2019
Financial barriers in accessing medical care for peripheral artery disease are associated with delay of presentation and adverse health status outcomes in the United States
Jelani QU, Jhamnani S, Spatz ES, Spertus J, Smolderen KG, Wang J, Desai NR, Jones P, Gosch K, Shah S, Attaran R, Mena-Hurtado C. Financial barriers in accessing medical care for peripheral artery disease are associated with delay of presentation and adverse health status outcomes in the United States. Vascular Medicine 2019, 25: 13-24. PMID: 31603393, DOI: 10.1177/1358863x19872542.Peer-Reviewed Original ResearchMeSH KeywordsAgedFemaleHealth Care CostsHealth Services AccessibilityHealth Status DisparitiesHealthcare DisparitiesHumansInsurance, HealthMaleMedically UninsuredMiddle AgedPatient Reported Outcome MeasuresPeripheral Arterial DiseaseProspective StudiesQuality of LifeRisk FactorsTime FactorsTime-to-TreatmentUnited StatesConceptsPeripheral artery diseasePeripheral Artery QuestionnaireHealth status outcomesHealth statusArtery diseaseStatus outcomesFinancial barriersGeneral health-related qualityDisease-specific health statusPatient-reported health statusDelay of presentationPatient-reported difficultyVascular specialty clinicsPeripheral arterial diseaseEuroQol-5 DimensionsHealth-related qualityPoor health statusUnited States patientsMulticenter registryMultivariable adjustmentPAD symptomsArterial diseaseTreatment patternsUS patientsLate presentationEffects of Mobile Text Messaging on Glycemic Control in Patients With Coronary Heart Disease and Diabetes Mellitus
Huo X, Krumholz HM, Bai X, Spatz ES, Ding Q, Horak P, Zhao W, Gong Q, Zhang H, Yan X, Sun Y, Liu J, Wu X, Guan W, Wang X, Li J, Li X, Spertus JA, Masoudi FA, Zheng X. Effects of Mobile Text Messaging on Glycemic Control in Patients With Coronary Heart Disease and Diabetes Mellitus. Circulation Cardiovascular Quality And Outcomes 2019, 12: e005805. PMID: 31474119, DOI: 10.1161/circoutcomes.119.005805.Peer-Reviewed Original ResearchMeSH KeywordsAgedAsian PeopleBiomarkersBlood GlucoseChinaCoronary DiseaseCulturally Competent CareDiabetes MellitusExerciseFemaleGlycated HemoglobinHealth CommunicationHealthy LifestyleHumansHypoglycemic AgentsMaleMedication AdherenceMiddle AgedMotivationPatient Education as TopicRisk Reduction BehaviorSelf CareSingle-Blind MethodTelemedicineText MessagingTime FactorsTreatment OutcomeConceptsCoronary heart diseaseHeart diseaseGlycemic controlIntervention groupUsual careDiabetes mellitusBlood glucosePhysical activityControl groupText message-based interventionBlood pressure controlProportion of patientsRisk factor managementGood glycemic controlSystolic blood pressureBody mass indexText messaging programsText message interventionMobile health interventionsSecondary outcomesBlood pressurePrimary outcomeLDL cholesterolMass indexMedication adherenceAssociation of Diabetes Mellitus With Health Status Outcomes in Young Women and Men After Acute Myocardial Infarction: Results From the VIRGO Study
Ding Q, Funk M, Spatz ES, Whittemore R, Lin H, Lipska KJ, Dreyer RP, Spertus JA, Krumholz HM. Association of Diabetes Mellitus With Health Status Outcomes in Young Women and Men After Acute Myocardial Infarction: Results From the VIRGO Study. Journal Of The American Heart Association 2019, 8: e010988. PMID: 31441351, PMCID: PMC6755841, DOI: 10.1161/jaha.118.010988.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAge FactorsDiabetes MellitusFemaleHealth StatusHealth Status IndicatorsHumansMaleMental HealthMiddle AgedMyocardial InfarctionPatient Reported Outcome MeasuresPredictive Value of TestsPrevalencePrognosisQuality of LifeRecovery of FunctionRisk AssessmentRisk FactorsSex FactorsSpainTime FactorsUnited StatesYoung AdultConceptsAcute myocardial infarctionEuroQol visual analogue scaleSeattle Angina QuestionnaireDiabetes mellitusForm Health SurveyHealth status outcomesHealth statusVIRGO StudyAnalog scaleMyocardial infarctionHealth SurveyStatus outcomesYoung adultsSAQ angina frequencyCardiovascular risk factorsHealth status scoresRisk of mortalityWorse health statusPoor health statusQuality of lifeWorse anginaAngina QuestionnaireClinical characteristicsHealthcare useStatus scoreEffect of Text Messaging on Risk Factor Management in Patients With Coronary Heart Disease
Zheng X, Spatz ES, Bai X, Huo X, Ding Q, Horak P, Wu X, Guan W, Chow CK, Yan X, Sun Y, Wang X, Zhang H, Liu J, Li J, Li X, Spertus JA, Masoudi FA, Krumholz HM. Effect of Text Messaging on Risk Factor Management in Patients With Coronary Heart Disease. Circulation Cardiovascular Quality And Outcomes 2019, 12: e005616. PMID: 30998400, DOI: 10.1161/circoutcomes.119.005616.Peer-Reviewed Original ResearchMeSH KeywordsAgedAsian PeopleBlood PressureChinaCoronary DiseaseCulturally Competent CareFemaleHealth Knowledge, Attitudes, PracticeHumansMaleMiddle AgedPatient Education as TopicRisk AssessmentRisk FactorsSecondary PreventionSingle-Blind MethodTelemedicineText MessagingTime FactorsTreatment OutcomeConceptsCoronary heart diseaseSystolic blood pressureBody mass indexBlood pressureHeart diseaseSecondary preventionIntervention groupPhysical activityEnd pointSmoking statusMass indexControl groupPrimary end pointRisk factor controlSecondary end pointsRisk factor managementLDL-C levelsDisease-specific knowledgeMobile phone textMobile health technologyUsual careDiabetes mellitusMedication adherenceRisk factorsFactor management
2018
Admission diagnoses among patients with heart failure: Variation by ACO performance on a measure of risk-standardized acute admission rates
Benchetrit L, Zimmerman C, Bao H, Dharmarajan K, Altaf F, Herrin J, Lin Z, Krumholz HM, Drye EE, Lipska KJ, Spatz ES. Admission diagnoses among patients with heart failure: Variation by ACO performance on a measure of risk-standardized acute admission rates. American Heart Journal 2018, 207: 19-26. PMID: 30404047, DOI: 10.1016/j.ahj.2018.09.006.Peer-Reviewed Original ResearchMeSH KeywordsAccountable Care OrganizationsAgedAlgorithmsAnalysis of VarianceCardiovascular DiseasesComorbidityFemaleHeart FailureHospitalizationHumansInternational Classification of DiseasesMaleMedicare Part AMedicare Part BPatient AdmissionPatient DischargePatient-Centered CareSex DistributionTime FactorsUnited StatesConceptsHeart failureAccountable care organizationsMean admission rateAdmission ratesAdmission typeAcute admission ratesNoncardiovascular conditionsAdmission diagnosisCause admission ratesMedicare Shared Savings Program Accountable Care OrganizationsRate of hospitalizationPrincipal discharge diagnosisProportion of admissionsType of admissionNoncardiovascular causesHF admissionsHF patientsPerson yearsDischarge diagnosisPatient populationPatientsAdmissionKey quality metricDiagnosisSubstantial proportionHeart Failure After Ischemic Stroke or Transient Ischemic Attack in Insulin-Resistant Patients Without Diabetes Mellitus Treated With Pioglitazone
Young LH, Viscoli CM, Schwartz GG, Inzucchi SE, Curtis JP, Gorman MJ, Furie KL, Conwit R, Spatz E, Lovejoy A, Abbott JD, Jacoby DL, Kolansky DM, Ling FS, Pfau SE, Kernan WN. Heart Failure After Ischemic Stroke or Transient Ischemic Attack in Insulin-Resistant Patients Without Diabetes Mellitus Treated With Pioglitazone. Circulation 2018, 138: 1210-1220. PMID: 29934374, PMCID: PMC6202153, DOI: 10.1161/circulationaha.118.034763.Peer-Reviewed Original ResearchConceptsRisk of HFTransient ischemic attackEffect of pioglitazoneHF riskHeart failureInsulin-resistant patientsMyocardial infarctionIschemic attackCardiovascular benefitsIschemic strokeDiabetes mellitusInsulin resistanceHigher C-reactive proteinComposite of strokeHF risk scoreHigher HF riskDrug dose reductionHospitalized heart failureIncident myocardial infarctionLower mean doseC-reactive proteinBaseline patient featuresHF hospitalizationCardiovascular eventsPlacebo groupPresentation, Clinical Profile, and Prognosis of Young Patients With Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): Results From the VIRGO Study
Safdar B, Spatz ES, Dreyer RP, Beltrame JF, Lichtman JH, Spertus JA, Reynolds HR, Geda M, Bueno H, Dziura JD, Krumholz HM, D'Onofrio G. Presentation, Clinical Profile, and Prognosis of Young Patients With Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): Results From the VIRGO Study. Journal Of The American Heart Association 2018, 7: e009174. PMID: 29954744, PMCID: PMC6064896, DOI: 10.1161/jaha.118.009174.Peer-Reviewed Original ResearchConceptsMI-CAD patientsNonobstructive coronary arteriesMI-CADYounger patientsClinical profileCoronary arteryMyocardial infarctionTraditional cardiac risk factorsAcute myocardial infarction patientsCardiac risk factorsGestational diabetes mellitusMyocardial infarction patientsTimes higher oddsMINOCA patientsSAQ qualityVIRGO StudyClinical characteristicsHypercoaguable stateDiabetes mellitusObstructive diseaseClinical outcomesInfarction patientsRisk factorsMINOCAPsychosocial statusLife's Simple 7 and the risk of atrial fibrillation: The Multi-Ethnic Study of Atherosclerosis
Ogunmoroti O, Michos ED, Aronis KN, Salami JA, Blankstein R, Virani SS, Spatz ES, Allen NB, Rana JS, Blumenthal RS, Veledar E, Szklo M, Blaha MJ, Nasir K. Life's Simple 7 and the risk of atrial fibrillation: The Multi-Ethnic Study of Atherosclerosis. Atherosclerosis 2018, 275: 174-181. PMID: 29920438, DOI: 10.1016/j.atherosclerosis.2018.05.050.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAtrial FibrillationBlood GlucoseBlood PressureBody Mass IndexDiet, HealthyExerciseFemaleHealth StatusHealthy LifestyleHumansIncidenceLipidsMaleMiddle AgedPrimary PreventionProspective StudiesProtective FactorsRisk AssessmentRisk FactorsRisk Reduction BehaviorSmokingTime FactorsUnited StatesConceptsAtrial fibrillationMulti-Ethnic StudyRace/ethnicityHazard ratioOverall cohortSimple 7Cardiovascular healthCardiovascular diseaseLower riskAmerican Heart Association's LifeBurden of AFFirst AF episodeSimple 7 (LS7) metricsIdeal cardiovascular healthProportional hazard ratiosProspective cohort studyLife's Simple 7Hospital discharge recordsICD-9 codesLS7 metricsCohort studyIncidence rateAF episodesInadequate scoresAssociation's LifeSex Differences in Omega‐3 and ‐6 Fatty Acids and Health Status Among Young Adults With Acute Myocardial Infarction: Results From the VIRGO Study
Lu Y, Ding Q, Xu X, Spatz ES, Dreyer RP, D'Onofrio G, Caulfield M, Nasir K, Spertus JA, Krumholz HM. Sex Differences in Omega‐3 and ‐6 Fatty Acids and Health Status Among Young Adults With Acute Myocardial Infarction: Results From the VIRGO Study. Journal Of The American Heart Association 2018, 7: e008189. PMID: 29848494, PMCID: PMC6015388, DOI: 10.1161/jaha.117.008189.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionHealth status scoresArachidonic acidVIRGO StudyStatus scoreMyocardial infarctionHealth statusPoorer health status outcomesYoung menPatient-reported health statusYoung womenOmega-3 fatty acidsSex differencesPatient-reported outcomesFatty acidsHealth status outcomesCardiovascular outcomesClinical characteristicsAdjusted analysisAMI patientsRisk factorsUS adultsStatus outcomesOmega-3Women 1Favorable Modifiable Cardiovascular Risk Profile Is Associated With Lower Healthcare Costs Among Cancer Patients: The 2012–2013 Medical Expenditure Panel Survey
Singh J, Valero‐Elizondo J, Salami JA, Warraich HJ, Ogunmoroti O, Spatz ES, Desai N, Rana JS, Virani SS, Blankstein R, Blaha MJ, Nasir K. Favorable Modifiable Cardiovascular Risk Profile Is Associated With Lower Healthcare Costs Among Cancer Patients: The 2012–2013 Medical Expenditure Panel Survey. Journal Of The American Heart Association 2018, 7: e007874. PMID: 29686026, PMCID: PMC6015292, DOI: 10.1161/jaha.117.007874.Peer-Reviewed Original ResearchConceptsAtherosclerotic cardiovascular diseaseAbsence of ASCVDCancer patientsMedical Expenditure PanelCRF profileRepresentative US adult populationHealthcare expendituresCardiovascular risk profileRisk factor profileBurden of cancerMean annual costAnnual healthcare expendituresMedical Expenditure Panel SurveyUS adult populationLower medical expendituresYears of ageLower healthcare costsCardiovascular managementCardiovascular diseaseHigh prevalenceRepresentative adult sampleUS adultsTwo-part econometric modelHealthcare costsEconomic burdenTraditional Chinese Medicine for Acute Myocardial Infarction in Western Medicine Hospitals in China
Spatz ES, Wang Y, Beckman AL, Wu X, Lu Y, Du X, Li J, Xu X, Davidson PM, Masoudi FA, Spertus JA, Krumholz HM, Jiang L. Traditional Chinese Medicine for Acute Myocardial Infarction in Western Medicine Hospitals in China. Circulation Cardiovascular Quality And Outcomes 2018, 11: e004190. PMID: 29848478, PMCID: PMC5882246, DOI: 10.1161/circoutcomes.117.004190.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionTraditional Chinese medicineTCM useWestern Medicine HospitalMyocardial infarctionHospital bleedingMedicine HospitalChinese medicineCardiovascular risk factorsHospital-level factorsHours of hospitalizationMultivariable hierarchical modelsQuality of careLack of evidenceChart reviewChina PatientRetrospective studySecondary hospitalsEarly managementRisk factorsIntravenous useCardiovascular diseasePatientsSignificant associationHospitalSex Differences in Timeliness of Reperfusion in Young Patients With ST‐Segment–Elevation Myocardial Infarction by Initial Electrocardiographic Characteristics
Gupta A, Barrabes JA, Strait K, Bueno H, Porta‐Sánchez A, Acosta‐Vélez J, Lidón R, Spatz E, Geda M, Dreyer RP, Lorenze N, Lichtman J, D'Onofrio G, Krumholz HM. Sex Differences in Timeliness of Reperfusion in Young Patients With ST‐Segment–Elevation Myocardial Infarction by Initial Electrocardiographic Characteristics. Journal Of The American Heart Association 2018, 7: e007021. PMID: 29514807, PMCID: PMC5907538, DOI: 10.1161/jaha.117.007021.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAge of OnsetElectrocardiographyFemaleHealthcare DisparitiesHumansMaleMiddle AgedMyocardial ReperfusionPredictive Value of TestsProspective StudiesRisk AssessmentRisk FactorsSex FactorsSpainST Elevation Myocardial InfarctionTime FactorsTime-to-TreatmentTreatment OutcomeUnited StatesYoung AdultConceptsST-segment elevation myocardial infarctionElectrocardiographic characteristicsMyocardial infarctionReperfusion delayYounger patientsVentricular hypertrophyST elevationPrehospital ECGLateral leadsMultivariable logistic regression modelTimeliness of reperfusionVoltage criteriaElevation myocardial infarctionLeft ventricular hypertrophyAcute myocardial infarctionYears of ageLogistic regression modelsSex differencesClinical characteristicsCohort studyElectrocardiographic correlatesMultivariable analysisFemale sexSpanish hospitalsReperfusion guidelinesComparison of Prevalence, Awareness, Treatment, and Control of Cardiovascular Risk Factors in China and the United States
Lu Y, Wang P, Zhou T, Lu J, Spatz ES, Nasir K, Jiang L, Krumholz HM. Comparison of Prevalence, Awareness, Treatment, and Control of Cardiovascular Risk Factors in China and the United States. Journal Of The American Heart Association 2018, 7: e007462. PMID: 29374046, PMCID: PMC5850247, DOI: 10.1161/jaha.117.007462.Peer-Reviewed Original ResearchMeSH KeywordsAgedAntihypertensive AgentsAttitude of Health PersonnelBlood GlucoseBlood PressureBody Mass IndexCardiovascular DiseasesChinaDiabetes MellitusDyslipidemiasFemaleHealth Knowledge, Attitudes, PracticeHealth Status DisparitiesHumansHypertensionHypolipidemic AgentsLipidsLongitudinal StudiesMaleMiddle AgedNutrition SurveysObesityPractice Patterns, Physicians'PrevalencePrognosisRisk AssessmentRisk FactorsTime FactorsUnited StatesWaist CircumferenceConceptsHigher stroke prevalenceCardiovascular risk factorsHigh-sensitivity C-reactive proteinBody mass indexC-reactive proteinRisk factorsBlood pressureWaist circumferenceMass indexStroke prevalenceCardiovascular risk factor profileHigher mean blood pressureControl of hypertensionMean blood pressureBlood pressure levelsRisk factor profileComparison of prevalenceRepresentative population sampleLower ratesDyslipidemia awarenessSevere hypertensionHemoglobin A1cHypertension treatmentControl ratePlasma glucoseNational Trends in Nonstatin Use and Expenditures Among the US Adult Population From 2002 to 2013: Insights From Medical Expenditure Panel Survey
Salami JA, Warraich HJ, Valero‐Elizondo J, Spatz ES, Desai NR, Rana JS, Virani SS, Blankstein R, Khera A, Blaha MJ, Blumenthal RS, Katzen BT, Lloyd‐Jones D, Krumholz HM, Nasir K. National Trends in Nonstatin Use and Expenditures Among the US Adult Population From 2002 to 2013: Insights From Medical Expenditure Panel Survey. Journal Of The American Heart Association 2018, 7: e007132. PMID: 29358195, PMCID: PMC5850149, DOI: 10.1161/jaha.117.007132.Peer-Reviewed Original ResearchAdultAgedAtherosclerosisDatabases, FactualDrug CostsDrug PrescriptionsDyslipidemiasFemaleHealth Care SurveysHealth ExpendituresHealthcare DisparitiesHumansHydroxymethylglutaryl-CoA Reductase InhibitorsHypolipidemic AgentsLongitudinal StudiesMaleMedically UninsuredMiddle AgedPractice Patterns, Physicians'Racial GroupsRetrospective StudiesRisk FactorsSex FactorsSocioeconomic FactorsTime FactorsTreatment OutcomeUnited States
2017
Persistent socioeconomic disparities in cardiovascular risk factors and health in the United States: Medical Expenditure Panel Survey 2002–2013
Valero-Elizondo J, Hong JC, Spatz ES, Salami JA, Desai NR, Rana JS, Khera R, Virani SS, Blankstein R, Blaha MJ, Nasir K. Persistent socioeconomic disparities in cardiovascular risk factors and health in the United States: Medical Expenditure Panel Survey 2002–2013. Atherosclerosis 2017, 269: 301-305. PMID: 29254694, DOI: 10.1016/j.atherosclerosis.2017.12.014.Peer-Reviewed Original ResearchConceptsCardiovascular diseaseSocioeconomic statusWorse cardiovascular risk factor profileCardiovascular risk factor profileHighest prevalence increasePrevalence of CRFCardiovascular risk factorsRisk factor profileHealthy lifestyle behaviorsMedical Expenditure Panel Survey 2002Medical Expenditure Panel SurveyHealth disparity gapRelative percent increasePhysical inactivityLifestyle behaviorsRisk factorsPrevalence increasesHigh burdenHigh prevalenceLow-income groupsProportion of individualsUS adultsFactor profileDisparity gapSocioeconomic disparitiesHome Health Agency Performance in the United States: 2011–15
Wang Y, Spatz ES, Tariq M, Angraal S, Krumholz HM. Home Health Agency Performance in the United States: 2011–15. Journal Of The American Geriatrics Society 2017, 65: 2572-2579. PMID: 28960228, PMCID: PMC5729079, DOI: 10.1111/jgs.14987.Peer-Reviewed Original ResearchLife's Simple 7 and Incident Heart Failure: The Multi‐Ethnic Study of Atherosclerosis
Ogunmoroti O, Oni E, Michos ED, Spatz ES, Allen NB, Rana JS, Virani SS, Blankstein R, Aronis KN, Blumenthal RS, Veledar E, Szklo M, Blaha MJ, Nasir K. Life's Simple 7 and Incident Heart Failure: The Multi‐Ethnic Study of Atherosclerosis. Journal Of The American Heart Association 2017, 6: e005180. PMID: 28655734, PMCID: PMC5669160, DOI: 10.1161/jaha.116.005180.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBiomarkersBlood GlucoseBlood PressureBody Mass IndexCholesterolDiet, HealthyExerciseFemaleHealthy LifestyleHeart FailureHumansIncidenceKaplan-Meier EstimateMaleMiddle AgedPrognosisProtective FactorsRisk FactorsRisk Reduction BehaviorSmoking CessationTime FactorsUnited StatesConceptsSimple 7 (LS7) metricsIncident heart failureHeart failureMulti-Ethnic StudyLS7 metricsHazard ratioSimple 7Cardiovascular healthBurden of HFLife's Simple 7 (LS7) metricsIncidence of HFIdeal cardiovascular healthProportional hazard ratiosLife's Simple 7American Heart AssociationRace/ethnicityLS7 scoreHeart AssociationIncidence rateCardiovascular diseaseMultiethnic cohortLower riskInadequate scoresIdeal metricsAtherosclerosisOutcomes after observation stays among older adult Medicare beneficiaries in the USA: retrospective cohort study
Dharmarajan K, Qin L, Bierlein M, Choi JES, Lin Z, Desai NR, Spatz ES, Krumholz HM, Venkatesh AK. Outcomes after observation stays among older adult Medicare beneficiaries in the USA: retrospective cohort study. The BMJ 2017, 357: j2616. PMID: 28634181, PMCID: PMC5476173, DOI: 10.1136/bmj.j2616.Peer-Reviewed Original ResearchYoung Women With Acute Myocardial Infarction
Dreyer RP, Sciria C, Spatz ES, Safdar B, D'Onofrio G, Krumholz HM. Young Women With Acute Myocardial Infarction. Circulation Cardiovascular Quality And Outcomes 2017, 10: e003480. PMID: 28228455, PMCID: PMC5502480, DOI: 10.1161/circoutcomes.116.003480.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionYoung womenMyocardial infarctionManagement of AMIPost-AMI periodContinuum of careCoronary diseaseAged menHigh riskWorse recoveryWomenInfarctionHighlight gapsRecent studiesDifferent mechanismsMorbidityHospitalMortalityEpidemiologyPublic awarenessDiseaseDiagnosisCareFavorable cardiovascular risk factor profile is associated with lower healthcare expenditure and resource utilization among adults with diabetes mellitus free of established cardiovascular disease: 2012 Medical Expenditure Panel Survey (MEPS)
Feldman DI, Valero-Elizondo J, Salami JA, Rana JS, Ogunmoroti O, Osondu CU, Spatz ES, Virani SS, Blankstein R, Blaha MJ, Veledar E, Nasir K. Favorable cardiovascular risk factor profile is associated with lower healthcare expenditure and resource utilization among adults with diabetes mellitus free of established cardiovascular disease: 2012 Medical Expenditure Panel Survey (MEPS). Atherosclerosis 2017, 258: 79-83. PMID: 28214425, DOI: 10.1016/j.atherosclerosis.2017.02.004.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedCardiovascular DiseasesCost SavingsDiabetes ComplicationsDiabetes MellitusFemaleHealth Care CostsHealth Care SurveysHealth ExpendituresHealth ResourcesHumansLogistic ModelsMaleMiddle AgedModels, EconomicOdds RatioProcess Assessment, Health CareRisk AssessmentRisk FactorsTime FactorsTreatment OutcomeUnited StatesYoung AdultConceptsFavorable cardiovascular risk factor profileCardiovascular risk factor profileRisk factor profileDiabetes mellitusMedical Expenditure Panel SurveyLower healthcare expendituresCardiovascular diseaseCRF profileDM statusHealthcare expendituresFactor profileCVD-free individualsMean annual expenditureLifestyle modificationMean ageIndividualized prescriptionTwo-part econometric modelEconomic burdenTherapeutic treatmentMellitusDiseaseCost dataAnnual expenditureIndividualsResource utilization