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Regional variations in ambulatory care and incidence of cardiovascular events.

Abstract Variations in the prevalence of traditional cardiac risk factors only partially account for geographic variations in the incidence of cardiovascular disease. We examined the extent to which preventive ambulatory health care services contribute to geographic variations in cardiovascular event rates.
PMID
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Keywords
Journal Title cmaj : canadian medical association journal = journal de l'association medicale canadienne
Publication Year Start




PMID- 28385894
OWN - NLM
STAT- MEDLINE
DA  - 20170407
DCOM- 20170419
LR  - 20170419
IS  - 1488-2329 (Electronic)
IS  - 0820-3946 (Linking)
VI  - 189
IP  - 13
DP  - 2017 Apr 03
TI  - Regional variations in ambulatory care and incidence of cardiovascular events.
PG  - E494-E501
LID - 10.1503/cmaj.160823 [doi]
AB  - BACKGROUND: Variations in the prevalence of traditional cardiac risk factors only
      partially account for geographic variations in the incidence of cardiovascular
      disease. We examined the extent to which preventive ambulatory health care
      services contribute to geographic variations in cardiovascular event rates.
      METHODS: We conducted a cohort study involving 5.5 million patients aged 40 to 79
      years in Ontario, Canada, with no hospital stays for cardiovascular disease as of
      January 2008, through linkage of multiple population-based health databases. The 
      primary outcome was the occurrence of a major cardiovascular event (myocardial
      infarction, stroke or cardiovascular-related death) over the following 5 years.
      We compared patient demographics, cardiac risk factors and ambulatory health care
      services across the province's 14 health service regions, known as Local Health
      Integration Networks (LHINs), and evaluated the contribution of these variables
      to regional variations in cardiovascular event rates. RESULTS: Cardiovascular
      event rates across LHINs varied from 3.2 to 5.7 events per 1000 person-years.
      Compared with residents of high-rate LHINs, those of low-rate health regions
      received physician services more often (e.g., 4.2 v. 3.5 mean annual family
      physician visits, p value for LHIN-level trend = 0.01) and were screened for risk
      factors more often. Low-rate LHINs were also more likely to achieve treatment
      targets for hypercholes-terolemia (51.8% v. 49.6% of patients, p = 0.03) and
      controlled hypertension (67.4% v. 53.3%, p = 0.04). Differences in patient and
      health system factors accounted for 74.5% of the variation in events between
      LHINs, of which 15.5% was attributable to health system factors alone.
      INTERPRETATION: Preventive ambulatory health care services were provided more
      frequently in health regions with lower cardiovascular event rates. Health system
      interventions to improve equitable access to preventive care might improve
      cardiovascular outcomes.
CI  - (c) 2017 Canadian Medical Association or its licensors.
FAU - Tu, Jack V
AU  - Tu JV
AD  - Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko,
      Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter,
      Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health
      Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto
      (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral,
      K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyere Research
      Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), 
      Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St.
      Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for
      Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University
      Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, 
      Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.;
      Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research
      Institute (Manuel), Ottawa, Ont. [email protected]
FAU - Chu, Anna
AU  - Chu A
AD  - Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko,
      Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter,
      Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health
      Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto
      (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral,
      K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyere Research
      Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), 
      Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St.
      Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for
      Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University
      Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, 
      Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.;
      Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research
      Institute (Manuel), Ottawa, Ont.
FAU - Maclagan, Laura
AU  - Maclagan L
AD  - Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko,
      Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter,
      Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health
      Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto
      (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral,
      K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyere Research
      Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), 
      Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St.
      Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for
      Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University
      Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, 
      Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.;
      Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research
      Institute (Manuel), Ottawa, Ont.
FAU - Austin, Peter C
AU  - Austin PC
AD  - Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko,
      Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter,
      Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health
      Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto
      (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral,
      K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyere Research
      Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), 
      Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St.
      Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for
      Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University
      Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, 
      Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.;
      Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research
      Institute (Manuel), Ottawa, Ont.
FAU - Johnston, Sharon
AU  - Johnston S
AD  - Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko,
      Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter,
      Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health
      Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto
      (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral,
      K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyere Research
      Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), 
      Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St.
      Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for
      Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University
      Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, 
      Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.;
      Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research
      Institute (Manuel), Ottawa, Ont.
FAU - Ko, Dennis T
AU  - Ko DT
AD  - Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko,
      Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter,
      Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health
      Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto
      (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral,
      K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyere Research
      Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), 
      Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St.
      Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for
      Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University
      Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, 
      Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.;
      Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research
      Institute (Manuel), Ottawa, Ont.
FAU - Cheung, Ingrid
AU  - Cheung I
AD  - Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko,
      Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter,
      Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health
      Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto
      (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral,
      K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyere Research
      Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), 
      Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St.
      Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for
      Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University
      Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, 
      Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.;
      Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research
      Institute (Manuel), Ottawa, Ont.
FAU - Atzema, Clare L
AU  - Atzema CL
AD  - Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko,
      Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter,
      Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health
      Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto
      (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral,
      K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyere Research
      Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), 
      Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St.
      Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for
      Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University
      Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, 
      Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.;
      Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research
      Institute (Manuel), Ottawa, Ont.
FAU - Booth, Gillian L
AU  - Booth GL
AD  - Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko,
      Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter,
      Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health
      Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto
      (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral,
      K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyere Research
      Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), 
      Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St.
      Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for
      Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University
      Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, 
      Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.;
      Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research
      Institute (Manuel), Ottawa, Ont.
FAU - Bhatia, R Sacha
AU  - Bhatia RS
AD  - Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko,
      Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter,
      Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health
      Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto
      (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral,
      K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyere Research
      Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), 
      Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St.
      Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for
      Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University
      Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, 
      Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.;
      Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research
      Institute (Manuel), Ottawa, Ont.
FAU - Lee, Douglas S
AU  - Lee DS
AD  - Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko,
      Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter,
      Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health
      Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto
      (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral,
      K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyere Research
      Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), 
      Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St.
      Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for
      Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University
      Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, 
      Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.;
      Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research
      Institute (Manuel), Ottawa, Ont.
FAU - Jackevicius, Cynthia A
AU  - Jackevicius CA
AD  - Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko,
      Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter,
      Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health
      Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto
      (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral,
      K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyere Research
      Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), 
      Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St.
      Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for
      Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University
      Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, 
      Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.;
      Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research
      Institute (Manuel), Ottawa, Ont.
FAU - Kapral, Moira K
AU  - Kapral MK
AD  - Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko,
      Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter,
      Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health
      Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto
      (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral,
      K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyere Research
      Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), 
      Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St.
      Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for
      Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University
      Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, 
      Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.;
      Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research
      Institute (Manuel), Ottawa, Ont.
FAU - Tu, Karen
AU  - Tu K
AD  - Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko,
      Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter,
      Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health
      Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto
      (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral,
      K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyere Research
      Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), 
      Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St.
      Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for
      Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University
      Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, 
      Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.;
      Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research
      Institute (Manuel), Ottawa, Ont.
FAU - Wijeysundera, Harindra C
AU  - Wijeysundera HC
AD  - Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko,
      Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter,
      Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health
      Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto
      (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral,
      K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyere Research
      Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), 
      Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St.
      Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for
      Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University
      Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, 
      Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.;
      Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research
      Institute (Manuel), Ottawa, Ont.
FAU - Alter, David A
AU  - Alter DA
AD  - Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko,
      Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter,
      Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health
      Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto
      (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral,
      K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyere Research
      Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), 
      Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St.
      Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for
      Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University
      Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, 
      Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.;
      Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research
      Institute (Manuel), Ottawa, Ont.
FAU - Udell, Jacob A
AU  - Udell JA
AD  - Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko,
      Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter,
      Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health
      Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto
      (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral,
      K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyere Research
      Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), 
      Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St.
      Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for
      Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University
      Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, 
      Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.;
      Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research
      Institute (Manuel), Ottawa, Ont.
FAU - Manuel, Douglas G
AU  - Manuel DG
AD  - Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko,
      Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter,
      Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health
      Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto
      (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral,
      K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyere Research
      Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), 
      Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St.
      Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for
      Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University
      Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, 
      Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.;
      Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research
      Institute (Manuel), Ottawa, Ont.
FAU - Mondal, Prosanta
AU  - Mondal P
AD  - Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko,
      Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter,
      Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health
      Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto
      (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral,
      K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyere Research
      Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), 
      Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St.
      Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for
      Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University
      Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, 
      Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.;
      Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research
      Institute (Manuel), Ottawa, Ont.
FAU - Hogg, William
AU  - Hogg W
AD  - Institute for Clinical Evaluative Sciences (J. Tu, Chu, Maclagan, Austin, Ko,
      Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral, K. Tu, Wijeysundera, Alter,
      Udell, Manuel, Mondal), Toronto, Ont.; Schulich Heart Centre, Sunnybrook Health
      Sciences Centre (J. Tu, Ko, Wijeysundera), Toronto, Ont.; University of Toronto
      (J. Tu, Chu, Austin, Ko, Cheung, Atzema, Booth, Bhatia, Lee, Jackevicius, Kapral,
      K. Tu, Wijeysundera, Alter, Udell, Manuel), Toronto, Ont.; Bruyere Research
      Institute (Johnston, Hogg), Ottawa, Ont.; University of Ottawa (Johnston, Hogg), 
      Ottawa, Ont.; Sunnybrook Health Sciences Centre (Atzema), Toronto, Ont.; St.
      Michael's Hospital (Booth), Toronto, Ont.; Women's College Hospital Institute for
      Health Systems Solutions and Virtual Care (Bhatia), Toronto, Ont.; University
      Health Network (Bhatia, Lee, Jackevicius, Kapral, K. Tu, Alter, Udell), Toronto, 
      Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.;
      Women's College Hospital (Udell), Toronto, Ont.; Ottawa Hospital Research
      Institute (Manuel), Ottawa, Ont.
CN  - Cardiovascular Health in Ambulatory Care Research Team (CANHEART)
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PL  - Canada
TA  - CMAJ
JT  - CMAJ : Canadian Medical Association journal = journal de l'Association medicale
      canadienne
JID - 9711805
RN  - 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors)
RN  - EC 1.1.1.- (Hydroxymethylglutaryl CoA Reductases)
SB  - AIM
SB  - IM
MH  - Adult
MH  - Aged
MH  - Ambulatory Care/*statistics & numerical data
MH  - Cohort Studies
MH  - Demography
MH  - Diabetes Mellitus/drug therapy
MH  - Drug Prescriptions/*statistics & numerical data
MH  - Dyslipidemias/*epidemiology
MH  - Female
MH  - Humans
MH  - Hydroxymethylglutaryl CoA Reductases/therapeutic use
MH  - Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use
MH  - Hypertension/*epidemiology
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Ontario/epidemiology
MH  - Practice Patterns, Physicians'/*statistics & numerical data
MH  - Preventive Health Services/*statistics & numerical data
MH  - Proportional Hazards Models
MH  - Risk Factors
PMC - PMC5378509
EDAT- 2017/04/08 06:00
MHDA- 2017/04/20 06:00
CRDT- 2017/04/08 06:00
PHST- 2016/12/29 [accepted]
AID - 189/13/E494 [pii]
AID - 10.1503/cmaj.160823 [doi]
PST - ppublish
SO  - CMAJ. 2017 Apr 3;189(13):E494-E501. doi: 10.1503/cmaj.160823.

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