Featured Publications
Multinational patterns of second line antihyperglycaemic drug initiation across cardiovascular risk groups: federated pharmacoepidemiological evaluation in LEGEND-T2DM
Khera R, Dhingra L, Aminorroaya A, Li K, Zhou J, Arshad F, Blacketer C, Bowring M, Bu F, Cook M, Dorr D, Duarte-Salles T, DuVall S, Falconer T, French T, Hanchrow E, Horban S, Lau W, Li J, Liu Y, Lu Y, Man K, Matheny M, Mathioudakis N, McLemore M, Minty E, Morales D, Nagy P, Nishimura A, Ostropolets A, Pistillo A, Posada J, Pratt N, Reyes C, Ross J, Seager S, Shah N, Simon K, Wan E, Yang J, Yin C, You S, Schuemie M, Ryan P, Hripcsak G, Krumholz H, Suchard M. Multinational patterns of second line antihyperglycaemic drug initiation across cardiovascular risk groups: federated pharmacoepidemiological evaluation in LEGEND-T2DM. BMJ Medicine 2023, 2: e000651. PMID: 37829182, PMCID: PMC10565313, DOI: 10.1136/bmjmed-2023-000651.Peer-Reviewed Original ResearchType 2 diabetes mellitusSecond-line treatmentCardiovascular risk groupsDiabetes mellitusCardiovascular diseaseAntihyperglycaemic drugsLine treatmentRisk groupsObservational Health Data SciencesGlucagon-like peptide-1 receptor agonistsElectronic health recordsSodium-glucose cotransporter 2 inhibitorsCalendar year trendsPeptide-1 receptor agonistsUS databaseOutcomes of patientsCotransporter 2 inhibitorsAdministrative claims databaseSecond-line drugsHealth recordsSodium-glucose cotransporter-2 inhibitorsMedication useMetformin monotherapyGuideline recommendationsOutcome measures
2024
Comparative Effectiveness of Second-Line Antihyperglycemic Agents for Cardiovascular Outcomes A Multinational, Federated Analysis of LEGEND-T2DM
Khera R, Aminorroaya A, Dhingra L, Thangaraj P, Pedroso Camargos A, Bu F, Ding X, Nishimura A, Anand T, Arshad F, Blacketer C, Chai Y, Chattopadhyay S, Cook M, Dorr D, Duarte-Salles T, DuVall S, Falconer T, French T, Hanchrow E, Kaur G, Lau W, Li J, Li K, Liu Y, Lu Y, Man K, Matheny M, Mathioudakis N, McLeggon J, McLemore M, Minty E, Morales D, Nagy P, Ostropolets A, Pistillo A, Phan T, Pratt N, Reyes C, Richter L, Ross J, Ruan E, Seager S, Simon K, Viernes B, Yang J, Yin C, You S, Zhou J, Ryan P, Schuemie M, Krumholz H, Hripcsak G, Suchard M. Comparative Effectiveness of Second-Line Antihyperglycemic Agents for Cardiovascular Outcomes A Multinational, Federated Analysis of LEGEND-T2DM. Journal Of The American College Of Cardiology 2024, 84: 904-917. PMID: 39197980, DOI: 10.1016/j.jacc.2024.05.069.Peer-Reviewed Original ResearchConceptsGLP-1 RAsSecond-line agentsGLP-1Antihyperglycemic agentsCardiovascular diseaseMACE riskGlucagon-like peptide-1 receptor agonistsSodium-glucose cotransporter 2 inhibitorsPeptide-1 receptor agonistsDipeptidyl peptidase-4 inhibitorsEffects of SGLT2isType 2 diabetes mellitusPeptidase-4 inhibitorsAdverse cardiovascular eventsCox proportional hazards modelsRandom-effects meta-analysisCardiovascular risk reductionTarget trial emulationProportional hazards modelDesigning medical artificial intelligence systems for global use: focus on interoperability, scalability, and accessibility
Oikonomou E, Khera R. Designing medical artificial intelligence systems for global use: focus on interoperability, scalability, and accessibility. Hellenic Journal Of Cardiology 2024 PMID: 39025234, DOI: 10.1016/j.hjc.2024.07.003.Peer-Reviewed Original ResearchArtificial intelligenceMedical artificial intelligence systemsDesigning AI systemsMachine learning systemsArtificial intelligence systemsBenefits of AIIntelligent systemsAI systemsLearning systemEnd-usersData typesAI developmentInteroperabilityTemporal settingAccessScalabilityTreatment of cardiovascular diseasesIntelligenceSystemMachineQuality assuranceInternational cohortCardiovascular diseaseObstaclesPerformance of contemporary cardiovascular risk stratification scores in Brazil: an evaluation in the ELSA-Brasil study
Camargos A, Barreto S, Brant L, Ribeiro A, Dhingra L, Aminorroaya A, Bittencourt M, Figueiredo R, Khera R. Performance of contemporary cardiovascular risk stratification scores in Brazil: an evaluation in the ELSA-Brasil study. Open Heart 2024, 11: e002762. PMID: 38862252, PMCID: PMC11168182, DOI: 10.1136/openhrt-2024-002762.Peer-Reviewed Original ResearchConceptsPooled Cohort EquationsELSA-BrasilRisk scoreCardiovascular diseaseCVD eventsCommunity-based cohort studyArea under the receiver operating characteristic curveCVD risk scoreELSA-Brasil studyIncident CVD eventsMiddle-income countriesAdjudicated CVD eventsCardiovascular disease riskCVD scoreCohort EquationsNational guidelinesRisk stratification scoresWhite womenAge/sex groupsCohort studyProspective cohortLMICsSex/race groupsHigher incomeRisk discriminationDevelopment and multinational validation of an algorithmic strategy for high Lp(a) screening
Aminorroaya A, Dhingra L, Oikonomou E, Saadatagah S, Thangaraj P, Vasisht Shankar S, Spatz E, Khera R. Development and multinational validation of an algorithmic strategy for high Lp(a) screening. Nature Cardiovascular Research 2024, 3: 558-566. PMID: 39195936, DOI: 10.1038/s44161-024-00469-1.Peer-Reviewed Original ResearchElectronic health recordsAssociated with premature atherosclerotic cardiovascular diseaseElevated Lp(aHealth recordsUK BiobankPremature atherosclerotic cardiovascular diseaseMachine learning modelsAtherosclerotic cardiovascular diseaseCohort studyReal-world settingsTargeted screeningCardiovascular diseaseLearning modelsNovel targeted therapeuticsAlgorithmic strategiesCohortProbability thresholdScreeningClinical featuresValidation cohortElevated lipoproteinRisk inspectionARICLp(a
2023
Validation of the European SCORE2 models in a Canadian primary care cohort
Sud M, Sivaswamy A, Austin P, Abdel-Qadir H, Anderson T, Khera R, Naimark D, Lee D, Roifman I, Thanassoulis G, Tu K, Wijeysundera H, Ko D. Validation of the European SCORE2 models in a Canadian primary care cohort. European Journal Of Preventive Cardiology 2023, 31: 668-676. PMID: 37946603, PMCID: PMC11025037, DOI: 10.1093/eurjpc/zwad352.Peer-Reviewed Original ResearchPrimary care cohortAtherosclerotic cardiovascular diseaseLow-risk regionsCare cohortC-statisticOlder personsElectronic medical record dataLarge Canadian cohortMedical record dataYears of ageYoung personASCVD riskCanadian cohortCardiovascular diseaseOlder womenIndividuals 70Age groupsSCORE2CohortRecord dataWomenMenRiskPersonsDiseaseUse of Smart Devices to Track Cardiovascular Health Goals in the United States
Aminorroaya A, Dhingra L, Nargesi A, Oikonomou E, Krumholz H, Khera R. Use of Smart Devices to Track Cardiovascular Health Goals in the United States. JACC Advances 2023, 2: 100544. PMID: 38094515, PMCID: PMC10718569, DOI: 10.1016/j.jacadv.2023.100544.Peer-Reviewed Original ResearchHealth goalsRisk of cardiovascular diseaseCardiovascular risk factorsNationally representative Health Information National Trends SurveyHealth Information National Trends SurveyU.S. adultsCardiovascular diseaseNational Trends SurveyRisk factors of hypertensionDigital health interventionsCardiovascular health goalsHealth-related goalsRisk of CVDFactors of hypertensionU.S. adult populationCardiovascular risk managementHigher educational attainmentLow-income individualsSmart devicesTrends SurveyImprove careHealth interventionsNational estimatesRisk factorsSurvey participantsUse of Wearable Devices in Individuals With or at Risk for Cardiovascular Disease in the US, 2019 to 2020
Dhingra L, Aminorroaya A, Oikonomou E, Nargesi A, Wilson F, Krumholz H, Khera R. Use of Wearable Devices in Individuals With or at Risk for Cardiovascular Disease in the US, 2019 to 2020. JAMA Network Open 2023, 6: e2316634. PMID: 37285157, PMCID: PMC10248745, DOI: 10.1001/jamanetworkopen.2023.16634.Peer-Reviewed Original ResearchConceptsHealth Information National Trends SurveyUS adultsExacerbate disparitiesWearable device usersCardiovascular diseaseCardiovascular healthPopulation-based cross-sectional studySelf-reported cardiovascular diseaseCardiovascular disease risk factorsNational Trends SurveyOverall US adult populationCardiovascular risk factor profileSelf-reported accessAssociated with lower useUse of wearable devicesImprove cardiovascular healthLower household incomeLower educational attainmentUS adult populationRisk factor profileNationally representative sampleCross-sectional studyProportion of adultsTrends SurveyWearable device data
2022
Unfavorable social determinants of health are associated with higher burden of financial toxicity among patients with atherosclerotic cardiovascular disease in the US: findings from the National Health Interview Survey
Valero-Elizondo J, Javed Z, Khera R, Tano M, Dudum R, Acquah I, Hyder A, Andrieni J, Sharma G, Blaha M, Virani S, Blankstein R, Cainzos-Achirica M, Nasir K. Unfavorable social determinants of health are associated with higher burden of financial toxicity among patients with atherosclerotic cardiovascular disease in the US: findings from the National Health Interview Survey. Archives Of Public Health 2022, 80: 248. PMID: 36474300, PMCID: PMC9727868, DOI: 10.1186/s13690-022-00987-z.Peer-Reviewed Original ResearchFinancial toxicityEconomic stabilityNational Health Interview SurveyFood povertyCost-effective interventionHealth Interview SurveyCumulative social disadvantageMedical billsForegone careCost-related medicationComprehensive measureCardiovascular diseaseFinancial strainSocial determinantsInterview SurveyAtherosclerotic cardiovascular diseaseAge-stratified analysisNeighborhood conditionsDeterminantsSpecific social determinantsVulnerable groupsIncomeSDOH domainsHigh burdenHigher odds
2021
Patterns of Prescribing Sodium-Glucose Cotransporter-2 Inhibitors for Medicare Beneficiaries in the United States
Sangha V, Lipska K, Lin Z, Inzucchi SE, McGuire DK, Krumholz HM, Khera R. Patterns of Prescribing Sodium-Glucose Cotransporter-2 Inhibitors for Medicare Beneficiaries in the United States. Circulation Cardiovascular Quality And Outcomes 2021, 14: e008381. PMID: 34779654, PMCID: PMC9022137, DOI: 10.1161/circoutcomes.121.008381.Peer-Reviewed Original ResearchConceptsType 2 diabetesMedicare beneficiariesSodium-glucose cotransporter 2 inhibitorsLarge randomized clinical trialsMedicare Part D prescriber dataChronic kidney diseaseCotransporter 2 inhibitorsAtherosclerotic cardiovascular diseasePercent of cliniciansRandomized clinical trialsUS Medicare beneficiariesAdvanced practice providersCross-sectional studyKidney outcomesSGLT2i useSulfonylurea prescriptionUnique cliniciansCardiovascular deathMedication classesKidney diseaseLabel indicationsClinical trialsSGLT2iCardiovascular diseasePractice providersDigital Cardiovascular Epidemiology—Ushering in a New Era Through Computational Phenotyping of Cardiovascular Disease
Khera R. Digital Cardiovascular Epidemiology—Ushering in a New Era Through Computational Phenotyping of Cardiovascular Disease. JAMA Network Open 2021, 4: e2135561. PMID: 34807263, DOI: 10.1001/jamanetworkopen.2021.35561.Commentaries, Editorials and LettersConceptsCardiovascular diseaseScope and Social Determinants of Food Insecurity Among Adults With Atherosclerotic Cardiovascular Disease in the United States
Mahajan S, Grandhi GR, Valero‐Elizondo J, Mszar R, Khera R, Acquah I, Yahya T, Virani SS, Blankstein R, Blaha MJ, Cainzos‐Achirica M, Nasir K. Scope and Social Determinants of Food Insecurity Among Adults With Atherosclerotic Cardiovascular Disease in the United States. Journal Of The American Heart Association 2021, 10: e020028. PMID: 34387089, PMCID: PMC8475063, DOI: 10.1161/jaha.120.020028.Peer-Reviewed Original ResearchConceptsHigh-risk characteristicsUS adultsNational Health Interview Survey dataHealth Interview Survey dataAtherosclerotic cardiovascular diseaseCoronary heart diseaseSelf-reported diagnosisNon-Hispanic blacksInterview Survey dataFood Security Survey ModuleCardiovascular disease resultsLow family incomeAdult Food Security Survey ModuleFood insecurityHeart diseaseASCVDCardiovascular diseasePocket healthcare expenditureHigher oddsSociodemographic determinantsDisease resultsStudy participantsSocial determinantsHealthcare expendituresSociodemographic subgroupsAtherosclerotic Cardiovascular Disease, Cancer, and Financial Toxicity Among Adults in the United States
Valero-Elizondo J, Chouairi F, Khera R, Grandhi GR, Saxena A, Warraich HJ, Virani SS, Desai NR, Sasangohar F, Krumholz HM, Esnaola NF, Nasir K. Atherosclerotic Cardiovascular Disease, Cancer, and Financial Toxicity Among Adults in the United States. JACC CardioOncology 2021, 3: 236-246. PMID: 34396329, PMCID: PMC8352280, DOI: 10.1016/j.jaccao.2021.02.006.Peer-Reviewed Original ResearchCost-related medication nonadherenceFinancial toxicityMedication nonadherenceNational Health Interview SurveyAtherosclerotic cardiovascular diseaseMedical billsHealth Interview SurveyCancer careASCVDCardiovascular diseaseHigh burdenHigher oddsElderly populationCancerInterview SurveyFood insecurityCareNonadherenceSignificant proportionAdultsToxicityHigh financial distressPatientsPrevalenceDiseaseContemporary National Patterns of Eligibility and Utilization of Novel Cardioprotective Anti‐hyperglycemic agents in Type 2 Diabetes
Nargesi AA, Jeyashanmugaraja GP, Desai N, Lipska K, Krumholz H, Khera R. Contemporary National Patterns of Eligibility and Utilization of Novel Cardioprotective Anti‐hyperglycemic agents in Type 2 Diabetes. Journal Of The American Heart Association 2021, 10: e021084. PMID: 33998258, PMCID: PMC8403287, DOI: 10.1161/jaha.121.021084.Peer-Reviewed Original ResearchMeSH KeywordsAgedBiomarkersBlood GlucoseCardiovascular DiseasesDiabetes Mellitus, Type 2Drug UtilizationEligibility DeterminationFemaleGlucagon-Like Peptide-1 ReceptorGuideline AdherenceHeart Disease Risk FactorsHumansIncretinsMaleMiddle AgedNutrition SurveysPractice Guidelines as TopicPractice Patterns, Physicians'Risk AssessmentSodium-Glucose Transporter 2 InhibitorsTime FactorsTreatment OutcomeUnited StatesConceptsSGLT-2 inhibitorsType 2 diabetes mellitusAtherosclerotic cardiovascular diseaseChronic kidney diseaseLarge clinical trialsGLP-1RAsDiabetes mellitusCardiovascular diseaseHeart failureKidney diseaseClinical trialsHigh-risk atherosclerotic cardiovascular diseaseGLP-1RA useAmerican Diabetes AssociationNutrition Examination SurveyAnti-hyperglycemic agentsPublic health benefitsComplex survey designCardiovascular riskGuideline recommendationsDiabetes AssociationExamination SurveyProtective therapyNational HealthAmerican CollegeFinancial burden, distress, and toxicity in cardiovascular disease
Slavin SD, Khera R, Zafar SY, Nasir K, Warraich HJ. Financial burden, distress, and toxicity in cardiovascular disease. American Heart Journal 2021, 238: 75-84. PMID: 33961830, DOI: 10.1016/j.ahj.2021.04.011.Peer-Reviewed Original ResearchConceptsCardiovascular diseaseFinancial burdenCommunity Health Worker IntegrationHigh-risk individualsComparative effectiveness studiesNon-medical needsHigh-cost interventionsHigh-cost treatmentsCVD managementEffectiveness studiesHealth systemPsychological distressInsurance coverageHealthcare policyBurdenDistressDiseaseSystem navigationInterventionCommunity-based initiativesPatientsPhysicians
2020
Financial Toxicity in Atherosclerotic Cardiovascular Disease in the United States: Current State and Future Directions
Khera R, Valero-Elizondo J, Nasir K. Financial Toxicity in Atherosclerotic Cardiovascular Disease in the United States: Current State and Future Directions. Journal Of The American Heart Association 2020, 9: e017793. PMID: 32924728, PMCID: PMC7792407, DOI: 10.1161/jaha.120.017793.Peer-Reviewed Original ResearchConceptsAtherosclerotic cardiovascular diseaseFinancial toxicitySubstantial economic impactCost sharingHigh deductiblesNational expenditureEconomic impactPolicy circlesPocket costsFinancial impactHealthcare expendituresHealth careASCVD patientsWell tradeoffCardiovascular diseaseExpenditureNecessary medical careAssociation of cardiovascular risk factor profile and financial hardship from medical bills among non-elderly adults in the United States
Grandhi GR, Valero-Elizondo J, Mszar R, Brandt EJ, Annapureddy A, Khera R, Saxena A, Virani SS, Blankstein R, Desai NR, Blaha MJ, Cheema FH, Vahidy FS, Nasir K. Association of cardiovascular risk factor profile and financial hardship from medical bills among non-elderly adults in the United States. American Journal Of Preventive Cardiology 2020, 2: 100034. PMID: 34327457, PMCID: PMC8315456, DOI: 10.1016/j.ajpc.2020.100034.Peer-Reviewed Original ResearchAtherosclerotic cardiovascular diseaseCardiovascular risk factor profileCost-related barriersRisk factor profileNon-elderly adultsCRF profileLow prevalenceMedical billsFactor profileNational Health Interview SurveyHealth Interview SurveyLack of insuranceFinancial hardshipLogistic regression modelsLow incomeASCVD statusRisk factorsCardiovascular diseaseStudy populationLower oddsLower mortalityUninsured individualsLow burdenHealthcare expendituresPrevalenceCumulative Burden of Financial Hardship From Medical Bills Across the Spectrum of Diabetes Mellitus and Atherosclerotic Cardiovascular Disease Among Non‐Elderly Adults in the United States
Mszar R, Grandhi GR, Valero‐Elizondo J, Caraballo C, Khera R, Desai N, Virani SS, Blankstein R, Blaha MJ, Nasir K. Cumulative Burden of Financial Hardship From Medical Bills Across the Spectrum of Diabetes Mellitus and Atherosclerotic Cardiovascular Disease Among Non‐Elderly Adults in the United States. Journal Of The American Heart Association 2020, 9: e015523. PMID: 32394783, PMCID: PMC7660844, DOI: 10.1161/jaha.119.015523.Peer-Reviewed Original ResearchConceptsAtherosclerotic cardiovascular diseaseDiabetes mellitusNon-elderly adultsMedical billsCardiovascular diseaseBackground Atherosclerotic cardiovascular diseaseNational Health Interview SurveyEffective public health policiesThird of deathsTreatment-related expensesHealth Interview SurveyHigher relative oddsLogistic regression analysisFinancial hardshipPublic health policyASCVD statusPatient populationStudy populationHigh riskRelative oddsWeighted populationCumulative burdenHealth policyInterview SurveyStrong association
2019
Cost-Related Medication Nonadherence in Adults With Atherosclerotic Cardiovascular Disease in the United States, 2013 to 2017
Khera R, Valero-Elizondo J, Das SR, Virani SS, Kash BA, de Lemos JA, Krumholz HM, Nasir K. Cost-Related Medication Nonadherence in Adults With Atherosclerotic Cardiovascular Disease in the United States, 2013 to 2017. Circulation 2019, 140: 2067-2075. PMID: 31760784, DOI: 10.1161/circulationaha.119.041974.Peer-Reviewed Original ResearchConceptsAtherosclerotic cardiovascular diseaseCost-related nonadherenceMedication nonadherenceCardiovascular diseaseHigher oddsHistory of ASCVDNational Health Interview SurveyCost-related medication nonadherenceHigher comorbidity burdenLong-term therapyLow-cost medicationsVulnerable patient groupHealth Interview SurveyLow family incomeASCVD morbidityComorbidity burdenEssential therapySecondary preventionLess medicationPatient groupFemale sexMedication fillsWorse outcomesPrescribed dosesDrug costs
2018
Association Between Financial Burden, Quality of Life, and Mental Health Among Those With Atherosclerotic Cardiovascular Disease in the United States
Annapureddy A, Valero-Elizondo J, Khera R, Grandhi GR, Spatz ES, Dreyer RP, Desai NR, Krumholz HM, Nasir K. Association Between Financial Burden, Quality of Life, and Mental Health Among Those With Atherosclerotic Cardiovascular Disease in the United States. Circulation Cardiovascular Quality And Outcomes 2018, 11: e005180. PMID: 30571331, DOI: 10.1161/circoutcomes.118.005180.Peer-Reviewed Original Research