Browsing by Author "Khan, Muhammad Shahzeb"
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Item Open Access Association Between Obesity and Cardiovascular Outcomes: A Systematic Review and Meta-analysis of Mendelian Randomization Studies.(JAMA network open, 2018-11-02) Riaz, Haris; Khan, Muhammad Shahzeb; Siddiqi, Tariq Jamal; Usman, Muhammad Shariq; Shah, Nishant; Goyal, Amit; Khan, Sadiya S; Mookadam, Farouk; Krasuski, Richard A; Ahmed, HaithamImportance:Although dyslipidemia has been consistently shown to be associated with atherogenesis, an association between obesity and cardiovascular disease outcomes remains controversial. Mendelian randomization can minimize confounding if variables are randomly and equally distributed in the population of interest. Objective:To assess evidence from mendelian randomization studies to provide a less biased estimate of any association between obesity and cardiovascular outcomes. Data Sources:Systematic searches of MEDLINE and Scopus from database inception until January 2018, supplemented with manual searches of the included reference lists. Study Selection:Studies that used mendelian randomization methods to assess the association between any measure of obesity and the incidence of cardiovascular events and those that reported odds ratios (ORs) with 95% CIs estimated using an instrumental variable method were included. The 5 studies included in the final analysis were based on a consensus among 3 authors. Data Extraction and Synthesis:Two investigators independently extracted study characteristics using a standard form and pooled data using a random-effects model. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline was followed. Main Outcomes and Measures:Obesity associated with type 2 diabetes, coronary artery disease, or stroke. The hypothesis was formulated prior to data collection. Results:Of 4660 potentially relevant articles, 2511 titles were screened. Seven studies were included in the systematic review, and 5 studies with 881 692 participants were eligible to be included in the meta-analysis. Pooled estimates revealed that obesity was significantly associated with an increased risk of type 2 diabetes (OR, 1.67; 95% CI, 1.30-2.14; P < .001; I2 = 93%) and coronary artery disease (OR, 1.20; 95% CI, 1.02-1.41; P = .03; I2 = 87%). No association between obesity and stroke was found (OR, 1.02; 95% CI, 0.95-1.09; P = .65; I2 = 0%). Conclusions and Relevance:The present meta-analysis suggests that obesity is associated with type 2 diabetes and coronary artery disease. Although this analysis of mendelian randomization studies does not prove causality, it is supportive of a causal association. Hence, health care practitioners should continue to emphasize weight reduction to combat coronary artery disease.Item Open Access Clinical Outcomes With Metformin and Sulfonylurea Therapies Among Patients With Heart Failure and Diabetes.(JACC. Heart failure, 2022-03) Khan, Muhammad Shahzeb; Solomon, Nicole; DeVore, Adam D; Sharma, Abhinav; Felker, G Michael; Hernandez, Adrian F; Heidenreich, Paul A; Matsouaka, Roland A; Green, Jennifer B; Butler, Javed; Yancy, Clyde W; Peterson, Pamela N; Fonarow, Gregg C; Greene, Stephen JObjectives
The authors sought to characterize associations between initiation of metformin and sulfonylurea therapy and clinical outcomes among patients with comorbid heart failure (HF) and diabetes (overall and by ejection fraction [EF] phenotype).Background
Metformin and sulfonylureas are frequently prescribed to patients with diabetes for glycemic control. The impact of these therapies on clinical outcomes among patients with comorbid HF and diabetes is unclear.Methods
The authors evaluated Medicare beneficiaries hospitalized for HF in the Get With The Guidelines-Heart Failure Registry between 2006 and 2014 with diabetes and not prescribed metformin or sulfonylurea before admission. In parallel separate analyses for metformin and sulfonylurea, patients with newly prescribed therapy within 90 days of discharge were compared with patients not prescribed therapy. Multivariable models landmarked at 90 days evaluated associations between prescription of therapy, and mortality and hospitalization for HF (HHF) at 12 months. Negative control (falsification) endpoints included hospitalization for urinary tract infection, hospitalization for gastrointestinal bleed, and influenza vaccination. Prespecified subgroup analyses were stratified by EF ≤40% versus >40%.Results
Of 5,852 patients, 454 (7.8%) were newly prescribed metformin and 504 (8.6%) were newly prescribed sulfonylurea. After adjustment, metformin prescription was independently associated with reduced risk of composite mortality/HHF (HR: 0.81; 95% CI: 0.67-0.98; P = 0.03), but individual components were not statistically significant. Findings among patients with EF >40% accounted for associations with mortality/HHF (HR: 0.68; 95% CI: 0.52-0.90) and HHF (HR: 0.58; 95% CI: 0.40-0.85) endpoints (all P for interaction ≤0.04). After adjustment, sulfonylurea initiation was associated with increased risk of mortality (HR: 1.24; 95% CI: 1.00-1.52; P = 0.045) and HHF (HR: 1.22; 95% CI: 1.00-1.48; P = 0.050) with nominal statistical significance. Associations between sulfonylurea initiation and endpoints were consistent regardless of EF (all P for interaction >0.11). Neither metformin initiation nor sulfonylurea initiation were associated with negative control endpoints.Conclusions
In this population of older U.S. adults hospitalized for HF with comorbid diabetes, metformin initiation was independently associated with substantial improvements in 12-month clinical outcomes, driven by findings among patients with EF >40%. By contrast, sulfonylurea initiation was associated with excess risk of death and HF hospitalization, regardless of EF.Item Open Access Conflicts of Interest and Outcomes of Cardiovascular Trials.(Am J Cardiol, 2016-03-01) Riaz, Haris; Khan, Muhammad Shahzeb; Riaz, Irbaz Bin; Raza, Sajjad; Khan, Abdur Rahman; Krasuski, Richard AConflicts of interests have long been recognized as potential sources of influence in the conduct and reporting of clinical trials. This controversy was again rekindled after the publication of the latest statin guidelines and a series of studies regarding competing interests in leading medical journals. We investigate the association between declared author conflicts and the outcomes of large cardiovascular trials. We searched the Medline (PubMed) database to identify "phase 2" and "phase 3" clinical trials using the search term "cardiovascular" over the past decade using "10 years" as the filter. We perceived the competing interest as present regardless of the nature such as consulting fees, honoraria, travel imbursements, stock holding, and employment. Of the 699 titles retrieved, 114 studies met the inclusion criteria. Nearly 80% of studies had at least a single author with competing interests. The 114 studies had a total of 1,433 investigators, of which 725 had declared conflicts of interests (50.6%). A total of 66 studies (58%) had half or >50 percent of investigators who had some conflicts of interests. Of these studies, 54 studies had favorable outcomes and only 12 had unfavorable outcomes (p <0.001). Among the type of competing interests, consulting or personal fees was the most common present in 58 investigators (51%). This was followed by research grants present in 55 the researchers (48%). Among 25 (22%) studies, at least one investigator reported stakes in the industry, of which only 2 studies had unfavorable outcomes for the intervention being investigated. Just 1 of the 25 clinical trials with a sample size of >1,000 had no investigators with competing interests. In conclusion, authors conflicts are associated with favorable outcomes in cardiovascular outcome trials.Item Open Access Evaluation of Industrial Compensation to Cardiologists in 2015.(Am J Cardiol, 2017-12-15) Khan, Muhammad Shahzeb; Siddiqi, Tariq Jamal; Fatima, Kaneez; Riaz, Haris; Khosa, Faisal; Manning, Warren J; Krasuski, RichardThe categorization and characterization of pharmaceutical and device manufacturers or group purchasing organization payments to clinicians is an important step toward assessing conflicts of interest and the potential impact of these payments on practice patterns. Payments have not previously been compared among the subspecialties of cardiology. This is a retrospective analysis of the Open Payments database, including all installments and payments made to doctors in the calendar year 2015 by pharmaceutical and device manufacturers or group purchasing organization. Total payments to individual physicians were then aggregated based on specialty, geographic region, and payment type. The Gini Index was further employed to calculate within each specialty to measure income disparity. In 2015, a total of $166,089,335 was paid in 943,744 payments (average $175.00 per payment) to cardiologists, including 23,372 general cardiologists, 7,530 interventional cardiologists, and 2,293 cardiac electro-physiologists. Payments were mal-distributed across the 3 subspecialties of cardiology (p <0.01), with general cardiology receiving the largest number (73.5%) and total payments (62.6%) and cardiac electrophysiologists receiving significantly higher median payments ($1,662 vs $361 for all cardiologists; p <0.01). The Medtronic Company was the largest single payer for all 3 subspecialties. In conclusion, pharmaceutical and device manufacturers or group purchasing organizations continue to make substantial payments to cardiac practitioners with a significant variation in payments made to different cardiology subspecialists. The largest number and total payments are to general cardiologists, whereas the highest median payments are made to cardiac electrophysiologists. The impact of these payments on practice patterns remains to be examined.Item Open Access Impact of Funding Source on Clinical Trial Results Including Cardiovascular Outcome Trials.(Am J Cardiol, 2015-12-15) Riaz, Haris; Raza, Sajjad; Khan, Muhammad Shahzeb; Riaz, Irbaz Bin; Krasuski, Richard APrevious authors have suggested a higher likelihood for industry-sponsored (IS) studies to have positive outcomes than non-IS studies, though the influence of publication bias was believed to be a likely confounder. We attempted to control for the latter using a prepublication database to compare the primary outcome of recent trials based on sponsorship. We used the "advanced search" feature in the clinicaltrials.gov website to identify recently completed phase III studies involving the implementation of a pharmaceutical agent or device for which primary data were available. Studies were categorized as either National Institutes of Health (NIH) sponsored or IS. Results were labeled "favorable" if the results favored the intervention under investigation or "unfavorable" if the intervention fared worse than standard medical treatment. We also performed an independent literature search to identify the cardiovascular trials as a case example and again categorized them into IS versus NIH sponsored. A total of 226 studies sponsored by NIH were found. When these were compared with the latest 226 IS studies, it was found that IS studies were almost 4 times more likely to report a positive outcome (odds ratio [OR] 3.90, 95% confidence interval [CI] 2.6087 to 5.9680, p <0.0001). As a case example of a specialty, we also identified 25 NIH-sponsored and 215 IS cardiovascular trials, with most focusing on hypertension therapy (31.6%) and anticoagulation (17.9%). IS studies were 7 times more likely to report favorable outcomes (OR 7.54, 95% CI 2.19 to 25.94, p = 0.0014). They were also considerably less likely to report unfavorable outcomes (OR 0.11, 95% CI 0.04 to 0.26, p <0.0001). In conclusion, the outcomes of large clinical studies especially cardiovascular differ considerably on the basis of their funding source, and publication bias appears to have limited influence on these findings.Item Open Access Is Anticoagulation Beneficial in Pulmonary Arterial Hypertension?(Circulation. Cardiovascular quality and outcomes, 2018-09) Khan, Muhammad Shahzeb; Usman, Muhammad Shariq; Siddiqi, Tariq Jamal; Khan, Safi U; Murad, M Hassan; Mookadam, Farouk; Figueredo, Vincent M; Krasuski, Richard A; Benza, Raymond L; Rich, Jonathan DBackground Data about anticoagulation in pulmonary arterial hypertension (PAH) patients are inconsistent. The objective of this study was to examine the impact of adjunctive oral anticoagulants in patients with PAH through meta-analysis, and to further assess whether response differs by PAH subtype. Methods and Results Cochrane CENTRAL, Medline, and Scopus databases were searched for randomized or nonrandomized studies that assessed the association between anticoagulation and outcomes in patients with PAH. Hazard ratios (HRs) for mortality were pooled using the random effects model. Subgroup analyses were performed for type of PAH and study design. Twelve nonrandomized studies, at moderate risk of bias, were included. These consisted of 2512 patients (1342 receiving anticoagulation and 1170 controls). Anticoagulation significantly reduced mortality in the overall PAH cohort (HR, 0.73 [0.57, 0.93]; P=0.001; I2=64%). On subgroup analysis, a significant mortality reduction was seen in idiopathic PAH patients (HR, 0.73 [0.56, 0.95]; P=0.02; I2=46%), whereas no significant difference was observed in connective tissue disease-related PAH (HR, 1.16 [0.58, 2.32]; P=0.67; I2=71%). Sensitivity analysis specific to scleroderma-associated PAH demonstrated a significant increase in mortality with anticoagulant use (HR, 1.58 [1.08, 2.31]; P=0.02; I2=9%). Conclusions This meta-analysis shows that use of anticoagulation may improve survival in idiopathic PAH patients, while increasing mortality when used in scleroderma-associated-PAH patients. Currently, no randomized clinical trials have been published, and until randomized data are available, anticoagulant use in PAH should be tailored to PAH subtype.Item Open Access Mapping 123 million neonatal, infant and child deaths between 2000 and 2017.(Nature, 2019-10-16) Burstein, Roy; Henry, Nathaniel J; Collison, Michael L; Marczak, Laurie B; Sligar, Amber; Watson, Stefanie; Marquez, Neal; Abbasalizad-Farhangi, Mahdieh; Abbasi, Masoumeh; Abd-Allah, Foad; Abdoli, Amir; Abdollahi, Mohammad; Abdollahpour, Ibrahim; Abdulkader, Rizwan Suliankatchi; Abrigo, Michael RM; Acharya, Dilaram; Adebayo, Oladimeji M; Adekanmbi, Victor; Adham, Davoud; Afshari, Mahdi; Aghaali, Mohammad; Ahmadi, Keivan; Ahmadi, Mehdi; Ahmadpour, Ehsan; Ahmed, Rushdia; Akal, Chalachew Genet; Akinyemi, Joshua O; Alahdab, Fares; Alam, Noore; Alamene, Genet Melak; Alene, Kefyalew Addis; Alijanzadeh, Mehran; Alinia, Cyrus; Alipour, Vahid; Aljunid, Syed Mohamed; Almalki, Mohammed J; Al-Mekhlafi, Hesham M; Altirkawi, Khalid; Alvis-Guzman, Nelson; Amegah, Adeladza Kofi; Amini, Saeed; Amit, Arianna Maever Loreche; Anbari, Zohreh; Androudi, Sofia; Anjomshoa, Mina; Ansari, Fereshteh; Antonio, Carl Abelardo T; Arabloo, Jalal; Arefi, Zohreh; Aremu, Olatunde; Armoon, Bahram; Arora, Amit; Artaman, Al; Asadi, Anvar; Asadi-Aliabadi, Mehran; Ashraf-Ganjouei, Amir; Assadi, Reza; Ataeinia, Bahar; Atre, Sachin R; Quintanilla, Beatriz Paulina Ayala; Ayanore, Martin Amogre; Azari, Samad; Babaee, Ebrahim; Babazadeh, Arefeh; Badawi, Alaa; Bagheri, Soghra; Bagherzadeh, Mojtaba; Baheiraei, Nafiseh; Balouchi, Abbas; Barac, Aleksandra; Bassat, Quique; Baune, Bernhard T; Bayati, Mohsen; Bedi, Neeraj; Beghi, Ettore; Behzadifar, Masoud; Behzadifar, Meysam; Belay, Yared Belete; Bell, Brent; Bell, Michelle L; Berbada, Dessalegn Ajema; Bernstein, Robert S; Bhattacharjee, Natalia V; Bhattarai, Suraj; Bhutta, Zulfiqar A; Bijani, Ali; Bohlouli, Somayeh; Breitborde, Nicholas JK; Britton, Gabrielle; Browne, Annie J; Nagaraja, Sharath Burugina; Busse, Reinhard; Butt, Zahid A; Car, Josip; Cárdenas, Rosario; Castañeda-Orjuela, Carlos A; Cerin, Ester; Chanie, Wagaye Fentahun; Chatterjee, Pranab; Chu, Dinh-Toi; Cooper, Cyrus; Costa, Vera M; Dalal, Koustuv; Dandona, Lalit; Dandona, Rakhi; Daoud, Farah; Daryani, Ahmad; Das Gupta, Rajat; Davis, Ian; Davis Weaver, Nicole; Davitoiu, Dragos Virgil; De Neve, Jan-Walter; Demeke, Feleke Mekonnen; Demoz, Gebre Teklemariam; Deribe, Kebede; Desai, Rupak; Deshpande, Aniruddha; Desyibelew, Hanna Demelash; Dey, Sagnik; Dharmaratne, Samath Dhamminda; Dhimal, Meghnath; Diaz, Daniel; Doshmangir, Leila; Duraes, Andre R; Dwyer-Lindgren, Laura; Earl, Lucas; Ebrahimi, Roya; Ebrahimpour, Soheil; Effiong, Andem; Eftekhari, Aziz; Ehsani-Chimeh, Elham; El Sayed, Iman; El Sayed Zaki, Maysaa; El Tantawi, Maha; El-Khatib, Ziad; Emamian, Mohammad Hassan; Enany, Shymaa; Eskandarieh, Sharareh; Eyawo, Oghenowede; Ezalarab, Maha; Faramarzi, Mahbobeh; Fareed, Mohammad; Faridnia, Roghiyeh; Faro, Andre; Fazaeli, Ali Akbar; Fazlzadeh, Mehdi; Fentahun, Netsanet; Fereshtehnejad, Seyed-Mohammad; Fernandes, João C; Filip, Irina; Fischer, Florian; Foigt, Nataliya A; Foroutan, Masoud; Francis, Joel Msafiri; Fukumoto, Takeshi; Fullman, Nancy; Gallus, Silvano; Gebre, Destallem Gebremedhin; Gebrehiwot, Tsegaye Tewelde; Gebremeskel, Gebreamlak Gebremedhn; Gessner, Bradford D; Geta, Birhanu; Gething, Peter W; Ghadimi, Reza; Ghadiri, Keyghobad; Ghajarzadeh, Mahsa; Ghashghaee, Ahmad; Gill, Paramjit Singh; Gill, Tiffany K; Golding, Nick; Gomes, Nelson GM; Gona, Philimon N; Gopalani, Sameer Vali; Gorini, Giuseppe; Goulart, Bárbara Niegia Garcia; Graetz, Nicholas; Greaves, Felix; Green, Manfred S; Guo, Yuming; Haj-Mirzaian, Arvin; Haj-Mirzaian, Arya; Hall, Brian James; Hamidi, Samer; Haririan, Hamidreza; Haro, Josep Maria; Hasankhani, Milad; Hasanpoor, Edris; Hasanzadeh, Amir; Hassankhani, Hadi; Hassen, Hamid Yimam; Hegazy, Mohamed I; Hendrie, Delia; Heydarpour, Fatemeh; Hird, Thomas R; Hoang, Chi Linh; Hollerich, Gillian; Rad, Enayatollah Homaie; Hoseini-Ghahfarokhi, Mojtaba; Hossain, Naznin; Hosseini, Mostafa; Hosseinzadeh, Mehdi; Hostiuc, Mihaela; Hostiuc, Sorin; Househ, Mowafa; Hsairi, Mohamed; Ilesanmi, Olayinka Stephen; Imani-Nasab, Mohammad Hasan; Iqbal, Usman; Irvani, Seyed Sina Naghibi; Islam, Nazrul; Islam, Sheikh Mohammed Shariful; Jürisson, Mikk; Balalami, Nader Jafari; Jalali, Amir; Javidnia, Javad; Jayatilleke, Achala Upendra; Jenabi, Ensiyeh; Ji, John S; Jobanputra, Yash B; Johnson, Kimberly; Jonas, Jost B; Shushtari, Zahra Jorjoran; Jozwiak, Jacek Jerzy; Kabir, Ali; Kahsay, Amaha; Kalani, Hamed; Kalhor, Rohollah; Karami, Manoochehr; Karki, Surendra; Kasaeian, Amir; Kassebaum, Nicholas J; Keiyoro, Peter Njenga; Kemp, Grant Rodgers; Khabiri, Roghayeh; Khader, Yousef Saleh; Khafaie, Morteza Abdullatif; Khan, Ejaz Ahmad; Khan, Junaid; Khan, Muhammad Shahzeb; Khang, Young-Ho; Khatab, Khaled; Khater, Amir; Khater, Mona M; Khatony, Alireza; Khazaei, Mohammad; Khazaei, Salman; Khazaei-Pool, Maryam; Khubchandani, Jagdish; Kianipour, Neda; Kim, Yun Jin; Kimokoti, Ruth W; Kinyoki, Damaris K; Kisa, Adnan; Kisa, Sezer; Kolola, Tufa; Kosen, Soewarta; Koul, Parvaiz A; Koyanagi, Ai; Kraemer, Moritz UG; Krishan, Kewal; Krohn, Kris J; Kugbey, Nuworza; Kumar, G Anil; Kumar, Manasi; Kumar, Pushpendra; Kuupiel, Desmond; Lacey, Ben; Lad, Sheetal D; Lami, Faris Hasan; Larsson, Anders O; Lee, Paul H; Leili, Mostafa; Levine, Aubrey J; Li, Shanshan; Lim, Lee-Ling; Listl, Stefan; Longbottom, Joshua; Lopez, Jaifred Christian F; Lorkowski, Stefan; Magdeldin, Sameh; Abd El Razek, Hassan Magdy; Abd El Razek, Muhammed Magdy; Majeed, Azeem; Maleki, Afshin; Malekzadeh, Reza; Malta, Deborah Carvalho; Mamun, Abdullah A; Manafi, Navid; Manda, Ana-Laura; Mansourian, Morteza; Martins-Melo, Francisco Rogerlândio; Masaka, Anthony; Massenburg, Benjamin Ballard; Maulik, Pallab K; Mayala, Benjamin K; Mazidi, Mohsen; McKee, Martin; Mehrotra, Ravi; Mehta, Kala M; Meles, Gebrekiros Gebremichael; Mendoza, Walter; Menezes, Ritesh G; Meretoja, Atte; Meretoja, Tuomo J; Mestrovic, Tomislav; Miller, Ted R; Miller-Petrie, Molly K; Mills, Edward J; Milne, George J; Mini, GK; Mir, Seyed Mostafa; Mirjalali, Hamed; Mirrakhimov, Erkin M; Mohamadi, Efat; Mohammad, Dara K; Mohammad, Dara K; Darwesh, Aso Mohammad; Mezerji, Naser Mohammad Gholi; Mohammed, Ammas Siraj; Mohammed, Shafiu; Mokdad, Ali H; Molokhia, Mariam; Monasta, Lorenzo; Moodley, Yoshan; Moosazadeh, Mahmood; Moradi, Ghobad; Moradi, Masoud; Moradi, Yousef; Moradi-Lakeh, Maziar; Moradinazar, Mehdi; Moraga, Paula; Morawska, Lidia; Mosapour, Abbas; Mousavi, Seyyed Meysam; Mueller, Ulrich Otto; Muluneh, Atalay Goshu; Mustafa, Ghulam; Nabavizadeh, Behnam; Naderi, Mehdi; Nagarajan, Ahamarshan Jayaraman; Nahvijou, Azin; Najafi, Farid; Nangia, Vinay; Ndwandwe, Duduzile Edith; Neamati, Nahid; Negoi, Ionut; Negoi, Ruxandra Irina; Ngunjiri, Josephine W; Thi Nguyen, Huong Lan; Nguyen, Long Hoang; Nguyen, Son Hoang; Nielsen, Katie R; Ningrum, Dina Nur Anggraini; Nirayo, Yirga Legesse; Nixon, Molly R; Nnaji, Chukwudi A; Nojomi, Marzieh; Noroozi, Mehdi; Nosratnejad, Shirin; Noubiap, Jean Jacques; Motlagh, Soraya Nouraei; Ofori-Asenso, Richard; Ogbo, Felix Akpojene; Oladimeji, Kelechi E; Olagunju, Andrew T; Olfatifar, Meysam; Olum, Solomon; Olusanya, Bolajoko Olubukunola; Oluwasanu, Mojisola Morenike; Onwujekwe, Obinna E; Oren, Eyal; Ortega-Altamirano, Doris DV; Ortiz, Alberto; Osarenotor, Osayomwanbo; Osei, Frank B; Osgood-Zimmerman, Aaron E; Otstavnov, Stanislav S; Owolabi, Mayowa Ojo; P A, Mahesh; Pagheh, Abdol Sattar; Pakhale, Smita; Panda-Jonas, Songhomitra; Pandey, Animika; Park, Eun-Kee; Parsian, Hadi; Pashaei, Tahereh; Patel, Sangram Kishor; Pepito, Veincent Christian Filipino; Pereira, Alexandre; Perkins, Samantha; Pickering, Brandon V; Pilgrim, Thomas; Pirestani, Majid; Piroozi, Bakhtiar; Pirsaheb, Meghdad; Plana-Ripoll, Oleguer; Pourjafar, Hadi; Puri, Parul; Qorbani, Mostafa; Quintana, Hedley; Rabiee, Mohammad; Rabiee, Navid; Radfar, Amir; Rafiei, Alireza; Rahim, Fakher; Rahimi, Zohreh; Rahimi-Movaghar, Vafa; Rahimzadeh, Shadi; Rajati, Fatemeh; Raju, Sree Bhushan; Ramezankhani, Azra; Ranabhat, Chhabi Lal; Rasella, Davide; Rashedi, Vahid; Rawal, Lal; Reiner, Robert C; Renzaho, Andre MN; Rezaei, Satar; Rezapour, Aziz; Riahi, Seyed Mohammad; Ribeiro, Ana Isabel; Roever, Leonardo; Roro, Elias Merdassa; Roser, Max; Roshandel, Gholamreza; Roshani, Daem; Rostami, Ali; Rubagotti, Enrico; Rubino, Salvatore; Sabour, Siamak; Sadat, Nafis; Sadeghi, Ehsan; Saeedi, Reza; Safari, Yahya; Safari-Faramani, Roya; Safdarian, Mahdi; Sahebkar, Amirhossein; Salahshoor, Mohammad Reza; Salam, Nasir; Salamati, Payman; Salehi, Farkhonde; Zahabi, Saleh Salehi; Salimi, Yahya; Salimzadeh, Hamideh; Salomon, Joshua A; Sambala, Evanson Zondani; Samy, Abdallah M; Santric Milicevic, Milena M; Jose, Bruno Piassi Sao; Saraswathy, Sivan Yegnanarayana Iyer; Sarmiento-Suárez, Rodrigo; Sartorius, Benn; Sathian, Brijesh; Saxena, Sonia; Sbarra, Alyssa N; Schaeffer, Lauren E; Schwebel, David C; Sepanlou, Sadaf G; Seyedmousavi, Seyedmojtaba; Shaahmadi, Faramarz; Shaikh, Masood Ali; Shams-Beyranvand, Mehran; Shamshirian, Amir; Shamsizadeh, Morteza; Sharafi, Kiomars; Sharif, Mehdi; Sharif-Alhoseini, Mahdi; Sharifi, Hamid; Sharma, Jayendra; Sharma, Rajesh; Sheikh, Aziz; Shields, Chloe; Shigematsu, Mika; Shiri, Rahman; Shiue, Ivy; Shuval, Kerem; Siddiqi, Tariq J; Silva, João Pedro; Singh, Jasvinder A; Sinha, Dhirendra Narain; Sisay, Malede Mequanent; Sisay, Solomon; Sliwa, Karen; Smith, David L; Somayaji, Ranjani; Soofi, Moslem; Soriano, Joan B; Sreeramareddy, Chandrashekhar T; Sudaryanto, Agus; Sufiyan, Mu'awiyyah Babale; Sykes, Bryan L; Sylaja, PN; Tabarés-Seisdedos, Rafael; Tabb, Karen M; Tabuchi, Takahiro; Taveira, Nuno; Temsah, Mohamad-Hani; Terkawi, Abdullah Sulieman; Tessema, Zemenu Tadesse; Thankappan, Kavumpurathu Raman; Thirunavukkarasu, Sathish; To, Quyen G; Tovani-Palone, Marcos Roberto; Tran, Bach Xuan; Tran, Khanh Bao; Ullah, Irfan; Usman, Muhammad Shariq; Uthman, Olalekan A; Vahedian-Azimi, Amir; Valdez, Pascual R; van Boven, Job FM; Vasankari, Tommi Juhani; Vasseghian, Yasser; Veisani, Yousef; Venketasubramanian, Narayanaswamy; Violante, Francesco S; Vladimirov, Sergey Konstantinovitch; Vlassov, Vasily; Vos, Theo; Vu, Giang Thu; Vujcic, Isidora S; Waheed, Yasir; Wakefield, Jon; Wang, Haidong; Wang, Yafeng; Wang, Yuan-Pang; Ward, Joseph L; Weintraub, Robert G; Weldegwergs, Kidu Gidey; Weldesamuel, Girmay Teklay; Westerman, Ronny; Wiysonge, Charles Shey; Wondafrash, Dawit Zewdu; Woyczynski, Lauren; Wu, Ai-Min; Xu, Gelin; Yadegar, Abbas; Yamada, Tomohide; Yazdi-Feyzabadi, Vahid; Yilgwan, Christopher Sabo; Yip, Paul; Yonemoto, Naohiro; Lebni, Javad Yoosefi; Younis, Mustafa Z; Yousefifard, Mahmoud; Yousof, Hebat-Allah Salah A; Yu, Chuanhua; Yusefzadeh, Hasan; Zabeh, Erfan; Moghadam, Telma Zahirian; Bin Zaman, Sojib; Zamani, Mohammad; Zandian, Hamed; Zangeneh, Alireza; Zerfu, Taddese Alemu; Zhang, Yunquan; Ziapour, Arash; Zodpey, Sanjay; Murray, Christopher JL; Hay, Simon ISince 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.Item Open Access Meta-analysis of Placebo-Controlled Randomized Controlled Trials on the Prevalence of Statin Intolerance.(Am J Cardiol, 2017-09-01) Riaz, Haris; Khan, Abdur Rahman; Khan, Muhammad Shahzeb; Rehman, Karim Abdur; Alansari, Shehab Ahmad Redha; Gheyath, Bashaer; Raza, Sajjad; Barakat, Amr; Luni, Faraz Khan; Ahmed, Haitham; Krasuski, Richard AThe prevalence of intolerance varies widely. Stopping statin therapy is associated with worse outcomes in patients with cardiovascular disease. Despite extensive studies, the benefits and risks of statins continue to be debated by clinicians and the lay public. We searched the PubMed, Medline, and Cochrane Central Register of Controlled Trials (CENTRAL) databases for all randomized controlled trials of statins compared with placebo. Studies were included if they had ≥1,000 participants, had patients who were followed up for ≥1 year, and reported rates of drug discontinuation. Studies were pooled as per the random effects model. A total of 22 studies (statins = 66,024, placebo = 63,656) met the inclusion criteria. The pooled analysis showed that, over a mean follow-up of 4.1 years, the rates of discontinuation were 13.3% (8,872 patients) for statin-treated patients and 13.9% (8,898 patients) for placebo-treated patients. The random effects model showed no significant difference between the placebo and statin arms (odds ratio [OR] = 0.99, 95% confidence interval [CI] = 0.93 to 1.06). The results were similar for both primary prevention (OR = 0.98, 95% CI = 0.92 to 1.05, p = 0.39) and secondary prevention (OR = 0.92, 95% CI = 0.83 to 1.05, p = 0.43) studies. The pooled analysis suggested that the rates of myopathy were also similar between the statins and placebos (OR = 1.2, 95% CI = 0.88 to 1.62, p = 0.25). In conclusion, this meta-analysis of >125,000 patients suggests that the rate of drug discontinuation and myopathy does not significantly differ between statin- and placebo-treated patients in randomized controlled trials. These findings are limited by the heterogeneity of results, the variable duration of follow-up, and the lower doses of statins compared with contemporary clinical practice.Item Open Access Novel oral anticoagulants versus vitamin K antagonists in patients with atrial fibrillation after transcatheter aortic valve replacement: A systematic review and meta-analysis.(Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, 2022-04-27) Memon, Muhammad Mustafa; Siddiqui, Asad Ali; Amin, Emaan; Shaikh, Fahd Niaz; Khan, Muhammad Shahzeb; Doukky, Rami; Krasuski, Richard ABackground
The efficacy and safety of novel oral anticoagulants (NOACs) compared to the current guideline-recommended vitamin K antagonists (VKAs) in atrial fibrillation (AF) patients undergoing transcatheter aortic valve replacement (TAVR) has not been well established. We pooled evidence from all available studies to assess the risks and benefits of this drug class.Methods
We queried electronic databases (MEDLINE, Scopus, and Cochrane central) up until January 28th, 2022 for studies comparing NOACs to VKAs in AF patients undergoing TAVR. Results from studies were presented as risk ratios (RR) and pooled using a random-effects model. Subgroup analysis by study design and meta-regression analysis were performed to explore heterogeneity.Results
A total of 12 studies (3 RCTs and 9 observational) containing 12,203 patients (mean age 81.2 years; 50.5% men) were identified and included in the analysis. Pooled analysis revealed no significant difference between NOACs and VKAs in terms of stroke or systemic embolism (RR: 0.78; p = 0.18), major bleeding (RR: 0.84; p = 0.32), intracranial hemorrhage (RR 0.61; p = 0.06), all-cause mortality (RR: 0.69; p = 0.07), and myocardial infarction (RR: 1.60; p = 0.24) at a mean length of follow-up of 15.1 months. RCTs and observational studies did not significantly differ across outcomes on subgroup analysis. Meta-regression analysis found heterogeneity in all-cause mortality to be significantly explained by percentage of males (coefficient: 0.049, p = 0.007), mean age (coefficient: 0.221, p < 0.001), and CHA2DS2-VASc score (coefficient: -1.657, p < 0.001).Conclusions
This meta-analysis suggests that outcomes with NOACs do not significantly differ compared to VKAs following TAVR in patients with AF.Item Open Access Safety and Use of Anticoagulation After Aortic Valve Replacement With Bioprostheses: A Meta-Analysis.(Circ Cardiovasc Qual Outcomes, 2016-05) Riaz, Haris; Alansari, Shehab Ahmad Redha; Khan, Muhammad Shahzeb; Riaz, Talha; Raza, Sajjad; Luni, Faraz Khan; Khan, Abdur Rahman; Riaz, Irbaz Bin; Krasuski, Richard ABACKGROUND: The American College of Cardiology guidelines recommend 3 months of anticoagulation after replacement of the aortic valve with a bioprosthesis. However, there remains great variability in the current clinical practice and conflicting results from clinical studies. To assist clinical decision making, we pooled the existing evidence to assess whether anticoagulation in the setting of a new bioprosthesis was associated with improved outcomes or greater risk of bleeding. METHODS AND RESULTS: We searched the PubMed database from the inception of these databases until April 2015 to identify original studies (observational studies or clinical trials) that assessed anticoagulation with warfarin in comparison with either aspirin or no antiplatelet or anticoagulant therapy. We included the studies if their outcomes included thromboembolism or stroke/transient ischemic attacks and bleeding events. Quality assessment was performed in accordance with the Newland Ottawa Scale, and random effects analysis was used to pool the data from the available studies. I(2) testing was done to assess the heterogeneity of the included studies. After screening through 170 articles, a total of 13 studies (cases=6431; controls=18210) were included in the final analyses. The use of warfarin was associated with a significantly increased risk of overall bleeding (odds ratio, 1.96; 95% confidence interval, 1.25-3.08; P<0.0001) or bleeding risk at 3 months (odds ratio, 1.92; 95% confidence interval, 1.10-3.34; P<0.0001) compared with aspirin or placebo. With regard to composite primary outcome variables (risk of venous thromboembolism, stroke, or transient ischemic attack) at 3 months, no significant difference was seen with warfarin (odds ratio, 1.13; 95% confidence interval, 0.82-1.56; P=0.67). Moreover, anticoagulation was also not shown to improve outcomes at time interval >3 months (odds ratio, 1.12; 95% confidence interval, 0.80-1.58; P=0.79). CONCLUSIONS: Contrary to the current guidelines, a meta-analysis of previous studies suggests that anticoagulation in the setting of an aortic bioprosthesis significantly increases bleeding risk without a favorable effect on thromboembolic events. Larger, randomized controlled studies should be performed to further guide this clinical practice.Item Open Access Transcatheter closure of patent foramen ovale following cryptogenic stroke: An updated meta-analysis of randomized controlled trials.(American heart journal, 2018-05) Riaz, Haris; Khan, Muhammad Shahzeb; Schenone, Aldo L; Waheed, Anam A; Khan, Arooj Razzak; Krasuski, Richard ATranscatheter closure of patent foramen ovale (PFO) after cryptogenic stroke has long been a contentious issue. Herein, we pool aggregate data examining safety and efficacy of transcatheter closure of PFO compared with medical therapy following initial cryptogenic stroke.We searched for randomized clinical trials (RCT) that compared device closure with medical management and reported on subsequent stroke and adverse events. Stroke was considered as the primary efficacy endpoint, whereas bleeding and atrial fibrillation were considered primary safety endpoints. Data were pooled by the random effects model and I2 was used to assess heterogeneity.A total of 5 RCT investigating 3630 patients met inclusion criteria. Pooled analysis revealed that device closure compared to medical management was associated with a significant reduction in stroke (RR=0.3, 95% CI=0.02-0.57). There was, however, a significant increase in atrial arrhythmias with device therapy (RR=4.8, 95% CI=2.2-10.7). We found no increase in bleeding (RR=0.80, 95% CI=0.5-1.4), death (RR=0.76, 95% CI=0.3-1.99) or "any adverse events" (RR=1.02, 95% CI=0.85-1.23) with device therapy. Sub-group analysis revealed that device closure significantly reduced the incidence of the composite primary endpoint among patients who had moderate to large shunt sizes (RR=0.22, 95% CI=0.02-0.42).Transcatheter closure is associated with a significant reduction in the risk of stroke compared to medical management at the expense of an increased risk of atrial arrhythmias.