and 17.9 million adults ≥ 40 years in U.S, respectively. Generally, there was a direct decrease in health expenditures with favorable MRF across CVD status (Table). These differences persisted after taking into account demographics, insurance status and comorbid conditions. Among those without established CVD, the average medical expenditure was $4,013 (95% CI 5,117, 2,910) and $2,696 (95% CI 4,416, 977) lower for those with 0-1 & 2-3 MRF, as compared to those with ≥ 4 MRF. Conclusion: Favorable MRF profile is associated with significantly lower medical expenditure among individuals with and without established CVD. Our study provides robust estimates for potential healthcare savings with nationwide policies focusing on preventing and managing modifiable CV risk factors.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.133.suppl_1.25
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
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