Thomas Gaziano

• MD, MSC
• Professor (Assistant) at Brigham and Women's Hospital

Introduction: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) offer cardiovascular (CV) and kidney protective effects in patients with Type 2 DM (T2DM). Despite the benefits, these medications are underutilized due to various barriers. Remote management programs present a scalable solution...

Background: Several sodium-glucose transport protein 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) reduce cardiovascular (CV) events and improve kidney outcomes in patients with type 2 diabetes (T2D); however, utilization remains low despite guideline recommendations. Methods: A randomized, remote implementation tri...

Background The sodium glucose cotransporter‐2 inhibitors are guideline‐recommended to treat heart failure across the spectrum of left ventricular ejection fraction; however, economic evaluations of adding sodium glucose cotransporter‐2 inhibitors to standard of care in chronic heart failure across a broad left ventricular ejection fraction range ar...

Background and Objectives Hypertension is a major modifiable contributor to disease burden in sub-Saharan Africa. We exploited an expansion to age eligibility for men in South Africa’s noncontributory public pension to assess the impact of pension eligibility on hypertension in a rural, low-income South African setting. Research Design and Methods...

Cardiovascular diseases (CVDs) are the leading cause of mortality globally. Of the 20.5 million CVD-related deaths in 2021, approximately 80% occurred in low- and middle-income countries. Using data from the Global Burden of Disease Study, NCD Risk Factor Collaboration, NCD Countdown initiative, WHO Global Health Observatory, and WHO Global Health...

Background/Objectives: Remote clinical studies offer new outreach opportunities, but recruitment remains challenging. We report our experience in identifying potential participants from diverse sources and adopting various outreach and recruitment methods. Methods: We utilized multiple screening and recruitment methods to identify and enroll patien...

Background: Evidence-based SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP-1 RA) reduce cardiovascular (CV) events and improve kidney outcomes in patients with type 2 diabetes (T2D) who are at elevated cardiac or renal risk; however, prescription rates are low despite guidelines recommending their use. We aimed to evaluate the eligibilit...

Importance The US Food and Drug Administration expanded labeling of sacubitril-valsartan from the treatment of patients with chronic heart failure (HF) with reduced ejection fraction (EF) to all patients with HF, noting the greatest benefits in those with below-normal EF. However, the upper bound of below normal is not clearly defined, and value de...

Background: Hypertension is the primary risk factor for stroke and heart disease, which are leading causes of death in South Africa. Despite the availability of treatments, there is an implementation gap in how best to deliver hypertension care in this resource-limited region. Methods: We describe a three-arm parallel group individually randomiz...

Background: The American Heart Association and American Stroke Association (AHA/ASA) endorsed 15 process measures for acute ischemic stroke (AIS) to improve the quality of care. Identifying the highest-value measures could reduce the administrative burden of quality measure adoption while retaining much of the value of quality improvement. Object...

Background Over half of the South African adults aged 45 years and older have hypertension but its effective management along the treatment cascade (awareness, treatment, and control) remains poorly understood. Methods We compared the prevalence of all stages of the hypertension treatment cascade in the rural HAALSI cohort of older adults at basel...

Background: Sub-Saharan Africa is undergoing an epidemiologic transition from infectious diseases to cardiovascular diseases. From 2014 to 2019, sociodemographic surveillance was performed in a large cohort in rural South Africa. Methods: Disease prevalence and incidence were calculated using inverse probability weights. Poisson regression was u...

Background: South Africa has introduced regulations to reduce sodium in processed foods. Assessing salt consumption with 24-h urine collection is logistically challenging and expensive. We assess the accuracy of using spot urine samples to estimate 24-h urine sodium (24hrUNa) excretion at the population level in a cohort of older adults in rural S...

Importance Blood pressure (BP) and cholesterol control remain challenging. Remote care can deliver more effective care outside of traditional clinician-patient settings but scaling and ensuring access to care among diverse populations remains elusive. Objective To implement and evaluate a remote hypertension and cholesterol management program acro...

Background: Heart failure (HF) disproportionately affects populations traditionally underserved in medicine. Remote healthcare delivery expands the reach of health care systems and providers, however some fear new models may pose challenges to equitable health care delivery. By building a remote HF clinic we aimed to increase equitable access to gu...

Background Sub-Saharan Africa is undergoing an epidemiologic transition dominated by a widespread epidemic of hypertension (HTN). Since 2014, we began studying a cohort of 5,059 individuals in rural South Africa, to describe the evolution of HTN among older adults, and understand the impact of targeted interventions by local health systems. Purpos...

Background: The rate of events such as recurrent heart failure (HF) hospitalization and death are known to dramatically increase directly after HF hospitalization. Furthermore, the number of HF hospitalizations is associated with irreversible long-term disease progression, which is in turn associated with increased event rates. However, cost-effec...

Poor diet increases cardiometabolic disease risk, yet the impact of food service guidelines on employee health and its cost effectiveness is poorly understood. Federal food service guidelines (FFSG) aim to provide United States (U.S.) government employees with healthier food options. Using microsimulation modeling, we estimated changes in the incid...

Objectives There is a scarcity of longitudinal cohort studies in sub-Saharan Africa to understand the epidemiology of cardiovascular disease as a basis for intervention. We estimated incident hypertension and associated sociodemographic, health and behavioural risk factors in a population aged 40 years and older over a 5-year period. Design We ass...

Background Sub-Saharan Africa is undergoing an epidemiological transition fueled by the interaction between infectious and cardiovascular diseases. Our cross-sectional study aimed to characterize the spectrum of abnormalities suggesting end-organ damage on ECG and transthoracic echocardiograms (TTE) among older adults with cardiovascular diseases i...

Background Implementation of guideline-directed cholesterol management remains low despite definitive evidence establishing their reduction of cardiovascular (CV) events, especially in high atherosclerotic CV disease (ASCVD) risk patients. Modern electronic resources now exist that may help improve health care delivery. While electronic medical rec...

Background: High intake of added sugar is linked to weight gain and cardiometabolic risk. In 2018, the US National Salt and Sugar Reduction Initiative (NSSRI) proposed government supported voluntary national sugar reduction targets. This intervention's potential health and equity impacts, and cost-effectiveness are unclear. Methods: A validated mic...

Objectives We investigated concordance between haemoglobin A1c (HbA 1 c)-defined diabetes and fasting plasma glucose (FPG)-defined diabetes in a black South African population with a high prevalence of obesity. Design Cross-sectional study. Setting Rural South African population-based cohort. Participants 765 black individuals aged 40–70 years a...

Background Although strategies for optimization of pharmacologic therapy in patients with heart failure with reduced ejection fraction (HFrEF) are scripted by guidelines, data from HF registries suggests that guideline-directed medical therapies (GDMT) are underutilized among eligible patients. Whether this discrepancy reflects medication intoleran...

Importance: Optimal treatment of heart failure with reduced ejection fraction (HFrEF) is scripted by treatment guidelines, but many eligible patients do not receive guideline-directed medical therapy (GDMT) in clinical practice. Objective: To determine whether a remote, algorithm-driven, navigator-administered medication optimization program cou...

A woman in her 90s with a history of rheumatic heart disease, severe mitral stenosis, and 2 prior balloon valvuloplasty procedures (most recently 3 years prior) presented to the emergency department with 1 week of increased dyspnea on exertion. Her physical examination results were notable for a holosystolic murmur and faint low-pitched diastolic r...

Background: Sugar-sweetened beverage taxes are a rapidly growing policy tool and can be based on absolute volume, sugar content tiers, or absolute sugar content. Yet, their comparative health and economic impacts have not been quantified, in particular, tiered or sugar content taxes that provide industry incentives for sugar reduction. Methods:...

Objectives Financial incentives and disincentives are effective tools for improving food purchases and health. Healthy food subsidies have only been considered for vulnerable populations and can be costly, while sugar-sweetened beverage (SSB) taxes can be considered financially regressive and punitive. The potential joint health and economic impact...

Background: While elevations in fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c) are both recognized by the American Diabetes Association (ADA) as diagnostic of hyperglycemia, previous comparisons of these tests have demonstrated discordant individual classifications and population estimates. This may be due to additional postprandi...

Background Poor diet is a leading risk factor for cardiometabolic disease (CMD) in the United States, but its economic costs are unknown. We sought to estimate the cost associated with suboptimal diet in the US. Methods and findings A validated microsimulation model (Cardiovascular Disease Policy Model for Risk, Events, Detection, Interventions, C...

Background: Evidence on cognitive function in older South Africans is limited, with few population-based studies. We aimed to estimate baseline associations between cognitive function and cardiometabolic disease risk factors in rural South Africa. Methods: We use baseline data from "Health and Aging in Africa: A Longitudinal Study of an INDEPTH...

Aim: The aim of this project is to describe a causal (counterfactual) approach for analyzing when to start statin treatment to prevent cardiovascular disease using real-world evidence. Methods: We use directed acyclic graphs to operationalize and visualize the causal research question considering selection bias, potential time-independent and time-...

Objectives: Sugar-sweetened beverage (SSB) intake is linked to weight gain, type 2 diabetes, and cardiovascular disease (CVD). SSBs taxes are a policy tool to reduce intake, and volume-based taxes have been passed in the US. Yet, the comparative health and economic impacts of volume-based, tiered, or sugar content-based SSB taxes have not been qua...

Objectives: Excess caloric intake is linked to weight gain, obesity and related diseases including type 2 diabetes and cardiovascular disease (CVD). Obesity incidence has been on the rise, with almost 2 of 3 people being overweight or obese in the US. In 2018, the US federal government passed a law mandating the labeling of calories on all menu it...

Background: There is underutilization of appropriate medications for secondary prevention of cardiovascular disease (CVD). Methods: Usual care (UC) was compared to polypill-based care with 3 versions using a validated micro-simulation model in the NHANES population with prior CVD. UC included individual prescription of up to 4 drug classes (anti...

Background Control of cardiovascular disease (CVD) risk factors is suboptimal in Argentina, despite the government's provision of free blood pressure and cholesterol‐lowering medications for people without private insurance. We assessed whether community health workers’ use of an integrated mHealth tool encourages patients to attend visits at prima...

Table S1. List of Chronic Medications Used for Medical Record Review Figure S1. mHealth tools screenshots for CVD risk calculation and appointment scheduling. Figure S2. WHO/ISH risk prediction chart for AMR B. 10‐year risk of a fatal or non‐fatal cardiovascular event by sex, age, systolic blood pressure, smoking status and presence or absence of...

Introduction Participation in antiretroviral therapy (ART) programmes has been associated with greater utilization of care for hypertension and diabetes in rural South Africa. The objective of this study was to assess whether people living with HIV on ART with comorbid hypertension or diabetes also have improved chronic disease management indicator...

Table S1. Association between stage in the HIV care cascade and utilization of hypertension screening, diagnosis and systolic blood pressure among those with hypertension in the HAALSI cohort, 2015 Table S2. Association between stage in the HIV care cascade and utilization of diabetes screening, diagnosis and glucose among those with diabetes in t...

Background Economic incentives through health insurance may promote healthier behaviors. Little is known about health and economic impacts of incentivizing diet, a leading risk factor for diabetes and cardiovascular disease (CVD), through Medicare and Medicaid. Methods and findings A validated microsimulation model (CVD-PREDICT) estimated CVD and...

Analysis plan, model description and validation, key modeling assumptions, model inputs, and results of sensitivity analyses. (DOCX)

Objective: To examine how multimorbidity might affect progression along the continuum of care among older adults with hypertension, diabetes and human immunodeficiency virus (HIV) infection in rural South Africa. Methods: We analysed data from 4447 people aged 40 years or older who were enrolled in a longitudinal study in Agincourt sub-district....

Objectives: To estimate the health impact and cost-effectiveness of a national penny-per-ounce sugar-sweetened beverage (SSB) tax, overall and with stratified costs and benefits for 9 distinct stakeholder groups. Methods: We used a validated microsimulation model (CVD PREDICT) to estimate cardiovascular disease reductions, quality-adjusted life...

Background The Supplemental Nutrition Assistance Program (SNAP) provides approximately US$70 billion annually to support food purchases by low-income households, supporting approximately 1 in 7 Americans. In the 2018 Farm Bill, potential SNAP revisions to improve diets and health could include financial incentives, disincentives, or restrictions fo...

Summary of health and cost-effectiveness findings for 3 dietary policy interventions in SNAP. A 30% F&V incentive, a 30% F&V incentive with SSB restriction, and a combined 30% incentive/disincentive program for multiple foods that preserves choice (SNAP-plus). Findings are shown at 5 years, 10 years, and 20 years and over a lifetime. (TIF)

Food categories for financial incentives or disincentives in SNAP. (DOCX)

Lifetime estimated health gains, costs, and cost-effectiveness of each SNAP intervention, by age, sex, race, education, and insurance. (DOCX)

Changes over time in SNAP participation. (DOCX)

Sources and calculations for intervention effect sizes of incentives and disincentives applied in each of the scenarios in SNAP. (DOCX)

Sensitivity analyses of estimated cost-effectiveness of SNAP food subsidies, restrictions, and incentives/disincentives over 5, 10, and 20 years and over a lifetime. (DOCX)

Model inputs for probabilistic sensitivity analyses. (DOCX)

Comparison of relative risks for CHD calculated based on changes in systolic blood pressure and LDL-cholesterol in randomized controlled feeding trials of dietary patterns versus estimated relative risks for individual dietary factors. (DOCX)

CVD-PREDICT microsimulation model. (DOCX)

Estimated etiologic effects of dietary components on cardiometabolic outcomes, by age. (DOCX)

Multivariable associations of junk food consumption with other dietary factors linked to cardiometabolic risk, based on dietary data among US adults aged 35+ years in NHANES 2009–2014. (DOCX)

Estimated intervention costs to implement financial incentive and disincentive policies through SNAP. (DOCX)

Estimated healthcare costs. (DOCX)

Comparison of relative risks for CHD observed in a large randomized clinical trial of dietary patterns versus estimated relative risks for individual dietary factors. (DOCX)

Shifts in food purchases between SNAP versus non-SNAP dollars. (DOCX)

Assessment of validity and bias in diet–disease etiologic effects. (DOCX)

Probabilistic sensitivity analyses at 5 years and over a lifetime. (DOCX)

Comparison of relative risks for CHD observed in prospective cohort studies of dietary patterns and estimated relative risks for individual dietary factors. (DOCX)

Objectives To characterize the cardiovascular disease (CVD) profile of individuals aged 80 and older in rural South Africa. Design First wave of population‐based longitudinal cohort. Setting Agincourt subdistrict (Mpumalanga Province) in rural South Africa. Participants Adults residents (N = 5,059). Measurements In‐person interviews were conduc...

Importance Financial incentives shared between physicians and patients were shown to significantly reduce low-density lipoprotein cholesterol (LDL-C) levels in a randomized clinical trial, but it is not known whether these health benefits are worth the added incentive and utilization costs required to achieve them. Objective To evaluate the long-t...

Multiple cardiovascular risk factors are directly related to the severity of atherosclerosis, even in children and adolescents. In this context accurate assessment of risk factors at the individual level play a decisive role in cardiovascular disease (CVD) prevention. The objective of this study was to estimate the prevalence of cardiovascular risk...

Background Understanding how depression is associated with chronic conditions and socio-demographic characteristics can inform the design and effective targeting of depression screening and care interventions. In this study, we present some of the first evidence from sub-Saharan Africa on the association between depressive symptoms and a range of c...

Background Cardiovascular disease (CVD) is the leading cause of mortality in India. Yet, evidence on the CVD risk of India’s population is limited. To inform health system planning and effective targeting of interventions, this study aimed to determine how CVD risk—and the factors that determine risk—varies among states in India, by rural–urban loc...

All supplementary tables. (DOCX)

Matching AHS biomarker data to participants’ sociodemographic data. (DOCX)

Introduction Cardiovascular disease (CVD) accounts for approximately one-third of Argentina’s deaths. Despite government provision of free primary care health services to the uninsured population, with a focus on non-communicable diseases, screening and management of those with high CVD risk at primary care clinics (PCCs) remain low. Methods and a...

Purpose of review: Suboptimal diet is a leading cause of cardiometabolic disease and economic burdens. Evidence-based dietary policies within 5 domains-food prices, reformulation, marketing, labeling, and government food assistance programs-appear promising at improving cardiometabolic health. Yet, the extent of new dietary policy adoption in the...

Background: The scale-up of antiretroviral treatment (ART) programmes has seen HIV/AIDS transition to a chronic condition characterised by high rates of comorbidity with tuberculosis, non-communicable diseases (NCDs) and mental health disorders. Depression is one such disorder that is associated with higher rates of non-adherence, progression to A...

Background: The high co-morbidity of mental disorders, particularly depression, with non-communicable diseases (NCDs) such as cardiovascular disease (CVD), is concerning given the rising burden of NCDs globally, and the role depression plays in confounding prevention and treatment of NCDs. The objective of this randomised control trial (RCT) is to...

Background: While economic incentives through health insurance are being considered to promote healthy behaviors, little is known about health or financial impacts of incentivizing diet, a leading risk factor for CVD. We estimated health and economic impacts of programs to incentivize healthful foods through Medicare and Medicaid over a 5, 10, and...

Introduction: Despite the clear association between poor diet and cardiometabolic diseases (CMD) and the overall economic burden of such conditions, the costs of an unhealthy diet pattern have not been assessed for the US population. Aim: Estimate the costs of CMD related to suboptimal intakes of 10 specific dietary factors in the US adult populati...

Background Fiscal interventions are promising strategies to improve diets, reduce cardiovascular disease and diabetes (cardiometabolic diseases; CMD), and address health disparities. The aim of this study is to estimate the impact of specific dietary taxes and subsidies on CMD deaths and disparities in the US. Methods Using nationally representati...