Elizabeth A Jackson

University of Michigan, Ann Arbor, Michigan, United States

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Publications (64)465.89 Total impact

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    ABSTRACT: Physical performance measures have been shown to predict mortality and incident cardiovascular disease (CVD) mainly in elderly populations. We evaluated whether physical performance measures are associated with vascular health indices (carotid intima–media thickness (cIMT), adventitial diameter (cAD) and carotid plaque) in a large sample of multi-ethnic, late midlife women.
    International Journal of Cardiology 03/2015; 182. DOI:10.1016/j.ijcard.2014.12.042 · 6.18 Impact Factor
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    ABSTRACT: Young women with acute coronary syndrome (ACS) may represent a high risk group, but little is known about specific age and sex differences in clinical characteristics, treatment, outcomes, and trends over time. Data from 3237 men and women admitted with an ACS event from 1999 to 2006 were analyzed. Patients were grouped by sex and age less than 55 years. Demographics, presentation, treatment, and outcomes at 6 months were analyzed. Primary outcomes included mortality, recurrent myocardial infarction, rehospitalization, and stroke at 6 months. Secondary analyses assessed risk factors, management, and trends over time. Women under 55 years represented 8 % of the entire cohort, and 26 % of patients under age 55 years. Compared to older women, young women were more likely to be smokers (51 vs. 14 %, p < 0.001) and obese (44 vs. 34 %, p = 0.006). Young women had more diabetes and hypertension than young men. Mortality was lowest among young women and did not change over time. Young women received less treatment with aspirin, beta blockers, lipid-lowering agents, and ACE inhibitors, and underwent less coronary angiography and stenting than young men (44 vs. 59 %, p < 0.001). Rehospitalization was higher among young women than young men (37 vs. 27 %, p < 0.001), with no change over time. Modifiable risk factors such as smoking, obesity, diabetes, and hypertension should be addressed in young women. Following ACS, young women received fewer evidence-based medications, were treated less invasively, and had higher readmission rates within 6 months compared to young men.
    Clinical Research in Cardiology 02/2015; DOI:10.1007/s00392-015-0827-2 · 4.17 Impact Factor
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    ABSTRACT: Several non-pharmacological therapies, such as sodium restriction and weight loss, have been promoted by hypertension guidelines based upon the trial evidence supporting their capacity to lower blood pressure. However, many patients may not respond nor be able to adhere to these non-pharmacological treatments. Despite numerous formal diet-lifestyle recommendations the prevalence of hypertension continues to grow worldwide. As such, additional approaches are needed to help combat this public health epidemic. In this review, we outline the evidence supporting the efficacy of a number of alternative approaches for blood pressure-lowering. Based upon the recommendations by a recent American Heart Association scientific statement, we also provide guidance on when and how to implement these methods in clinical practice. The available evidence supports several approaches including Transcendental Meditation, device-guided slow breathing, as well as aerobic, resistance, and isometric exercises. Nonetheless, many questions remain and future recommendations for employing alternative approaches will need to be updated as new trials are published. Copyright © 2015 Elsevier Inc. All rights reserved.
    The American Journal of Medicine 01/2015; 128(6). DOI:10.1016/j.amjmed.2014.12.029 · 5.30 Impact Factor
  • Paolo Giorgini, Alan B. Weder, Elizabeth A. Jackson, Robert D. Brook
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    ABSTRACT: Background Hypertension guidelines recommend following published standardized protocols to obtain accurate blood pressure (BP) readings in clinical practice. However, the various measurement techniques among clinical trials that provide the basis for evidence-based management have not been evaluted or compared to guideline recommendations. Methods We reviewed published information regarding BP measurement in clinical trials (n=64) from 1990-2014 by searching PubMed and Google Scholar databases. Results Every trial failed to provide published information regarding at least one of the 10 methodological aspects we evaluated. Details regarding the healthcare provider(s) performing measurement(s), temporal-relation to last medication dosage, number of readings, resting time before (and between recordings), and the device(s) employed varied amongst the trials and often differed from clinical recommendations. Most studies did evaluate ≥2 BP readings in a seated position, presumably from the upper arm (though explicit acknowledgement of this latter detail was rare). When indicated, “trough” BP levels were most commonly obtained (15/16 trials), while the usage of automated devices increased over time. Conclusions Numerous aspects of BP measurement varied considerably across trials and often from most recent guideline recommendations. The lack of uniform methodologies in outcome studies that form the foundation of evidence-based guidelines may have significant clinical implications.
    Journal of the American Society of Hypertension 09/2014; DOI:10.1016/j.jash.2014.07.024 · 2.68 Impact Factor
  • The American journal of medicine 08/2014; 127(8). DOI:10.1016/j.amjmed.2014.02.016 · 5.30 Impact Factor
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    ABSTRACT: Objectives: Inflammation has been implicated as a risk variable for cardiovascular disease (CVD). One source of inflammation is oral periapical disease, so elimination of periapical inflammation should affect CVD survival. We have investigated the relationship between radiographic evidence of endodontic treatment (endoTx) and CVD mortality. Methods: The Kuopio Oral Health and Heart study was a case-control study (256 CAD cases and 250 controls, mean age=60) with data collection in 1995. We have linked subsequent CVD mortality status to these baseline data to achieve a 15-year longitudinal follow-up. The relationship between radiographic evidence of endoTx on cardiovascular mortality was examined by proportional hazard regression analyses adjusting for age, sex and smoking, diabetes, hypertension, total/HDL cholesterol ratio and education. As endoTx may be dependent on the number of teeth present (NT), we also adjusted for this confounding variable. We also undertook subgroup analyses stratified by Coronary Artery Disease (CAD) or dentate status. Results: In the fully adjusted multivariate model, those who received at least 1 endoTx demonstrated a 67% improvement in CVD survival compared with those who did not. [Hazard ratio (HR) 0.33, 95% confidence interval (CI): 0.14 - 0.75 P=0.009. With additional adjustment for NT, endoTx was still protective against cardiovascular mortality [HR 0.45 CI 0.22 - 0.93 P=0.03. Subgroups who had CAD at baseline or the dentate group also demonstrated beneficial trends of endoTx with HR =0.48 CI: 0.18 - 1.30 P=0.15 and HR 0.49 CI:0.22 - 1.03 P=0.06, respectively. Conclusions: In this age 60 and older population, those who had had endodontic treatment that had eliminated periapical inflammation at baseline had a 67% improvement in cardiovascular survival at 15- years follow-up. There was also a non-significant trend for those who had both CAD at baseline and endodontic treatment for improved CVD survival. Future larger studies are warranted.
    IADR General Session and Exhibition 2014; 06/2014
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    ABSTRACT: Objectives We sought to examine gender-related differences in outcomes related to PVI procedures. Background Percutaneous peripheral vascular intervention (PVI) is frequently performed for the treatment of peripheral arterial disease (PAD). However, little is known about gender-related differences related to PVI procedures. Methods We assessed the impact of gender among 12,379 patients (41% female) who underwent lower extremity (LE)-PVI from 2004 to 2009 at 16 hospitals participating in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium PVI registry. Multivariate propensity matched analyses were performed to adjust for differences in baseline characteristics, procedural indications and comorbidities based on gender. Results Compared with males, females were older, have multilevel disease and critical limb ischemia. In a propensity-matched analysis, female sex was associated with a higher rate of vascular complications, transfusions, and embolism. No differences were observed for in-hospital death, myocardial infarction or stroke/transient ischemic attack. Technical success was more commonly achieved in females (91.2% vs. 89.1%, p=0.014) but due to a higher complication rate, the overall procedural success rates were similar in men and women (79.7% vs. 81.6%, p=0.08). Conclusions Females represent a significant proportion of patients undergoing LE-PVI, have more severe and complex disease process, and are at increased risk for adverse outcomes. Despite higher complications rates, females had similar procedural success compared with men, making PVI an effective treatment strategy among women LE-PAD.
    Journal of the American College of Cardiology 06/2014; 63(23). DOI:10.1016/j.jacc.2014.03.036 · 15.34 Impact Factor
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    ABSTRACT: Several cohort studies report associations between chronic exposure to ambient fine particles (PM2.5) and cardiovascular mortality. Uncertainty exists about biological mechanisms responsible for this observation, but systemic inflammation has been postulated. In addition, the subgroups susceptible to inflammation have not been fully elucidated. We investigated whether certain subgroups are susceptible to the effects of long-term exposure to PM2.5 on C-reactive protein (CRP), a marker of inflammation directly linked to subsequent cardiovascular disease. We used data from the SWAN cohort of 1923 mid-life women with up to five annual repeated measures of CRP. Linear mixed and GEE models accounting for repeated measurements within an individual were used to estimate the effects of prior-year PM2.5 exposure on CRP. We examined CRP as a continuous and as binary outcome for CRP greater than 3mg/l, a level of clinical significance. We found strong associations between PM2.5 and CRP among several subgroups. For example a 10µg/m(3) increase in annual PM2.5 more than doubled the risk of CRP greater than 3mg/l in older diabetics, smokers and the unmarried. Larger effects were also observed among those with low income, high blood pressure, or who were using hormone therapy, with indications of a protective effects for those using statins or consuming moderate amounts of alcohol. In this study, we observed significant associations between long-term exposure to PM2.5 and CRP in several susceptible subgroups. This suggests a plausible pathway by which exposure to particulate matter may be associated with increased risk of cardiovascular disease.
    Environmental Research 04/2014; 132C:168-175. DOI:10.1016/j.envres.2014.03.042 · 3.95 Impact Factor
  • Journal of the American College of Cardiology 04/2014; 63(12):A1292. DOI:10.1016/S0735-1097(14)61292-4 · 15.34 Impact Factor
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    ABSTRACT: Background Several cohort studies report associations between chronic exposure to ambient fine particles (PM2.5) and cardiovascular mortality. Uncertainty exists about biological mechanisms responsible for this observation, but systemic inflammation has been postulated. In addition, the subgroups susceptible to inflammation have not been fully elucidated. Methods We investigated whether certain subgroups are susceptible to the effects of long-term exposure to PM2.5 on C-reactive protein (CRP), a marker of inflammation directly linked to subsequent cardiovascular disease. We used data from the SWAN cohort of 1923 mid-life women with up to five annual repeated measures of CRP. Linear mixed and GEE models accounting for repeated measurements within an individual were used to estimate the effects of prior-year PM2.5 exposure on CRP. We examined CRP as a continuous and as binary outcome for CRP greater than 3 mg/l, a level of clinical significance. Results We found strong associations between PM2.5 and CRP among several subgroups. For example a 10 µg/m3 increase in annual PM2.5 more than doubled the risk of CRP greater than 3 mg/l in older diabetics, smokers and the unmarried. Larger effects were also observed among those with low income, high blood pressure, or who were using hormone therapy, with indications of a protective effects for those using statins or consuming moderate amounts of alcohol. Conclusions In this study, we observed significant associations between long-term exposure to PM2.5 and CRP in several susceptible subgroups. This suggests a plausible pathway by which exposure to particulate matter may be associated with increased risk of cardiovascular disease.
  • Douglas Darden, Caroline Richardson, Elizabeth A. Jackson
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    ABSTRACT: Most adults do not achieve the recommended levels of physical activity, including patients with cardiovascular disease (CVD). Furthermore, healthcare providers often do not understand the benefits of physical activity in CVD patients, rather over emphasizing the potential risks related to activity. Recent studies suggest reductions in cardiovascular events including mortality with concomitant improvements in quality of life for many vascular conditions. However gaps in our current knowledge base remain. Recent research on physical activity including use of novel internet based interventions are developing areas of interest have moved to reduce such knowledge gaps.
    Current Cardiovascular Risk Reports 12/2013; 7(6). DOI:10.1007/s12170-013-0354-5
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    ABSTRACT: To test whether the number of teeth, an inverse proxy for composite oral infection scores is associated with better survival. The Kuopio Oral Health and Heart study initiated a case-control study in 1995-1996 consisting of 256 consecutive coronary artery disease patients and 250 age and gender-matched controls. We appended the mortality data and formulated a longitudinal study. By May 31st, 2011, 124 mortalities had occurred and 80 of which were of cardiovascular origin. Using Cox proportional hazards models, we assessed the association of the teeth group (Teethgrp) - consisting of 10 teeth - with cardiovascular and all-cause mortality after 15.8 years of median follow-up. In multivariate models, with the edentulous state as reference, one level increase in Teethgrp was associated with significantly increased survival from cardiovascular disease (CVD) mortality with a Hazard Ratio (HR) 0.73, p-value = 0.02 but not with all-cause mortality (HR = 0.87, p = 0.13). The findings were not mediated by C-reactive protein (CRP) levels ≥3 mg/L or by median fibrinogen levels, but were mediated by CRP levels >5 mg/L. Each increment of 10 teeth from the edentulous state was associated with a 27% improved CVD survival, independent of low-grade systemic inflammation.
    Journal Of Clinical Periodontology 11/2013; 41(2). DOI:10.1111/jcpe.12192 · 3.61 Impact Factor
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    ABSTRACT: To examine factors associated with low high-density lipoprotein cholesterol (HDL-C) levels among middle school children. HDL-C levels were the primary outcome of interest. A total of 1,104 middle-school children (mean age 11.6 years, 51.2 % female) were included in this analysis, of whom 177 (16 %) had an HDL-C level ≤40 mg/dL. More than half of those with low HDL-C were overweight or obese (62.2 %) and had greater systolic and diastolic blood pressure, triglyceride (TRG) levels, and low-density lipoprotein cholesterol levels compared with children with an HDL-C level >40 mg/dL. Among those with an HDL-C ≤ 40 mg/dL, 35 % also had body mass index ≥85 % and TRG levels ≥150 mg/dL. Exercise habits were significantly associated with HDL-C level, whereas sedentary behaviors, such as screen time, were not significantly associated with HDL-C level. Fruit and vegetable intake was also not significantly associated with HDL-C level. Children with low HDL-C levels are more likely to be overweight and to have other physiological indicators of increased cardiovascular risk. Further research is needed to determine if school-based interventions can result in long-term improvements in HDL-C.
    Pediatric Cardiology 10/2013; 35(3). DOI:10.1007/s00246-013-0814-1 · 1.55 Impact Factor
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    ABSTRACT: BACKGROUND:Previous studies have demonstrated gender-related differences in body composition, physical activity, and diet. This observational study assesses gender variance in independent predictors for obesity to determine targeted areas for intervention.METHODS:Data from 1714 sixth-grade students enrolled in Project Healthy Schools were compared by using health behaviors and physiologic markers (lipids, random glucose, blood pressure, and resting and recovery heart rates). Students were stratified by gender and obesity (BMI ≥95th percentile by age and gender). Physiologic markers and behaviors were compared by using χ(2) analysis. Univariate associations with P < .10 were included in a stepwise logistic regression model to determine independent predictors for obesity by gender.RESULTS:Nonobese students (both boys and girls) showed significantly healthier physiologic parameters compared with their obese counterparts. Two behaviors independently correlated with obesity in both boys and girls: regularly eating school lunches (odds ratio [OR] 1.29, 95% confidence interval [CI] 1.01-1.64; OR 1.27, 95% CI 1.00-1.62, respectively) and watching ≥2 hours of television per day (OR 1.19, 95% CI 1.07-1.32; OR 1.19, 95% CI 1.06-1.34, respectively). Vigorous physical activity and involvement in school sports teams appeared to be protective against obesity in boys (OR 0.90, 95% CI 0.82-0.98; OR 0.77, 95% CI 0.64-0.94, respectively), whereas milk consumption appeared protective in girls (OR 0.81, 95% CI 0.67-0.98).CONCLUSIONS:Among middle-school children, we observed gender-related differences in factors associated with obesity. Additional research is warranted to determine the beneficial impact of improving school lunches and decreasing screen time, while improving our understanding of gender-related differences in milk consumption and physical activities in relation to BMI.
    PEDIATRICS 08/2013; 132(3). DOI:10.1542/peds.2012-2994 · 5.30 Impact Factor
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    ABSTRACT: This study aimed to measure the impact of a school-based multidisciplinary intervention program on risk factors for atherosclerosis in sixth-grade middle school students. We also measured health behaviors before and after the intervention using a validated questionnaire. A prospective study was performed in which students served as historical controls. Sixth-grade students from 23 middle schools in 12 cities with varying populations were exposed to a program promoting healthful activity and nutrition habits through educational and environmental change. Along with a modified School-Based Nutrition Monitoring behavioral questionnaire, physiologic risk factors were studied, including body mass index, systolic and diastolic blood pressures, cholesterol panel, and random blood glucose, which were measured before the 10-week program and again 1 to 3 months after program completion. Of 4021 sixth graders (male, 49%) at 23 middle schools completing a before and after behavioral survey, 2118 students, aged 11.56 ± 0.47 years, consented to participate in the screening. The mean total cholesterol value decreased from 161.64 ± 28.99 mg/dL to 154.77 ± 27.26 mg/dL (P < .001). The low-density lipoprotein value decreased from 89.37 ± 25.08 mg/dL to 87.14 ± 24.25 mg/dL (P < .001). The high-density lipoprotein value decreased from 52.15 ± 13.35 md/dL to 49.95 ± 13.28 mg/dL (P < .001). The measure of triglycerides decreased from 113.34 ± 73.19 mg/dL to 101.22 ± 63.93 mg/dL (P < .001). The random glucose value decreased from 97.51 ± 16.00 to 94.94 ± 16.62 (P < .001). The mean systolic blood pressure decreased from 109.47 ± 15.26 mm Hg to 107.76 ± 10.87 mm Hg (P < .001), and the mean diastolic blood pressure decreased from 64.78 ± 8.57 mm Hg to 63.35 ± 7.81 mm Hg (P < .001). These changes in physiologic measures seemed to correlate with self-reported increases in vegetable and fruit consumption, increases in physical activity, and less screen time. Project Healthy Schools, a middle school intervention to improve childhood cardiovascular risk factors, is feasible and seems to be effective. The results showed significant improvements in risk factors associated with early atherosclerosis among sixth-grade students, including total cholesterol, low-density lipoprotein cholesterol, triglycerides, and systolic and diastolic blood pressures. Further study with a larger group of students and a longer follow-up period would be valuable.
    The American journal of medicine 08/2013; 126(10). DOI:10.1016/j.amjmed.2013.04.019 · 5.30 Impact Factor
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    ABSTRACT: OBJECTIVE: The relatively modest benefit of vasomotor symptom relief in clinical trials of isoflavones may reflect once-daily dosing and low percentages of participants who are able to metabolize daidzein into equol, a potentially more biologically active isoflavone. This pilot study examined whether symptom reduction was greater with more frequent administration and with higher daily doses. In addition, we explored possible effect modification by equol producer status. METHODS: We randomized 130 perimenopausal (no menses in the past 3 mo) and postmenopausal (≥12 mo of amenorrhea) women with a mean of five or more moderate/severe hot flashes per day to treatment arms with varying total daily isoflavone doses and dosing frequency, separately for equol producers and nonproducers. Participants recorded the daily frequency and severity of hot flashes. Analyses compared mean daily hot flash intensity scores (sum of hot flashes weighted by severity) by total daily dose and by dosing frequency. Dose- and frequency-related differences were also compared for equol producers and nonproducers. RESULTS: Hot flash intensity scores were lowest in women randomized to the highest total daily dose (100-200 mg) and in women randomized to the highest dosing frequency (twice daily to thrice daily), with greater benefits on nighttime scores than on daytime scores. Dose- and frequency-related differences were somewhat larger in equol producers than in nonproducers. CONCLUSIONS: These results suggest that a twice-daily to thrice-daily dosing frequency may improve the benefit of isoflavones for vasomotor symptom relief, particularly in equol producers and for nighttime symptoms. Larger studies are needed to confirm these findings.
    Menopause (New York, N.Y.) 03/2013; DOI:10.1097/GME.0b013e3182829413 · 2.81 Impact Factor
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    ABSTRACT: Recovery heart rate (RHR) has been used in adults to evaluate cardiovascular (CV) fitness, but less is known about RHR in children. Data from 1,276 participants in Project Healthy Schools, a school-based intervention in southeast Michigan, were collected. In addition, to demographic characteristics, physiologic factors examined included body mass index (BMI), lipid and glucose levels, blood pressure, and HR. Information on diet, physical activity, and sedentary behavior was collected through self-report. RHR was determined by measurement of HR after a 3-minute step test. Using quartiles of RHR as a marker of fitness, associations with demographic, physiologic, and behavioral factors were explored using χ2 and Student t tests. Compared with children in the lowest quartile of RHR (i.e., most fit), those in the upper quartile of RHR (i.e., least fit) had greater mean LDL cholesterol (93.0 vs. 86.7 mg/dL; P = 0.02) and lower mean HDL cholesterol (50.9 vs. 55.9 mg/dL; P < 0.001). Children in the upper 95 % of BMI had greater mean RHR compared with those in the normal BMI range (116.6 vs. 100.3 kg/m2). Children in the upper quartile of RHR reported fewer days of vigorous to moderate exercise per week compared with children in the lowest quartile of RHR [4.8 vs. 4.1 (P < 0.001) for moderate exercise and 3.6 vs. 3.0 (P = 0.001) for vigorous exercise]. Among middle school children, RHR appears to be associated with physiologic parameters and health behaviors. RHR may be useful for identifying children at increased risk for developing CV risk factors.
    Pediatric Cardiology 03/2013; 34(6). DOI:10.1007/s00246-013-0667-7 · 1.55 Impact Factor
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    ABSTRACT: Over the past three decades the proportion of students classified as overweight has almost tripled. This trend in childhood obesity is a cause for concern. Stakeholders have come together to stem growth and implement healthy habits in childhood to not only prevent obesity, but also future cardiovascular risk. School-based health interventions have proven to be an effective medium to reach youth. Sustainable practices remain the largest determinant of long-term success of these programs. Project Healthy Schools, a community–university collaborative school-based health intervention program, sustainable practices have led to positive changes in participating middle schools. This collaborative has provided important insight on key factors needed for long-term sustainability for a school-based wellness program. These key factors are described under leadership, policy, finances, and reproducibility. Future school-based programs may plan for success with sustainability while drawing from our experience.
    12/2012; 4(3-4). DOI:10.1002/wmh3.6
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    ABSTRACT: Understanding childhood obesity's root causes is critical to the creation of strategies to improve our children's health. We sought to define the association between childhood obesity and household income and how household income and childhood behaviors promote childhood obesity. We assessed body mass index in 109,634 Massachusetts children, identifying the percentage of children who were overweight/obese versus the percentage of children in each community residing in low-income homes. We compared activity patterns and diet in 999 sixth graders residing in 4 Michigan communities with varying annual household income. In Massachusetts, percentage of overweight/obese by community varied from 9.6% to 42.8%. As household income dropped, percentage of overweight/obese children rose. In Michigan sixth graders, as household income goes down, frequency of fried food consumption per day doubles from 0.23 to 0.54 (P < .002), and daily TV/video time triples from 0.55 to 2.00 hours (P < .001), whereas vegetable consumption and moderate/vigorous exercise go down. The prevalence of overweight/obese children rises in communities with lower household income. Children residing in lower income communities exhibit poorer dietary and physical activity behaviors, which affect obesity.
    American heart journal 05/2012; 163(5):836-43. DOI:10.1016/j.ahj.2012.02.025 · 4.56 Impact Factor
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    Journal of the American College of Cardiology 03/2012; 59(13). DOI:10.1016/S0735-1097(12)61853-1 · 15.34 Impact Factor

Publication Stats

318 Citations
465.89 Total Impact Points

Institutions

  • 2008–2015
    • University of Michigan
      • • Division of Cardiovascular Medicine
      • • Department of Internal Medicine
      Ann Arbor, Michigan, United States
  • 2008–2014
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States
  • 2012
    • Wayne State University
      Detroit, Michigan, United States